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SAMHSA publishes guidelines, toolkit to strengthen crisis care in America's communities | SAMHSA seroquel online canada Skip to main contentStart Preamble Centers for Medicare &. Medicaid Services seroquel online canada (CMS), Health and Human Services (HHS). Final rule seroquel online canada. Correction.

This document corrects technical and seroquel online canada typographical errors in the final rule that appeared in the September 18, 2020 issue of the Federal Register titled âMedicare Program. Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment seroquel online canada System and Final Policy Changes and Fiscal Year 2021 Rates. Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible Hospitals seroquel online canada and Critical Access Hospitalsâ. Effective Date.

This correcting document is effective on December seroquel online canada 1, 2020. Applicability Date seroquel online canada. The corrections in this correcting document are applicable to discharges occurring on or seroquel online canada after October 1, 2020. Start Further Info Donald Thompson and Michele Hudson, (410) 786-4487.

End Further Info End Preamble Start Supplemental Information I seroquel online canada. Background In seroquel online canada FR Doc. 2020-19637 of September 18, 2020 (85 FR 58432) there were a number of technical and typographical errors that are identified and corrected in the Correction of seroquel online canada Errors section of this correcting document. The corrections in this correcting document are applicable to discharges occurring on or after October 1, 2020, as if they had been included in the document that appeared in the September 18, 2020 Federal Register.

II. Summary of Errors A. Summary of Errors in the Preamble On the following pages. 58435 through 58436, 58448, 58451, 58453, 58459, 58464, 58471, 58479, 58487, 58495, 58506, 58509, 58520, 58529, 58531 through 58532, 58537, 58540 through 58541, 58553 through 58556, 58559 through 58560, 58580 through 58583, 58585 through 58588, 58596, 58599, 58603 through 58604, 58606 through 58607, 58610, 58719, 58734, 58736 through 58737, 58739, 58741, 58842, 58876, 58893, and 58898 through 58900, we are correcting inadvertent typographical errors in the internal section references.

On page 58596, we are correcting an inadvertent typographical error in the date of the MedPAR data used for developing the Medicare Severity Diagnosis-Related Group (MS-DRG) relative weights. On pages 58716 and 58717, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the BAROSTIM NEOÂ® System technology. On pages 58721 and 58723, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the Cefiderocol technology. On page 58768, due to a conforming change to the Rural Floor Budget Neutrality adjustment (listed in the table titled âSummary of FY 2021 Budget Neutrality Factorsâ on page 59034) as discussed in section II.B.

Of this correcting document and the conforming changes to the Out-Migration Adjustment discussed in section II. D of this correcting document (with regard to Table 4A), we are correcting the 25th percentile wage index value across all hospitals. On page 59006, in the discussion of Medicare bad debt policy, we are correcting inadvertent errors in the regulatory citations and descriptions. B.

Summary of Errors in the Addendum On pages 59031 and 59037, we are correcting inadvertent typographical errors in the internal section references. We are correcting an error in the version 38 ICD-10 MS-DRG assignment for some cases in the historical claims data in the FY 2019 MedPAR files used in the ratesetting for the FY 2021 IPPS/LTCH PPS final rule, which resulted in inadvertent errors in the MS-DRG relative weights (and associated average length-of-stay (LOS)). Additionally, the version 38 MS-DRG assignment and relative weights are used when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, the corrections to the MS-DRG assignment under the ICD-10 MS-DRG GROUPER version 38 for some cases in the historical claims data in the FY 2019 MedPAR files and the recalculation of the relative weights directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold.

In addition, as discussed in section II.D. Of this correcting document, we made updates to the calculation of Factor 3 of the uncompensated care payment methodology to reflect updated information on hospital mergers received in response to the final rule. Factor 3 determines the total amount of the uncompensated care payment a hospital is eligible to receive for a fiscal year. This hospital-specific payment amount is then used to calculate the amount of the interim uncompensated care payments a hospital receives per discharge.

Per discharge uncompensated care payments are included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, the revisions made to the calculation of Factor 3 to address additional merger information directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold. We made an inadvertent error in the Medicare Geographic Classification Review Board (MGCRB) reclassification status of one hospital in the FY 2021 IPPS/LTCH PPS final rule. Specifically, CCN 050481 is incorrectly listed in Table 2 as reclassified to its geographic âhomeâ of CBSA 31084.

The correct reclassification area is to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100 and affected the final FY 2021 wage index with reclassification. The final FY 2021 IPPS wage index with reclassification is used when determining total payments for purposes of all budget neutrality factors (except for the MS-DRG reclassification and recalibration budget neutrality factor and the wage index budget neutrality adjustment factor) and the final outlier threshold. Due to the correction of the combination of errors listed previously (corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, revisions to Factor 3 of the uncompensated care payment methodology, and the correction to the MGCRB reclassification status of one hospital), we recalculated all IPPS budget neutrality adjustment factors, the fixed-loss cost threshold, the final wage indexes (and geographic adjustment factors (GAFs)), the national operating standardized amounts and capital Federal rate.

Therefore, we made conforming changes to the following. On page 59034, the table titled âSummary of FY 2021 Budget Neutrality Factorsâ. On page 59037, the estimated total Federal capital payments and the estimated capital outlier payments. On page 59040, the calculation of the outlier fixed-loss cost threshold, total operating Federal payments, total operating outlier payments, the outlier adjustment to the capital Federal rate and the related discussion of the percentage estimates of operating and capital outlier payments.

On page 59042, the table titled âChanges from FY 2020 Standardized Amounts to the FY 2021 Standardized Amountsâ. On page 59039, we are correcting a typographical error in the total cases from October 1, 2018 through September 31, 2019 used to calculate the average covered charge per case, which is then used to calculate the charge inflation factor. On pages 59047 through 59048, in our discussion of the determination of the Federal hospital inpatient capital-related prospective payment rate update, due to the recalculation of the GAFs as well as corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, we have made conforming corrections to the capital Federal rate, the incremental budget neutrality adjustment factor for changes in the GAFs, and the outlier threshold (as discussed previously). As a result of these changes, we also made conforming corrections in the table showing the comparison of factors and adjustments for the FY 2020 capital Federal rate and FY 2021 capital Federal rate.

As we noted in the final rule, the capital Federal rate is calculated using unrounded budget neutrality and outlier Start Printed Page 78750adjustment factors. The unrounded GAF/DRG budget neutrality factors and the unrounded outlier adjustment to the capital Federal rate were revised because of these errors. However, after rounding these factors to 4 decimal places as displayed in the final rule, the rounded factors were unchanged from the final rule. On page 59057, we are making conforming changes to the fixed-loss amount for FY 2021 site neutral payment rate discharges, and the high cost outlier (HCO) threshold (based on the corrections to the IPPS fixed-loss amount discussed previously).

On pages 59060 and 59061, we are making conforming corrections to the national adjusted operating standardized amounts and capital standard Federal payment rate (which also include the rates payable to hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a result of the conforming corrections to certain budget neutrality factors and the outlier threshold previously described. C. Summary of Errors in the Appendices On pages 59062, 59070, 59074 through 59076, and 59085 we are correcting inadvertent typographical errors in the internal section references. On pages 59064 through 59071, 59073 and 59074, and 59092 and 59093, in our regulatory impact analyses, we have made conforming corrections to the factors, values, and tables and accompanying discussion of the changes in operating and capital IPPS payments for FY 2021 and the effects of certain IPPS budget neutrality factors as a result of the technical errors that lead to changes in our calculation of the operating and capital IPPS budget neutrality factors, outlier threshold, final wage indexes, operating standardized amounts, and capital Federal rate (as described in section II.B.

Of this correcting document). These conforming corrections include changes to the following tables. On pages 59065 through 59069, the table titled âTable IâImpact Analysis of Changes to the IPPS for Operating Costs for FY 2021â. On pages 59073 and 59074, the table titled âTable IIâImpact Analysis of Changes for FY 2021 Acute Care Hospital Operating Prospective Payment System (Payments per discharge)â.

On pages 59092 and 59093, the table titled âTable IIIâComparison of Total Payments per Case [FY 2020 Payments Compared to Final FY 2021 payments]â. On pages 59076 through 59079, we are correcting the discussion of the âEffects of the Changes to Uncompensated Care Payments for FY 2021â for purposes of the Regulatory Impact Analysis in Appendix A of the FY 2021 IPPS/LTCH PPS final rule, including the table titled âModeled Uncompensated Care Payments for Estimated FY 2021 DSHs by Hospital Type. Uncompensated Care Payments ($ in Millions)*âfrom FY 2020 to FY 2021â on pages 59077 and 59078, in light of the corrections discussed in section II.D. Of this correcting document.

D. Summary of Errors in and Corrections to Files and Tables Posted on the CMS Website We are correcting the errors in the following IPPS tables that are listed on pages 59059 and 59060 of the FY 2021 IPPS/LTCH PPS final rule and are available on the internet on the CMS website at https://www.cms.gov/âMedicare/âMedicare-Fee-for-Service-Payment/âAcuteInpatientPPS/âindex.html. The tables that are available on the internet have been updated to reflect the revisions discussed in this correcting document. Table 2âCase-Mix Index and Wage Index Table by CCN-FY 2021 Final Rule.

As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed as reclassified to its home geographic area of CBSA 31084. In this table, we are correcting the columns titled âWage Index Payment CBSAâ and âMGCRB Reclassâ to accurately reflect its reclassification to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100.

Also, the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes listed in Table 2. In addition, as also discussed later in this section, because the wage indexes are one of the inputs used to determine the out-migration adjustment, some of the out migration adjustments changed.

Therefore, we are making corresponding changes to some of the out-migration adjustments listed in Table 2. Also, as discussed in section II.A of this correcting document, we made a conforming change to the 25th percentile wage index value across all hospitals. Accordingly, we are making corresponding changes to the values for hospitals in the columns titled âFY 2021 Wage Index Prior to Quartile and Transitionâ, âFY 2021 Wage Index With Quartileâ, âFY 2021 Wage Index With Quartile and Capâ and âOut-Migration Adjustmentâ. We also updated footnote number 6 to reflect the conforming change to the 25th percentile wage index value across all hospitals.

Table 3.âWage Index Table by CBSAâFY 2021 Final Rule. As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed in Table 2 as reclassified to its home geographic area of CBSA 31084 instead of reclassified to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100.

Also, corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes and GAFs of all CBSAs listed in Table 3. Specifically, we are correcting the values and flags in the columns titled âWage Indexâ, âGAFâ, âReclassified Wage Indexâ, âReclassified GAFâ, âState Rural Floorâ, âEligible for Rural Floor Wage Indexâ, âPre-Frontier and/or Pre-Rural Floor Wage Indexâ, âReclassified Wage Index Eligible for Frontier Wage Indexâ, âReclassified Wage Index Eligible for Rural Floor Wage Indexâ, and âReclassified Wage Index Pre-Frontier and/or Pre-Rural Floorâ.

Table 4A.â List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the ActâFY 2021 Final Rule. As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed in Table 2 as reclassified to its home geographic area of CBSA 31084 instead of reclassified to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100.

Also, corrections to the version 38 MS-DRG assignment for some cases Start Printed Page 78751in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. As a result, as discussed previously, we are making corresponding changes to the FY 2021 wage indexes. Because the wage indexes are one of the inputs used to determine the out-migration adjustment, some of the out migration adjustments changed.

Therefore, we are making corresponding changes to some of the out-migration adjustments listed in Table 4A. Specifically, we are correcting the values in the column titled âFY 2021 Out Migration Adjustmentâ. Table 5.âList of Medicare Severity Diagnosis-Related Groups (MS-DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of StayâFY 2021. We are correcting this table to reflect the recalculation of the relative weights, geometric average length-of-stay (LOS), and arithmetic mean LOS as a result of the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data used in the calculations (as discussed in section II.B.

Of this correcting document). Table 7B.âMedicare Prospective Payment System Selected Percentile Lengths of Stay. FY 2019 MedPAR UpdateâMarch 2020 GROUPER Version 38 MS-DRGs. We are correcting this table to reflect the recalculation of the relative weights, geometric average LOS, and arithmetic mean LOS as a result of the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data used in the calculations (as discussed in section II.B.

Of this correcting document). Table 18.âFY 2021 Medicare DSH Uncompensated Care Payment Factor 3. For the FY 2021 IPPS/LTCH PPS final rule, we published a list of hospitals that we identified to be subsection (d) hospitals and subsection (d) Puerto Rico hospitals projected to be eligible to receive uncompensated care interim payments for FY 2021. As stated in the FY 2021 IPPS/LTCH PPS final rule (85 FR 58834 and 58835), we allowed the public an additional period after the issuance of the final rule to review and submit comments on the accuracy of the list of mergers that we identified in the final rule.

Based on the comments received during this additional period, we are updating this table to reflect the merger information received in response to the final rule and to revise the Factor 3 calculations for purposes of determining uncompensated care payments for the FY 2021 IPPS/LTCH PPS final rule. We are revising Factor 3 for all hospitals to reflect the updated merger information received in response to the final rule. We are also revising the amount of the total uncompensated care payment calculated for each DSH-eligible hospital. The total uncompensated care payment that a hospital receives is used to calculate the amount of the interim uncompensated care payments the hospital receives per discharge.

Accordingly, we have also revised these amounts for all DSH-eligible hospitals. These corrections will be reflected in Table 18 and the Medicare DSH Supplemental Data File. Per discharge uncompensated care payments are included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, these corrections to uncompensated care payments impacted the calculation of all the budget neutrality factors as well as the outlier fixed-loss cost threshold.

In section IV.C. Of this correcting document, we have made corresponding revisions to the discussion of the âEffects of the Changes to Medicare DSH and Uncompensated Care Payments for FY 2021â for purposes of the Regulatory Impact Analysis in Appendix A of the FY 2021 IPPS/LTCH PPS final rule to reflect the corrections discussed previously and to correct minor typographical errors. The files that are available on the internet have been updated to reflect the corrections discussed in this correcting document. III.

Waiver of Proposed Rulemaking, 60-Day Comment Period, and Delay in Effective Date Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), the agency is required to publish a notice of the proposed rulemaking in the Federal Register before the provisions of a rule take effect. Similarly, section 1871(b)(1) of the Act requires the Secretary to provide for notice of the proposed rulemaking in the Federal Register and provide a period of not less than 60 days for public comment. In addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in effective date after issuance or publication of a rule.

Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the notice and comment and delay in effective date APA requirements. In cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an agency to dispense with normal rulemaking requirements for good cause if the agency makes a finding that the notice and comment process are impracticable, unnecessary, or contrary to the public interest. In addition, both section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay in effective date where such delay is contrary to the public interest and an agency includes a statement of support.

We believe that this correcting document does not constitute a rule that would be subject to the notice and comment or delayed effective date requirements. This document corrects technical and typographical errors in the preamble, addendum, payment rates, tables, and appendices included or referenced in the FY 2021 IPPS/LTCH PPS final rule, but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule. As a result, this correcting document is intended to ensure that the information in the FY 2021 IPPS/LTCH PPS final rule accurately reflects the policies adopted in that document. In addition, even if this were a rule to which the notice and comment procedures and delayed effective date requirements applied, we find that there is good cause to waive such requirements.

Undertaking further notice and comment procedures to incorporate the corrections in this document into the final rule or delaying the effective date would be contrary to the public interest because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects our policies. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply implementing correctly the methodologies and policies that we previously proposed, requested comment on, and subsequently finalized. This correcting document is intended solely to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects these payment methodologies and policies. Therefore, we believe we have good cause to waive Start Printed Page 78752the notice and comment and effective date requirements.

Moreover, even if these corrections were considered to be retroactive rulemaking, they would be authorized under section 1871(e)(1)(A)(ii) of the Act, which permits the Secretary to issue a rule for the Medicare program with retroactive effect if the failure to do so would be contrary to the public interest. As we have explained previously, we believe it would be contrary to the public interest not to implement the corrections in this correcting document because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects our policies. IV. Correction of Errors In FR Doc.

2020-19637 of September 18, 2020 (85 FR 58432), we are making the following corrections. A. Corrections of Errors in the Preamble 1. On page 58435, third column, third full paragraph, line 1, the reference, âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â.

2. On page 58436, first column, first full paragraph, line 10, the reference, âsection II.G.9.c.â is corrected to read âsection II.F.9.c.â. 3. On page 58448, lower half of the page, second column, first partial paragraph, lines 19 and 20, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â.

4. On page 58451, first column, first full paragraph, line 12, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â. 5. On page 58453, third column, third full paragraph, line 13, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â.

6. On page 58459, first column, fourth paragraph, line 3, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. 7. On page 58464, bottom quarter of the page, second column, partial paragraph, lines 4 and 5, the phrase âand section II.E.15.

Of this final rule,â is corrected to read âand this final rule,â. 8. On page 58471, first column, first partial paragraph, lines 12 and 13, the reference, âsection II.E.15.â is corrected to read âsection II.D.15.â. 9.

On page 58479, first column, first partial paragraph. A. Line 6, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â. B.

Line 15, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. 10. On page 58487, first column, first full paragraph, lines 20 through 21, the reference, âsection II.E.12.b.â is corrected to read âsection II.D.12.b.â. 11.

On page 58495, middle of the page, third column, first full paragraph, line 5, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. 12. On page 58506. A.

Top half of the page, second column, first full paragraph, line 8, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. B. Bottom half of the page. (1) First column, first paragraph, line 5, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â.

(2) Second column, third full paragraph, line 5, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. 13. On page 58509. A.

First column, last paragraph, last line, the reference, âsection II.E.2.â is corrected to read âsection II.D.2.â. B. Third column, last paragraph, line 5, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. 14.

On page 58520, second column, second full paragraph, line 22, the reference, âsection II.E.11.â is corrected to read âsection II.D.11.â. 15. On page 58529, bottom half of the page, first column, last paragraph, lines 11 and 12, the reference, âsection II.E.12.a.â is corrected to read âsection II.D.12.a.â. 16.

On page 58531. A. Top of the page, second column, last paragraph, line 3, the reference, âsection II.E.4.â is corrected to read âsection II.D.4.â. B.

Bottom of the page, first column, last paragraph, line 3, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â. 17. On page 58532, top of the page, second column, first partial paragraph, line 5, the reference, âsection II.E.4.â is corrected to read âsection II.D.4.â. 18.

On page 58537. A. Second column, last paragraph, line 6, the reference, âsection II.E.11.c.5.â is corrected to read âsection II.D.11.c.(5).â. B.

Third column, fifth paragraph. (1) Lines 8 and 9, the reference, âsection II.E.11.c.1.â is corrected to read âsection II.D.11.c.(1).â. (2) Line 29, the reference, âsection II.E.11.c.1.â is corrected to read âsection II.D.11.c.(1).â. 19.

On page 58540, first column, first partial paragraph, line 19, the reference, âsection II.E.13.â is corrected to read âsection II.D.13.â. 20. On page 58541, second column, first partial paragraph, lines 9 and 10, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. 21.

On page 58553, second column, third full paragraph, line 20, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â. 22. On page 58554, first column, fifth full paragraph, line 1, the reference, âsection II.E.13.â is corrected to read âsection II.D.13.â. 23.

On page 58555, second column, fifth full paragraph, lines 8 and 9, the reference, âsection II.E.13.â is corrected to read âsection II.D.13.â. 24. On page 58556. A.

First column, first partial paragraph, line 5, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â. B. Second column, first full paragraph. (1) Line 6, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â.

(2) Line 38, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â. 25. On page 58559, bottom half of the page, third column, first full paragraph, line 21, the reference, âsection II.E.12.c.â is corrected to read âsection II.D.12.c.â. 26.

On page 58560, first column, first full paragraph, line 14, the reference, âsection II.E.16.â is corrected to read âsection II.D.16.â. 27. On page 58580, third column, last paragraph, line 3, the reference, âsection II.E.13. Of this final rule,â is corrected to read âthis final rule,â.

(1) First column, first paragraph, line 3, the reference, âsection II.E.13. Of this final rule,â is corrected to read âthis final rule,â. (2) Third column, last paragraph, line 3, the reference, âsection II.E.13. Of this final rule,â is corrected to read âthis final rule,â.

B. Bottom of the page, third column, last paragraph, line 3, the reference, âsection II.E.13. Of this final rule,â is corrected to read âthis final rule,â. 29.

On page 58582. A. Middle of the page. (1) First column, first paragraph, line 3, the reference, âsection II.E.13.

Of this final rule,â is corrected to read âthis final rule,â. (2) Third column, first full paragraph, line 3, the reference, âsection II.E.13. Of this final rule,â is corrected to read âthis final rule,â. B.

Bottom of the page, second column, first full paragraph, lines 2 and 3, the reference, âin section II.E.13. Of this final rule,â is corrected to read âthis final rule,â. 30. On page 58583.

A. Top of the page, second column, last paragraph, line 3, the reference, Start Printed Page 78753âsection II.E.13. Of this final rule,â is corrected to read âthis final rule,â. B.

Bottom of the page. (1) First column, last paragraph, line 3, the reference, âin section II.E.13. Of this final rule,â is corrected to read âthis final rule,â. (2) Third column, last paragraph, line 3, the reference, âsection II.E.13.

Of this final rule,â is corrected to read âthis final rule,â. 31. On page 58585, top of the page, third column, last paragraph, lines 3 and 4, the reference, âin section II.E.13. Of this final rule,â is corrected to read âthis final rule,â.

32. On page 58586. A. Second column, last partial paragraph, line 4, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â.

B. Third column. (1) First partial paragraph. (a) Lines 12 and 13, the reference, âin section II.E.2.b.

Of this final rule,â is corrected to read âthis final rule,â. (b) Lines 20 and 21, the reference, âin section II.E.8.a. Of this final rule,â is corrected to read âthis final rule,â. (2) Last partial paragraph.

(a) Line 3, the reference, âsection II.E.4. Of this final rule,â is corrected to read âthis final rule,â. (b) Line 38, the reference, âsection II.E.7.b. Of this final rule,â is corrected to read âthis final rule,â.

33. On page 58587. A. Top of the page, second column, partial paragraph, line 7, the reference, âsection II.E.8.a.

Of this final rule,â is corrected to read âthis final rule,â. B. Bottom of the page. (1) Second column, last partial paragraph, line 3, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â.

(2) Third column, first partial paragraph, line 1, the reference, âsection II.E.8.a.â is corrected to read âsection II.D.8.a.â. 34. On page 58588, first column. A.

First full paragraph, line 3, the reference, âsection II.E.4.â is corrected to read âsection II.D.4.â. B. Third full paragraph, line 3, the reference, âsection II.E.7.b.â is corrected to read âsection II.D.7.b.â. C.

Fifth full paragraph, line 3, the reference, âsection II.E.8.a.â is corrected to read âsection II.D.8.a.â. 35. On page 58596. A.

First column. (1) First full paragraph, line 1, the reference, âsection II.E.5.a.â is corrected to read âsection II.D.5.a.â. (2) Last paragraph, line 5, the reference, âsection II.E.1.b.â is corrected to read âsection II.D.1.b.â. C.

Second column, first full paragraph, line 14, the date âMarch 31, 2019â is corrected to read âMarch 31, 2020â. 36. On page 58599, first column, second full paragraph, line 1, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â. 37.

On page 58603, first column. A. First partial paragraph, line 13, the reference, âsection II.G.1.a.(2).b.â is corrected to read âsection II.F.1.a.(2).b.â. B.

Last partial paragraph, line 21, the reference, âsection II.G.1.a.(2).b.â is corrected to read âsection II.F.1.a.(2).b.â. 38. On page 58604, third column, first partial paragraph, line 38, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â. 39.

On page 58606. A. First column, second partial paragraph, line 13, the reference, âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â. B.

Second column. (1) First partial paragraph, line 3, the reference, âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â. (2) First full paragraph. (a) Line 29, the reference, âsection II.G.8.â is corrected to read âsection II.F.8.â.

(b) Line 36, âsection II.G.8.â is corrected to read âsection II.F.8.â. E. Third column, first full paragraph. (1) Lines 4 and 5, the reference, âsection II.G.9.b.â is corrected to read section âII.F.9.b.â.

(2) Line 13, the reference âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â. 40. On page 58607. A.

First column, first full paragraph. (1) Line 7, the reference, âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â. (2) Line 13, the reference, âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â. C.

Second column, first partial paragraph. (1) Line 20, the reference, âsection II.G.9.c.â is corrected to read âsection II.F.9.c.â. (2) Line 33, the reference, âsection II.G.9.c.â is corrected to read âsection II.F.9.c.â. 41.

On page 58610. A. Second column, last partial paragraph, lines 1 and 16, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â. B.

Third column, first partial paragraph. (1) Line 6, the reference, âsection II.G.1.a.(2).b.â is corrected to read âsection II.F.1.a.(2)b.â (2) Lines 20 and 21, the reference, âsection II.G.1.a.(2)b.â is corrected to read âsection II.F.1.a.(2)b.â. 42. On page 58716, first column, second full paragraph, lines 14 through 19, the phrase, âwith 03HK0MZ (Insertion of stimulator lead into right internal carotid artery, open approach) or 03HL0MZ (Insertion of stimulator lead into left internal carotid artery, open approach)â is corrected to read âwith 03HK3MZ (Insertion of stimulator lead into right internal carotid artery, percutaneous approach) or 03HL3MZ (Insertion of stimulator lead into left internal carotid artery, percutaneous approach).â.

43. On page 58717, first column, first partial paragraph, line 5, the phrase, âwith 03HK0MZ or 03HL0MZâ is corrected to read âwith 03HK3MZ or 03HL3MZ.â 44. On page 58719. A.

First column, last partial paragraph, line 12, the reference, âsection II.G.8.â is corrected to read âsection II.F.8.â. B. Third column, first partial paragraph, line 15, the reference, âsection II.G.8.â is corrected to read âsection II.F.8.â. 45.

On page 58721, third column, second full paragraph, line 17, the phrase, âXW03366 or XW04366â is corrected to read âXW033A6 (Introduction of cefiderocol anti-infective into peripheral vein, percutaneous approach, new technology group 6) or XW043A6 (Introduction of cefiderocol anti-infective into central vein, percutaneous approach, new technology group 6).â. 46. On page 58723, second column, first partial paragraph, line 14, the phrase, âprocedure codes XW03366 or XW04366â is corrected to read âprocedure codes XW033A6 or XW043A6.â 47. On page 58734, third column, second full paragraph, line 26, the reference, âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â.

48. On page 58736, second column, first full paragraph, line 27, the reference, âII.G.9.b.â is corrected to read âII.F.9.b.â. 49. On page 58737, third column, first partial paragraph, line 5, the reference, âsection II.G.1.d.â is corrected to read âsection II.F.1.d.â.

50. On page 58739, third column, first full paragraph, line 21, the reference, âsection II.G.8.â is corrected to read âsection II.F.8.â. 51. On page 58741, third column, second partial paragraph, line 17, the reference, âsection II.G.9.a.â is corrected to read âsection II.F.9.a.â.Start Printed Page 78754 52.

On page 58768, third column, first partial paragraph, line 3, the figure â0.8465â is corrected to read â0.8469â. 53. On page 58842, second column, first full paragraph, lines 19 and 35, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â. 54.

On page 58876, first column, first full paragraph, line 18, the reference, âsection II.E.â is corrected to read âsection II.D.â. 55. On page 58893, first column, second full paragraph, line 5, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â. 56.

On page 58898, third column, first full paragraph, line 9, the reference, âsection II.E.â is corrected to read âsection II.D.â. 57. On page 58899, third column, first full paragraph, line 24, the reference, âsection II.E.1.â is corrected to read âsection II.D.1.â. 58.

On page 58900, first column, third paragraph, line 26, the reference, âsection II.E.â is corrected to read âsection II.D.â. 59. On page 59006, second column, second full paragraph. A.

Line 4, the regulation citation, â(c)(3)(i)â is corrected to read â(c)(1)(ii)â. B. Line 12, the regulation citation, â(c)(3)(ii)â is corrected to read â(c)(2)(ii)â. C.

Lines 17 and 18, the phrase âcharged to an uncollectible receivables accountâ is corrected to read, ârecorded as an implicit price concessionâ. B. Correction of Errors in the Addendum 1. On page 59031.

A. First column. (1) First full paragraph, line 7, the reference, âsection âII.G.â is corrected to read âsection II.E.â. (2) Second partial paragraph, lines 26 and 27, the reference, âsection II.G.â is corrected to read âsection II.E.â.

B. Second column, first partial paragraph. (1) Line 5, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â. (2) Line 22, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â.

2. On page 59034, at the top of the page, the table titled âSummary of FY 2021 Budget Neutrality Factorsâ is corrected to read. 3. On page 59037, second column.

A. First full paragraph, line 4, the phrase â(estimated capital outlier payments of $429,431,834 divided by (estimated capital outlier payments of $429,431,834 plus the estimated total capital Federal payment of $7,577,697,269))â is corrected to read. Â(estimated capital outlier payments of $429,147,874 divided by (estimated capital outlier payments of $429,147,874 plus the estimated total capital Federal payment of $7,577,975,637))â b. Last partial paragraph, line 8, the reference, âsection II.E.2.b.â is corrected to read âsection II.D.2.b.â.

4. On page 59039, third column, last paragraph, lines 18 and 19, the phrase â9,519,120 casesâ is corrected to â9,221,466 casesâ. 5. On page 59040.

A. Top of the page, third column. (1) First partial paragraph. (a) Line 9, the figure â$29,051â is corrected to read â$29,064â.

(b) Line 11, the figure â$4,955,813,978â is corrected to read â$4,951,017,650â (c) Line 12, the figure â$92,027,177,037â is corrected to read â$91,937,666,182â. (d) Line 26, the figure â$29,108â is corrected to read â$29,121â. Start Printed Page 78755 (e) Line 33, the figure â$29,051â is corrected to read â$29,064â. (2) First full paragraph, line 11, the phrase âthreshold for FY 2021 (which reflects ourâ is corrected to read âthreshold for FY 2021 of $29,064 (which reflects ourâ.

B. Bottom of the page, the untitled table is corrected to read as follows. 6. On pages 59042, the table titled âCHANGES FROM FY 2020 STANDARDIZED AMOUNTS TO THE FY 2021 STANDARDIZED AMOUNTSâ is corrected to read as follows.

Start Printed Page 78756 7. On page 59047. A. Second column.

(1) Second full paragraph, line 43, the figure â0.9984â is corrected to read â0.9983â. (2) Last paragraph. (a) Line 17, the figure â0.9984â is corrected to read â0.9983â. (b) Line 18, the figure â0.9984â is corrected to read â0.9983â.

B. Third column. (1) Third paragraph, line 4, the figure â0.9984â is corrected to read â0.9983â. (2) Last paragraph, line 9, the figure â$466.22â is corrected to read â$466.21â.

8. On page 59048. A. The chart titled âCOMPARISON OF FACTORS AND ADJUSTMENTS.

FY 2020 CAPITAL FEDERAL RATE AND THE FY 2021 CAPITAL FEDERAL RATEâ is corrected to read as follows. b. Lower half of the page, first column, second full paragraph, last line, the figure â$29,051â is corrected to read â$29,064â. 9.

On page 59057, second column, second full paragraph. A. Line 11, the figure â$29,051â is corrected to read â$29,064â. B.

Last line, the figure â$29,051â is corrected to read â$29,064â. 10. On page 59060, the table titled âTABLE 1AâNATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (68.3 PERCENT LABOR SHARE/31.7 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1) âFY 2021â is corrected to read as follows. 11.

On page 59061, top of the page. A. The table titled âTABLE 1BâNATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)âFY 2021â is corrected to read as follows. Start Printed Page 78757 b.

The table titled âTable 1CâADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL. 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR EQUAL TO 1)âFY 2021â is corrected to read as follows. c. The table titled âTABLE 1DâCAPITAL STANDARD FEDERAL PAYMENT RATEâFY 2021â is corrected to read as follows.

C. Corrections of Errors in the Appendices 1. On page 59062, first column, second full paragraph. A.

Line 9, the reference âsections II.G.5. And 6.â is corrected to read âsections II.F.5. And 6.â b. Line 11, the reference âsection II.G.6.â is corrected to read âsection II.F.6.â 3.

On page 59064, third column, second full paragraph, last line, the figures â2,049, and 1,152â are corrected to read â2,050 and 1,151â. 4. On page 59065 through 59069, the table and table notes for the table titled âTABLE I.âIMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2021â are corrected to read as follows. Start Printed Page 78758 Start Printed Page 78759 Start Printed Page 78760 Start Printed Page 78761 Start Printed Page 78762 5.

On page 59070. A. First column. (1) Third full paragraph.

(a) Line 1, the reference, âsection II.E.â is corrected to read âsection II.D.â. (b) Line 11, the section reference âII.G.â is corrected to read âII.E.â. (2) Fourth full paragraph, line 6, the figure â0.99798â is corrected to read â0.997975â. B.

Third column, first full paragraph, line 26, the figure â1.000426â is corrected to read â1.000447â. 6. On page 59071, lower half of the page. A.

First column, third full paragraph, line 6, the figure â0.986583â is corrected to read â0.986616â. B. Second column, second full paragraph, line 5, the figure â0.993433â is corrected to read â0.993446â. C.

Third column, first partial paragraph, line 2, the figure â0.993433â is corrected to read â0.993446â. 7. On page 59073 and 59074, the table titled âTABLE II.âIMPACT ANALYSIS OF CHANGES FOR FY 2021 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM (PAYMENTS PER DISCHARGE)â is corrected to read as follows. Start Printed Page 78763 Start Printed Page 78764 Start Printed Page 78765 8.

On page 59074, bottom of the page, second column, last partial paragraph, line 1, the reference âsection II.G.9.b.â is corrected to read âsection II.F.9.b.â. 9. On page 59075. A.

First column. (1) First full paragraph, line 1, the reference âsection II.G.9.c.â is corrected to read âsection II.F.9.c.â. (2) Last partial paragraph. (i) Line 1, the reference âsection II.G.4.â is corrected to read âsection II.F.4.â.

(ii) Line 11, the reference âsection II.G.4.â is corrected to read âsection II.F.4.â. B. Third column. (1) First full paragraph.

(i) Line 1, the reference âsections II.G.5. And 6.â is corrected to read âsections II.F.5. And 6.â. (ii) Line 12, the reference âsection II.H.6.â is corrected to read âsection II.F.6.â.

(2) Last paragraph, line 1, the reference âsection II.G.6.â is corrected to read âsection II.F.6.â. 10. On page 59076, first column, first partial paragraph, lines 2 and 3, the reference âsection II.G.9.c.â is corrected to read âsection II.F.9.c.â. 11.

On pages 59077 and 59078 the table titled âModeled Uncompensated Care Payments for Estimated FY 2021 DSHs by Hospital Type. Uncompensated Care Payments ($ in Millions)âfrom FY 2020 to FY 2021â is corrected to read as follows. Start Printed Page 78766 Start Printed Page 78767 12. On pages 59078 and 59079 in the section titled âEffects of the Changes to Uncompensated Care Payments for FY 2021â, the section's language (beginning with the phrase âRural hospitals, in general, are projected to experienceâ and ending with the sentence âHospitals with greater than 65 percent Medicare utilization are projected to receive an increase of 0.62 percent.â) is corrected to read as follows.

ÂRural hospitals, in general, are projected to experience larger decreases in uncompensated care payments than their urban counterparts. Overall, rural hospitals are projected to receive a 7.19 percent decrease in uncompensated care payments, while urban hospitals are projected to receive a 0.29 percent decrease in uncompensated care payments. However, hospitals in large urban areas are projected to receive a 0.75 percent increase in uncompensated care payments and hospitals in other urban areas a 1.94 percent decrease. By bed size, smaller rural hospitals are projected to receive the largest decreases in uncompensated care payments.

Rural hospitals with 0-99 beds are projected to receive a 9.46 percent payment decrease, and rural hospitals with 100-249 beds are projected to receive a 7.44 percent decrease. These decreases for smaller rural hospitals are greater than the overall hospital average. However, larger rural hospitals with 250+ beds are projected to receive a 7.64 percent payment increase. In contrast, the smallest urban hospitals (0-99 beds) are projected to receive an increase in uncompensated care payments of 2.61 percent, while urban hospitals with 100-249 beds are projected to receive a decrease of 1.05 percent, and larger urban hospitals with 250+ beds are projected to receive a 0.18 percent decrease in uncompensated care payments, which is less than the overall hospital average.

By region, rural hospitals are expected to receive larger than average decreases in uncompensated care payments in all Regions, except for rural hospitals in the Pacific Region, which are projected to receive an increase in uncompensated care payments of 9.14 percent. Urban hospitals are projected to receive a more varied range of payment changes. Urban hospitals in the New England, the Middle Atlantic, West South Central, and Mountain Regions, as well as urban hospitals in Puerto Rico, are projected to receive larger than average decreases in uncompensated care payments, while urban hospitals in the South Atlantic, East North Central, East South Central, West North Central, and Pacific Regions are projected to receive increases in uncompensated care payments. By payment classification, hospitals in urban areas overall are expected to receive a 0.18 percent increase in uncompensated care payments, with hospitals in large urban areas expected to see an increase in uncompensated care payments of 1.15 percent, while hospitals in other urban areas are expected to receive a decrease of 1.60 percent.

In contrast, hospitals in rural areas are projected to receive a decrease in uncompensated care payments of 3.18 percent. Nonteaching hospitals are projected to receive a payment decrease of 0.99 percent, teaching hospitals with fewer than 100 residents are projected to receive a payment decrease of 0.83 percent, and teaching hospitals with 100+ residents have a projected payment decrease of 0.41 percent. All of these decreases are consistent with the overall hospital average. Proprietary and government hospitals are projected to receive larger than average decreases of 2.42 and 1.14 percent respectively, while voluntary hospitals are expected to receive a payment decrease of 0.03 percent.

Hospitals with less than 50 percent Medicare utilization are projected to receive decreases in uncompensated care payments consistent with the overall hospital average percent change, while hospitals with 50 to 65 percent Medicare utilization are projected to receive a larger than average decrease of 4.12 percent. Hospitals with greater than 65 percent Medicare utilization are projected to receive an increase of 0.80 percent.â 13. On page 59085, lower half of the page, second column, last partial paragraph, line 20, the section reference âII.H.â is corrected to read âIV.H.â. 14.

On pages 59092 and 59093, the table titled âTABLE III.âCOMPARISON OF TOTAL PAYMENTS PER CASE [FY 2020 PAYMENTS COMPARED TO FINAL FY 2021 PAYMENTS] is corrected to read as. Start Printed Page 78768 Start Printed Page 78769 Start Signature Wilma M. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental Information BILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-P[FR Doc.

2020-26698 Filed 12-1-20. 4:15 pm]BILLING CODE 4120-01-C.

Standard dose of seroquel

	Seroquel	Paxil cr
For womens	200mg 120 tablet $319.99	37.5mg 30 tablet $135.60
Price per pill	At cvs	At walmart
Where to get	Yes	Yes
Take with alcohol	15h	8h

Vancouver, B.C standard dose of seroquel Renova cost per tube. And Toronto, ON., December 11, 2020 - WELL Health Technologies Corp. (TSX.V. WELL) (the âCompanyâ or âWELLâ), a company focused on consolidating and modernizing clinical and digital assets within the primary health care sector, is pleased to announce it has partnered with Canada Health Infoway (âInfowayâ) to integrate Infowayâs national e-prescribing service, PrescribeITÂ®, with WELLâs OSCAR Pro Electronic Medical Records (EMR) software. Physicians and health care practitioners using OSCAR Pro are now able to easily create, renew and cancel prescriptions electronically, while improving overall patient care through secure clinician messaging.

WELL is offering an end-to-end solution from virtual and on-site patient consultation to electronic prescription, resulting in a better physician and patient experience. By partnering with PrescribeITÂ®, health care practitioners, pharmacists and patients can have confidence that the solution ensures patient privacy and security of information. ÂWe are very excited to launch our e-prescribing service with Infowayâs PrescribeITÂ®,â said Hamed Shahbazi, Chairman and CEO of WELL. ÂElectronic prescriptions will be a key for making virtual visits more efficient and effective, and this integration with the WELL EMR network can help create a better patient experience. I am very proud of our WELL EMR Group who has worked tirelessly to successfully achieve conformance approval from Infoway and our WELL Digital Health Apps team who have made the service available through the apps.health marketplace.âPrescribeITÂ® enhances clinical communications, e-renewals, privacy and security.

Prescriptions can now be sent directly from within OSCAR Pro EMR in a secure electronic format to the patient's pharmacy of choice and pharmacies can electronically request prescription renewals from the patient's health care provider. Electronic prescriptions are key for virtual visits as the patient does not have to rely on faxing prescriptions to pharmacies. Furthermore, patient safety is increased due to prevention of data entry errors at the pharmacy and prescription fraud is decreased through direct transmission of the prescription from the prescriber to the pharmacy through the PrescribeITÂ® service.âWe are excited about this partnership with WELL to make PrescribeITÂ® available to prescribers who use the OSCAR Pro EMR software,â said Jamie Bruce, Executive Vice President, Infoway. ÂPrescribeITÂ® makes prescribing safer, more secure, easier and more convenient. PrescribeITÂ® is also an increasingly important tool in the prescriberâs virtual care toolbox.âWELL HEALTH TECHNOLOGIES CORP.Per.

âHamed Shahbaziâ Hamed ShahbaziChief Executive Officer, Chairman and DirectorAbout WELLWELL is an omni-channel digital health company whose overarching objective is to empower doctors to provide the best and most advanced care possible while leveraging the latest trends in digital health. As such, WELL owns and operates 25 primary health care clinics, is Canada's third largest digital Electronic Medical Records (EMR) supplier serving over 2,000 medical clinics, operates a leading national telehealth service and is a provider of digital health, billing and cybersecurity related technology solutions. WELL is an acquisitive company that follows a disciplined and accretive capital allocation strategy. WELL is publicly traded on the Toronto Stock Exchange under the symbol "WELL" and the Company was recognized as a TSX Venture 50 Company three years in a row in 2018, 2019 and 2020. To access the Company's telehealth service, visit.

Tiahealth.com or virtualclinics.ca and for corporate information, visit. Www.well.company.About Canada Health InfowayInfoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians. Infoway is an independent, not-for-profit organization funded by the federal government. Visit www.infoway-inforoute.ca.About PrescribeITÂ®Canada Health Infoway is working with Health Canada, the provinces and territories, and industry stakeholders to develop, operate and maintain the national e-prescribing service known as PrescribeITÂ®.

PrescribeITÂ® will serve all Canadians, pharmacies and prescribers and provide safer and more effective medication management by enabling prescribers to transmit a prescription electronically between a prescriberâs electronic medical record (EMR) and the pharmacy management system (PMS) of a patientâs pharmacy of choice. PrescribeITÂ® will protect Canadiansâ personal health information from being sold or used for commercial activities. Visit www.PrescribeIT.ca.Forward-Looking StatementsThis news release may contain "forward-looking statements" within the meaning of applicable Canadian securities laws, including, without limitation statements regarding. Improvement to overall patient care through clinical messaging. And the belief that the launch will ensure patient privacy and security of information.

Forward-looking statements are necessarily based upon a number of estimates and assumptions that, while considered reasonable by management, are inherently subject to significant business, economic and competitive uncertainties, and contingencies. These statements generally can be identified by the use of forward-looking words such as âmayâ, âshouldâ, âwillâ, âcouldâ, âintendâ, âestimateâ, âplanâ, âanticipateâ, âexpectâ, âbelieveâ or âcontinueâ, or the negative thereof or similar variations. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause future results, performance or achievements to be materially different from the estimated future results, performance or achievements expressed or implied by those forward-looking statements and the forward-looking statements are not guarantees of future performance. WELLâs statements expressed or implied by these forward-looking statements are subject to a number of risks, uncertainties, and conditions, many of which are outside of WELL 's control, and undue reliance should not be placed on such statements. Forward-looking statements are qualified in their entirety by inherent risks and uncertainties, including.

Risks related to privacy and cyber security concerns. Risks related to compatibility between the two platforms and solutions. And error free adoption, use and growth of the service. Except as required by securities law, WELL does not assume any obligation to update or revise any forward-looking statements, whether as a result of new information, events or otherwise.Neither the TSX nor its Regulation Services Provider (as that term is defined in policies of the TSX) accepts responsibility for the adequacy or accuracy of this release.-30-For further information:Pardeep S. SanghaVP Corporate Strategy and Investor RelationsWELL Health Technologies Corp.604.572.6392This email address is being protected from spambots.

You need JavaScript enabled to view it.Inquiries about PrescribeITÂ® Tania EnsorSenior Director, Marketing, Stakeholder Relations and Reputation Management, PrescribeITÂ®Canada Health Infoway416.707.6285Email UsFollow @PrescribeIT_CA.

Vancouver, B.C seroquel online canada. And Toronto, ON., December 11, 2020 - WELL Health Technologies Corp. (TSX.V. WELL) (the âCompanyâ or âWELLâ), a company focused on consolidating and modernizing clinical and digital assets within the primary health care sector, is pleased to announce it has partnered with Canada Health Infoway (âInfowayâ) to integrate Infowayâs national e-prescribing service, PrescribeITÂ®, with WELLâs OSCAR Pro Electronic Medical Records (EMR) software. Physicians and health care practitioners using OSCAR Pro are now able to easily create, renew and cancel prescriptions electronically, while improving overall patient care through secure clinician messaging.

What side effects may I notice from Seroquel?

Side effects that you should report to your doctor or health care professional as soon as possible:

allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
difficulty swallowing
fast or irregular heartbeat
increased hunger or thirst
increased urination
problems with balance, talking, walking
seizures
stiff muscles
suicidal thoughts or other mood changes
uncontrollable head, mouth, neck, arm, or leg movements
unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

change in sex drive or performance
constipation
drowsy or dizzy
dry mouth
stomach upset
weight gain

This list may not describe all possible side effects.

Seroquel joint pain

Passengers wearing face masks as a preventive measure against the spread of antidepressant drugs are seen on an escalator at Orlando International Airport.Paul Hennessy | seroquel joint pain LightRocket | Getty ImagesThe number of people traveling again is on the rise http://counterbalancebeer.com/gallery-style-no-space-2/. So are prices.Airfares and hotel rates are climbing as travelers seroquel joint pain return in the highest numbers since the seroquel began, hitting beaches, mountains and visiting friends and family after a year of being cooped up. Even the cost of a road seroquel joint pain trip is climbing as gasoline prices reach the highest levels since 2014.The rock-bottom fares hit during the depths of the seroquel were largely in the rearview mirror earlier this spring.

Now airlines and hotels are gearing up for a bustling summer, and a rise in bookings is driving up prices even more. Add to that airlines are not flying as much as they did seroquel joint pain pre-seroquel, so travelers can expect some full flights ahead.Domestic U.S. Fares are up 9% since April 1 while international fares are up 17%, seroquel joint pain according to research from Bernstein published this week.

And fares are continuing to rise."For domestic travel, the June line is closest as it has ever been this past year to the preseroquel values," the report said.Southwest Airlines this week said leisure fares are approaching 2019 levels.Many travelers, like Diana Desierto, are eager to visit friends and family they haven't seen in months.The 40-year-old, speech pathologist who lives in Baltimore, hasn't seen her parents, sister, brother-in-law and nephews in Oakland, Calif., or her brother, sister-in-law and a niece and a nephew in Seattle since Christmas 2019."I have a 12-year-old nephew who had a crazy growth spurt," she said. "Last time seroquel joint pain I saw him he was little. And [now] his voice is low."Desierto seroquel joint pain paid $344 for a one-way trip to Seattle and a connecting flight to Oakland in July.

She used Southwest frequent flyer miles for the trip home. She said the west-bound fare was roughly in line with prices she had been used to for years though she briefly thought that "maybe no one's flying and it would be cheaper."Further helping boost fares is that airlines are reinstating the strict rules on their more inflexible and cheapest fares, known as basic economy, according to seroquel joint pain Samuel Engel, head of the aviation practice at consulting firm ICF. Airlines executives have said they hope travelers avoid such fares and buy standard coach tickets, which are more seroquel joint pain expensive.Airlines lifted the rules in the seroquel to get desperately needed travelers on board as carriers faced record losses."Relaxing the rules in basic economy, I'm basically giving you a $30-$50 discount," Engel said.

"The intention seroquel online no prescription of basic is not to sell basic economy. It's to bring you in the door and make you realize you don't want it."Another thing driving up the cost of a trip is that more attractions like theme parks seroquel joint pain are reopening. antidepressant drugs-era capacity restrictions and even masking guidelines (except during air, rail and bus travel), are lifting as well.Destinations that for about a year had less to offer visitors than normal seroquel joint pain.

Orlando hotel rates in early May were $107 a night, up from $62 last year but still below the $133 in 2019.Even New York City, which is planning to reopen Broadway theaters in September and is now offering indoor dining, is recovering. Rooms, which were going for $123 a night last year, rose to $151 in early May â still well below the nightly rate of $269 in 2019 seroquel joint pain. STR expects New York City room rates to rise to an average of $163 a night for June through August.Fares and hotel rates are still largely below 2019 levels because business and most international travel is largely absent seroquel joint pain.

That will keep a lid on prices going forward.Some travelers have other concerns beside price. Crowds.Tom Snitzer, 64, a retired real estate developer and currently a professional nature photographer seroquel joint pain based in the Chicago suburb of Arlington Heights, said he recently flew to Atlanta for his son's graduation from medical school.He said it took 40 minutes to get through airport security. The Transportation Security Administration is racing to hire more screeners before the busy summer travel season."Everyone is packed in like sardines," he said.Snitzer said his travel plans are flexible but that he plans to avoid big tourist attractions, including popular national parks."Everyone seroquel joint pain in the world has been cooped up," he said.

"The biggest trick is to avoid everybody else, find off-the-grid spots so we don't get trampled by tourists."--CNBC's Nate Rattner contributed to this story..

Passengers wearing seroquel online canada face masks as a preventive measure against the spread buy seroquel discount card of antidepressant drugs are seen on an escalator at Orlando International Airport.Paul Hennessy | LightRocket | Getty ImagesThe number of people traveling again is on the rise. So are prices.Airfares and hotel rates are climbing as travelers return in the highest numbers since the seroquel began, hitting beaches, mountains and visiting friends seroquel online canada and family after a year of being cooped up. Even the cost of a road trip is climbing as gasoline prices reach the highest levels since 2014.The seroquel online canada rock-bottom fares hit during the depths of the seroquel were largely in the rearview mirror earlier this spring. Now airlines and hotels are gearing up for a bustling summer, and a rise in bookings is driving up prices even more. Add to that airlines are not flying seroquel online canada as much as they did pre-seroquel, so travelers can expect some full flights ahead.Domestic U.S.

Fares are up 9% since seroquel online canada April 1 while international fares are up 17%, according to research from Bernstein published this week. And fares are continuing to rise."For domestic travel, the June line is closest as it has ever been this past year to the preseroquel values," the report said.Southwest Airlines this week said leisure fares are approaching 2019 levels.Many travelers, like Diana Desierto, are eager to visit friends and family they haven't seen in months.The 40-year-old, speech pathologist who lives in Baltimore, hasn't seen her parents, sister, brother-in-law and nephews in Oakland, Calif., or her brother, sister-in-law and a niece and a nephew in Seattle since Christmas 2019."I have a 12-year-old nephew who had a crazy growth spurt," she said. "Last time I saw him he seroquel online canada was little. And [now] his voice is low."Desierto paid $344 for a one-way trip to Seattle seroquel online canada and a connecting flight to Oakland in July. She used Southwest frequent flyer miles for the trip home.

She said the west-bound fare was roughly in line with prices she had been used to for years though she briefly thought that "maybe no one's flying and it would be cheaper."Further helping boost fares is that airlines are reinstating the strict rules on their more inflexible and cheapest fares, known as basic economy, according to Samuel Engel, head of the seroquel online canada aviation practice at consulting firm ICF. Airlines executives have said they hope travelers avoid such fares and buy standard coach tickets, which are more expensive.Airlines lifted the rules in the seroquel to get desperately needed travelers on board as carriers faced record losses."Relaxing the rules in basic economy, I'm basically giving you a $30-$50 discount," seroquel online canada Engel said. "The intention of basic is not to sell basic see this page economy. It's to bring you in the door and make you realize you don't want it."Another thing driving up the cost of a trip is that more attractions like seroquel online canada theme parks are reopening. antidepressant drugs-era capacity restrictions and even masking guidelines (except during air, rail and bus travel), seroquel online canada are lifting as well.Destinations that for about a year had less to offer visitors than normal.

Airline executives say beach, mountain and other outdoor destinations have been popular with travelers and continue to be important.The price of a hotel in some popular destinations are even higher than before the seroquel.Hotel rates in Cancun, Mexico were about $205 a night in early May, according to hotel data provider STR. That's up from seroquel online canada just $45 a year ago and $160 in 2019. In Hawaii, it was about $269, up from $122 last year and $263 the year before.But with more seroquel online canada reopening, other cities are recovering. Orlando hotel rates in early May were $107 a night, up from $62 last year but still below the $133 in 2019.Even New York City, which is planning to reopen Broadway theaters in September and is now offering indoor dining, is recovering. Rooms, which seroquel online canada were going for $123 a night last year, rose to $151 in early May â still well below the nightly rate of $269 in 2019.

STR expects New York City room seroquel online canada rates to rise to an average of $163 a night for June through August.Fares and hotel rates are still largely below 2019 levels because business and most international travel is largely absent. That will keep a lid on prices going forward.Some travelers have other concerns beside price. Crowds.Tom Snitzer, 64, seroquel online canada a retired real estate developer and currently a professional nature photographer based in the Chicago suburb of Arlington Heights, said he recently flew to Atlanta for his son's graduation from medical school.He said it took 40 minutes to get through airport security. The Transportation Security Administration is racing to hire more screeners before the busy summer travel season."Everyone is packed in like sardines," he said.Snitzer said his travel plans are flexible but that he plans to avoid big tourist attractions, including popular national parks."Everyone in the world has been seroquel online canada cooped up," he said. "The biggest trick is to avoid everybody else, find off-the-grid spots so we don't get trampled by tourists."--CNBC's Nate Rattner contributed to this story..

Is seroquel a tranquilizer

How to cite this article:Singh is seroquel a tranquilizer OP. Psychiatry research in India. Closing the research is seroquel a tranquilizer gap. Indian J Psychiatry 2020;62:615-6Research is an important aspect of the growth and development of medical science. Research in India in general and medical research in particular is always being criticized for is seroquel a tranquilizer lack of innovation and originality required for the delivery of health services suitable to Indian conditions.

Even the Indian Council of Medical Research (ICMR) which is a centrally funded frontier organization for conducting medical research couldn't avert criticism. It has been criticized heavily for not producing quality research papers which are pioneering, ground breaking, or pragmatic solutions for health issues plaguing India. In the words of a leading daily, The ICMR could not even list one practical application of its hundreds of research papers published in various national and international research journals which helped cure any disease, or diagnose it with better accuracy or in less time, or even one new basic, applied or clinical research or innovation that opened a new frontier of scientific knowledge.[1]This clearly indicates that the health research output of ICMR is not up to is seroquel a tranquilizer the mark and is not commensurate with the magnitude of the disease burden in India. According to the 12th Plan Report, the country contributes to a fifth of the world's share of diseases. The research is seroquel a tranquilizer conducted elsewhere may not be generalized to the Indian population owing to differences in biology, health-care systems, health practices, culture, and socioeconomic standards.

Questions which are pertinent and specific to the Indian context may not be answered and will remain understudied. One of the vital elements in improving this situation is the need for relevant research base that would equip policymakers to take informed health policy decisions.The Parliamentary Standing Committee on Health and Family Welfare in the 100th report on Demand for Grants (2017â2018) of the Department of Health Research observed that âthe biomedical research output needs to be augmented substantially to cater to the health challenges faced by the country.â[1]Among the various reasons, lack of fund, infrastructure, and resources is the prime cause which is glaringly evident from the inadequate budget allocation for biomedical research. While ICMR has a budget of 232 million dollars per year on health research, it is zilch in comparison to the annual budget expenditure of the National Institute of Health, USA, on biomedical research which is 32 billion dollars.The lacuna of quality research is not merely due to lack of is seroquel a tranquilizer funds. There are other important issues which need to be considered and sorted out to end the status quo. Some of the factors which need our immediate attention are:Lack of research training and teachingImproper allocation of research facilitiesLack of information about research work happening globallyLack of promotion, motivation, commitment, and passion in the field of researchClinicians being overburdened with patientsLack of collaboration between medical colleges and established research institutesLack of continuity of is seroquel a tranquilizer research in successive batches of postgraduate (PG) students, leading to wastage of previous research and resourcesDifficulty in the application of basic biomedical research into pragmatic intervention solutions due to lack of interdisciplinary technological support/collaboration between basic scientists, clinicians, and technological experts.Majority of the biomedical research in India are conducted in medical institutions.

The majority of these are done as thesis submission for fulfillment of the requirement of PG degree. From 2015 onward, publication of papers had been made an obligatory requirement for is seroquel a tranquilizer promotion of faculty to higher posts. Although it offered a unique opportunity for training of residents and stimulus for research, it failed to translate into production of quality research work as thesis was limited by time and it had to be done with other clinical and academic duties.While the top four medical colleges, namely AIIMS, New Delhi. PGIMER, Chandigarh. CMC, Vellore is seroquel a tranquilizer.

And SGIMS, Lucknow are among the top ten medical institutions in terms of publication in peer-reviewed journals, around 332 (57.3%) medical colleges have no research paper published in a decade between 2004 and 2014.[2]The research in psychiatry is realistically dominated by major research institutes which are doing commendable work, but there is a substantial lack of contemporary research originating from other centers. Dr. Chittaranjan Andrade (NIMHANS, Bengaluru) and Dr. K Jacob (CMC, Vellore) recently figured in the list of top 2% psychiatry researchers in the world from India in psychiatry.[3] Most of the research conducted in the field of psychiatry are limited to caregivers' burden, pathways of care, and other topics which can be done in limited resources available to psychiatry departments. While all these areas of work are important in providing proper care and treatment, there is overabundance of research in these areas.The Government of India is aggressively looking forward to enhancing the quality of research and is embarking on an ambitious project of purchasing all major journals and providing free access to universities across the country.

The India Genome Project started in January, 2020, is a good example of collaboration. While all these actions are laudable, a lot more needs to be done. Following are some measures which will reduce the gap:Research proposals at the level of protocol can be guided and mentored by institutes. Academic committees of different zones and journals can help in this endeavorBreaking the cubicles by establishing a collaboration between medical colleges and various institutes. While there is a lack of resources available in individual departments, there are universities and institutes with excellent infrastructure.

They are not aware of the requirements of the field of psychiatry and research questions. Creation of an alliance will enhance the quality of research work. Some of such institutes include Centre for Neuroscience, Indian Institute of Science, Bengaluru. CSIR-Institute of Genomics and Integrative Biology, New Delhi. And National Institute of Biomedical Genomics, KalyaniInitiation and establishment of interactive and stable relationships between basic scientists and clinical and technological experts will enhance the quality of research work and will lead to translation of basic biomedical research into real-time applications.

For example, work on artificial intelligence for mental health. Development of Apps by IITs. Genome India Project by the Government of India, genomic institutes, and social science and economic institutes working in the field of various aspects of mental healthUtilization of underutilized, well-equipped biotechnological labs of nonmedical colleges for furthering biomedical researchMedical colleges should collaborate with various universities which have labs providing testing facilities such as spectroscopy, fluoroscopy, gamma camera, scintigraphy, positron emission tomography, single photon emission computed tomography, and photoacoustic imagingCreating an interactive, interdepartmental, intradepartmental, and interinstitutional partnershipBy developing a healthy and ethical partnership with industries for research and development of new drugs and interventions.Walking the talk â the psychiatric fraternity needs to be proactive and rather than lamenting about the lack of resource, we should rise to the occasion and come out with innovative and original research proposals. With the implementation of collaborative approach, we can not only enhance and improve the quality of our research but to an extent also mitigate the effects of resource crunch and come up as a leader in the field of biomedical research. References 1.2.Nagoba B, Davane M.

Current status of medical research in India. Where are we?. Walawalkar Int Med J 2017;4:66-71. 3.Ioannidis JP, Boyack KW, Baas J. Updated science-wide author databases of standardized citation indicators.

PLoS Biol 2020;18:e3000918. Correspondence Address:Dr. Om Prakash SinghAA 304, Ashabari Apartments, O/31, Baishnabghata, Patuli Township, Kolkata - 700 094, West Bengal IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/indianjpsychiatry.indianjpsychiatry_1362_2Abstract Background. The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.Aim. The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research.Materials and Methods. Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis. PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically searched to identify relevant studies.

Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.Results. Thirty-two relevant studies were found and included in the review. Studies were categorized into the following three thematic areas. Alcohol and substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services.

Sociocultural factors play a major role in understanding and determining mental disorders.Conclusion. This study is the first of its kind to review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.Keywords. India, mental health, scheduled tribesHow to cite this article:Devarapalli S V, Kallakuri S, Salam A, Maulik PK.

Mental health research on scheduled tribes in India. Indian J Psychiatry 2020;62:617-30 Introduction Mental health is a highly neglected area particularly in low and middle-income countries (LMIC). Data from community-based studies showed that about 10% of people suffer from common mental disorders (CMDs) such as depression, anxiety, and somatic complaints.[1] A systematic review of epidemiological studies between 1960 and 2009 in India reported that about 20% of the adult population in the community are affected by psychiatric disorders in the community, ranging from 9.5 to 103/1000 population, with differences in case definitions, and methods of data collection, accounting for most of the variation in estimates.[2]The scheduled tribes (ST) population is a marginalized community and live in relative social isolation with poorer health indices compared to similar nontribal populations.[3] There are an estimated 90 million STs or Adivasis in India.[4] They constitute 8.6% of the total Indian population. The distribution varies across the states and union territories of India, with the highest percentage in Lakshadweep (94.8%) followed by Mizoram (94.4%). In northeastern states, they constitute 65% or more of the total population.[5] The ST communities are identified as culturally or ethnographically unique by the Indian Constitution.

They are populations with poorer health indicators and fewer health-care facilities compared to non-ST rural populations, even when within the same state, and often live in demarcated geographical areas known as ST areas.[4]As per the National Family Health Survey, 2015â2016, the health indicators such as infant mortality rate (IMR) is 44.4, under five mortality rate (U5MR) is 57.2, and anemia in women is 59.8 for STs â one of the most disadvantaged socioeconomic groups in India, which are worse compared to other populations where IMR is 40.7, U5MR is 49.7, and anemia in women among others is 53.0 in the same areas.[6] Little research is available on the health of ST population. Tribal mental health is an ignored and neglected area in the field of health-care services. Further, little data are available about the burden of mental disorders among the tribal communities. Health research on tribal populations is poor, globally.[7] Irrespective of the data available, it is clear that they have worse health indicators and less access to health facilities.[8] Even less is known about the burden of mental disorders in ST population. It is also found that the traditional livelihood system of the STs came into conflict with the forces of modernization, resulting not only in the loss of customary rights over the livelihood resources but also in subordination and further, developing low self-esteem, causing great psychological stress.[4] This community has poor health infrastructure and even less mental health resources, and the situation is worse when compared to other communities living in similar areas.[9],[10]Only 15%â25% of those affected with mental disorders in LMICs receive any treatment for their mental illness,[11] resulting in a large âtreatment gap.â[12] Treatment gaps are more in rural populations,[13] especially in ST communities in India, which have particularly poor infrastructure and resources for health-care delivery in general, and almost no capacity for providing mental health care.[14]The aim of this systematic review was to explore the extent and nature of mental health research on ST population in India and to identify gaps and inform future research.

Materials and Methods Search strategyWe searched major databases (PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar) and made hand searches from January 1980 to December 2018 to identify relevant literature. Hand search refers to searching through medical journals which are not indexed in the major electronic databases such as Embase, for instance, searching for Indian journals in IndMed database as most of these journals are not available in major databases. Physical search refers to searching the journals that were not available online or were not available online during the study years. We used relevant Medical Subject Heading and key terms in our search strategy, as follows. ÂMental health,â âMental disorders,â âMental illness,â âPsychiatry,â âScheduled Tribeâ OR âTribeâ OR âTribal Populationâ OR âIndigenous population,â âIndia,â âPsych*â (Psychiatric, psychological, psychosis).Inclusion criteriaStudies published between January 1980 and December 2018 were included.

Studies on mental disorders were included only when they focused on ST population. Both qualitative and quantitative studies on mental disorders of ST population only were included in the analysis.Exclusion criteriaStudies without any primary data and which are merely overviews and commentaries and those not focused on ST population were excluded from the analysis.Data management and analysisTwo researchers (SD and SK) initially screened the title and abstract of each record to identify relevant papers and subsequently screened full text of those relevant papers. Any disagreements between the researchers were resolved by discussion or by consulting with an adjudicator (PKM). From each study, data were extracted on objectives, study design, study population, study duration, interventions (if applicable), outcomes, and results. Quality of the included studies was assessed, independently by three researchers (SD, SK, and AS), using Critical Appraisal Checklist developed by Critical Appraisal Skills Programme (CASP).[15] After a thorough qualitative assessment, all quantitative data were generated and tabulated.

A narrative description of the studies is provided in [Table 1] using some broad categories. Results Search resultsOur search retrieved 2306 records (which included hand-searched articles), of which after removing duplicates, title and abstracts of 2278 records were screened. Of these, 178 studies were deemed as potentially relevant and were reviewed in detail. Finally, we excluded 146 irrelevant studies and 32 studies were included in the review [Figure 1].Quality of the included studiesSummary of quality assessment of the included studies is reported in [Table 2]. Overall, nine studies were of poor quality, twenty were of moderate quality, and three studies were of high quality.

The CASP shows that out of the 32 studies, the sample size of 21 studies was not representative, sample size of 7 studies was not justified, risk factors were not identified in 28 studies, methods used were not sufficiently described to repeat them in 24 studies, and nonresponse reasons were not addressed in 24 studies. The most common reasons for studies to be of poor-quality included sample size not justified. Sample is not representative. Nonresponse not addressed. Risk factors not measured correctly.

And methods used were not sufficiently described to repeat them. Studies under the moderate quality did not have a representative sample. Non-responders categories was not addressed. Risk factors were not measured correctly. And methods used were not sufficiently described to allow the study to be replicated by other researchers.The included studies covered three broad categories.

Alcohol and substance use disorders, CMD (depression, anxiety, stress, and suicide risk), socio-cultural aspects, and access to mental health services.Alcohol and substance use disordersFive studies reviewed the consumption of alcohol and opioid. In an ethnographic study conducted in three western districts in Rajasthan, 200 opium users were interviewed. Opium consumption was common among both younger and older males during nonharvest seasons. The common causes for using opium were relief of anxiety related to crop failure due to drought, stress, to get a high, be part of peers, and for increased sexual performance.[16]In a study conducted in Arunachal Pradesh involving a population of more than 5000 individuals, alcohol use was present in 30% and opium use in about 5% adults.[17] Contrary to that study, in Rajasthan, the prevalence of opium use was more in women and socioeconomic factors such as occupation, education, and marital status were associated with opium use.[16] The prevalence of opium use increased with age in both sexes, decreased with increasing education level, and increased with employment. It was observed that wages were used to buy opium.

In the entire region of Chamlang district of Arunachal Pradesh, female substance users were almost half of the males among ST population.[17] Types of substance used were tobacco, alcohol, and opium. Among tobacco users, oral tobacco use was higher than smoking. The prevalence of tobacco use was higher among males, but the prevalence of alcohol use was higher in females, probably due to increased access to homemade rice brew generally prepared by women. This study is unique in terms of finding a strong association with religion and culture with substance use.[18]Alcohol consumption among Paniyas of Wayanad district in Kerala is perceived as a male activity, with many younger people consuming it than earlier. A study concluded that alcohol consumption among them was less of a âchoiceâ than a result of their conditions operating through different mechanisms.

In the past, drinking was traditionally common among elderly males, however the consumption pattern has changed as a significant number of younger men are now drinking. Drinking was clustered within families as fathers and sons drank together. Alcohol is easily accessible as government itself provides opportunities. Some employers would provide alcohol as an incentive to attract Paniya men to work for them.[19]In a study from Jharkhand, several ST community members cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol. Societal acceptance of drinking alcohol and peer pressure, as well as high emotional problems, appeared to be the major etiology leading to higher prevalence of substance dependence in tribal communities.[20] Another study found high life time alcohol use prevalence, and the reasons mentioned were increased poverty, illiteracy, increased stress, and peer pressure.[21] A household survey from Chamlang district of Arunachal Pradesh revealed that there was a strong association between opium use and age, occupation, marital status, religion, and ethnicity among both the sexes of STs, particularly among Singhpho and Khamti.[15] The average age of onset of tobacco use was found to be 16.4 years for smoked and 17.5 years for smokeless forms in one study.[22]Common mental disorders and socio-cultural aspectsSuicide was more common among Idu Mishmi in Roing and Anini districts of Arunachal Pradesh state (14.2%) compared to the urban population in general (0.4%â4.2%).

Suicides were associated with depression, anxiety, alcoholism, and eating disorders. Of all the factors, depression was significantly high in people who attempted suicide.[24] About 5% out of 5007 people from thirty villages comprising ST suffered from CMDs in a study from West Godavari district in rural Andhra Pradesh. CMDs were defined as moderate/severe depression and/or anxiety, stress, and increased suicidal risk. Women had a higher prevalence of depression, but this may be due to the cultural norms, as men are less likely to express symptoms of depression or anxiety, which leads to underreporting. Marital status, education, and age were prominently associated with CMD.[14] In another study, gender, illiteracy, infant mortality in the household, having <3 adults living in the household, large family size with >four children, morbidity, and having two or more life events in the last year were associated with increased prevalence of CMD.[24] Urban and rural ST from the same community of Bhutias of Sikkim were examined, and it was found that the urban population experienced higher perceived stress compared to their rural counterparts.[25] Age, current use of alcohol, poor educational status, marital status, social groups, and comorbidities were the main determinants of tobacco use and nicotine dependence in a study from the Andaman and Nicobar Islands.[22] A study conducted among adolescents in the schools of rural areas of Ranchi district in Jharkhand revealed that about 5% children from the ST communities had emotional symptoms, 9.6% children had conduct problems, 4.2% had hyperactivity, and 1.4% had significant peer problems.[27] A study conducted among the female school teachers in Jharkhand examined the effects of stress, marital status, and ethnicity upon the mental health of school teachers.

The study found that among the three factors namely stress, marital status, and ethnicity, ethnicity was found to affect mental health of the school teachers most. It found a positive relationship between mental health and socioeconomic status, with an inverse relationship showing that as income increased, the prevalence of depression decreased.[28] A study among Ao-Nagas in Nagaland found that 74.6% of the population attributed mental health problems to psycho-social factors and a considerable proportion chose a psychiatrist or psychologist to overcome the problem. However, 15.4% attributed mental disorders to evil spirits. About 47% preferred to seek treatment with a psychiatrist and 25% preferred prayers. Nearly 10.6% wanted to seek the help of both the psychiatrist and prayer group and 4.4% preferred traditional healers.[28],[29] The prevalence of Down syndrome among the ST in Chikhalia in Barwani district of Madhya Pradesh was higher than that reported in overall India.

Three-fourth of the children were the first-born child. None of the parents of children with Down syndrome had consanguineous marriage or a history of Down syndrome, intellectual disability, or any other neurological disorder such as cerebral palsy and epilepsy in preceding generations. It is known that tribal population is highly impoverished and disadvantaged in several ways and suffer proportionately higher burden of nutritional and genetic disorders, which are potential factors for Down syndrome.[30]Access to mental health-care servicesIn a study in Ranchi district of Jharkhand, it was found that most people consulted faith healers rather than qualified medical practitioners. There are few mental health services in the regions.[31] Among ST population, there was less reliance and belief in modern medicine, and it was also not easily accessible, thus the health-care systems must be more holistic and take care of cultural and local health practices.[32]The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project was implemented in thirty ST villages in West Godavari District of Andhra Pradesh. The key objectives were to use task sharing, training of primary health workers, implementing evidence-based clinical decision support tools on a mobile platform, and providing mental health services to rural population.

The study included 238 adults suffering from CMD. During the intervention period, 12.6% visited the primary health-care doctors compared to only 0.8% who had sought any care for their mental disorders prior to the intervention. The study also found a significant reduction in the depression and anxiety scores at the end of intervention and improvements in stigma perceptions related to mental health.[14] A study in Gudalur and Pandalur Taluks of Nilgiri district from Tamil Nadu used low cost task shifting by providing community education and identifying and referring individuals with psychiatric problems as effective strategies for treating mental disorders in ST communities. Through the program, the health workers established a network within the village, which in turn helped the patients to interact with them freely. Consenting patients volunteered at the educational sessions to discuss their experience about the effectiveness of their treatment.

Community awareness programs altered knowledge and attitudes toward mental illness in the community.[33] A study in Nilgiri district, Tamil Nadu, found that the community had been taking responsibility of the patients with the system by providing treatment closer to home without people having to travel long distances to access care. Expenses were reduced by subsidizing the costs of medicine and ensuring free hospital admissions and referrals to the people.[34] A study on the impact of gender, socioeconomic status, and age on mental health of female factory workers in Jharkhand found that the ST women were more likely to face stress and hardship in life due to diverse economic and household responsibilities, which, in turn, severely affected their mental health.[35] Prevalence of mental health morbidity in a study from the Sunderbans delta found a positive relation with psycho-social stressors and poor quality of life. The health system in that remote area was largely managed by âquack doctorsâ and faith healers. Poverty, illiteracy, and detachment from the larger community helped reinforce superstitious beliefs and made them seek both mental and physical health care from faith healers.[36] In a study among students, it was found that children had difficulties in adjusting to both ethnic and mainstream culture.[27] Low family income, inadequate housing, poor sanitation, and unhealthy and unhygienic living conditions were some environmental factors contributing to poor physical and mental growth of children. It was observed that children who did not have such risk factors maintained more intimate relations with the family members.

Children belonging to the disadvantaged environment expressed their verbal, emotional need, blame, and harm avoidances more freely than their counterparts belonging to less disadvantaged backgrounds. Although disadvantaged children had poor interfamilial interaction, they had better relations with the members outside family, such as peers, friends, and neighbors.[37] Another study in Jharkhand found that epilepsy was higher among ST patients compared to non-ST patients.[31] Most patients among the ST are irregular and dropout rates are higher among them than the non-ST patients. Urbanization per se exerted no adverse influence on the mental health of a tribal community, provided it allowed preservation of ethnic and cultural practices. Women in the ST communities were less vulnerable to mental illness than men. This might be a reflection of their increased responsibilities and enhanced gender roles that are characteristic of women in many ST communities.[38] Data obtained using culturally relevant scales revealed that relocated Sahariya suffer a lot of mental health problems, which are partially explained by livelihood and poverty-related factors.

The loss of homes and displacement compromise mental health, especially the positive emotional well-being related to happiness, life satisfaction, optimism for future, and spiritual contentment. These are often not overcome even with good relocation programs focused on material compensation and livelihood re-establishment.[39] Discussion This systematic review is to our knowledge the first on mental health of ST population in India. Few studies on the mental health of ST were available. All attempts including hand searching were made to recover both published peer-reviewed papers and reports available on the website. Though we searched gray literature, it may be possible that it does not capture all articles.

Given the heterogeneity of the papers, it was not possible to do a meta-analysis, so a narrative review was done.The quality of the studies was assessed by CASP. The assessment shows that the research conducted on mental health of STs needs to be carried out more effectively. The above mentioned gaps need to be filled in future research by considering the resources effectively while conducting the studies. Mental and substance use disorders contribute majorly to the health disparities. To address this, one needs to deliver evidence-based treatments, but it is important to understand how far these interventions for the indigenous populations can incorporate cultural practices, which are essential for the development of mental health services.[30] Evidence has shown a disproportionate burden of suicide among indigenous populations in national and regional studies, and a global and systematic investigation of this topic has not been undertaken to date.

Previous reviews of suicide epidemiology among indigenous populations have tended to be less comprehensive or not systematic, and have often focused on subpopulations such as youth, high-income countries, or regions such as Oceania or the Arctic.[46] The only studies in our review which provided data on suicide were in Idu Mishmi, an isolated tribal population of North-East India, and tribal communities from Sunderban delta.[24],[37] Some reasons for suicide in these populations could be the poor identification of existing mental disorders, increased alcohol use, extreme poverty leading to increased debt and hopelessness, and lack of stable employment opportunities.[24],[37] The traditional consumption pattern of alcohol has changed due to the reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement.[19],[20]Faith healers play a dominant role in treating mental disorders. There is less awareness about mental health and available mental health services and even if such knowledge is available, access is limited due to remoteness of many of these villages, and often it involves high out-of-pocket expenditure.[35] Practitioners of modern medicine can play a vital role in not only increasing awareness about mental health in the community, but also engaging with faith healers and traditional medicine practitioners to help increase their capacity to identify and manage CMDs that do not need medications and can be managed through simple âtalk therapy.â Knowledge on symptoms of severe mental disorders can also help such faith healers and traditional medicine practitioners to refer cases to primary care doctors or mental health professionals.Remote settlements make it difficult for ST communities to seek mental health care. Access needs to be increased by using solutions that use training of primary health workers and nonphysician health workers, task sharing, and technology-enabled clinical decision support tools.[3] The SMART Mental Health project was delivered in the tribal areas of Andhra Pradesh using those principles and was found to be beneficial by all stakeholders.[14]Given the lack of knowledge about mental health problems among these communities, the government and nongovernmental organizations should collect and disseminate data on mental disorders among the ST communities. More research funding needs to be provided and key stakeholders should be involved in creating awareness both in the community and among policy makers to develop more projects for ST communities around mental health. Two recent meetings on tribal mental health â Round Table Meeting on Mental Health of ST Populations organized by the George Institute for Global Health, India, in 2017,[51] and the First National Conference on Tribal Mental Health organized by the Indian Psychiatric Society in Bhubaneswar in 2018 â have identified some key areas of research priority for mental health in ST communities.

A national-level policy on mental health of tribal communities or population is advocated which should be developed in consultation with key stakeholders. The Indian Psychiatric Society can play a role in coordinating research activities with support of the government which can ensure regular monitoring and dissemination of the research impact to the tribal communities. There is a need to understand how mental health symptoms are perceived in different ST communities and investigate the healing practices associated with distress/disaster/death/loss/disease. This could be done in the form of cross-sectional or cohort studies to generate proper evidence which could also include the information on prevalence, mental health morbidity, and any specific patterns associated with a specific disorder. Future research should estimate the prevalence of mental disorders in different age groups and gender, risk factors, and the influence of modernization.

Studies should develop a theoretical model to understand mental disorders and promote positive mental health within ST communities. Studies should also look at different ST communities as cultural differences exist across them, and there are also differences in socioeconomic status which impact on ability to access care.Research has shown that the impact and the benefits are amplified when research is driven by priorities that are identified by indigenous communities and involve their active participation. Their knowledge and perspectives are incorporated in processes and findings. Reporting of findings is meaningful to the communities. And indigenous groups and other key stakeholders are engaged from the outset.[47] Future research in India on ST communities should also adhere to these broad principles to ensure relevant and beneficial research, which have direct impact on the mental health of the ST communities.There is also a need to update literature related to mental health of ST population continuously.

Develop culturally appropriate validated instruments to measure mental morbidity relevant to ST population. And use qualitative research to investigate the perceptions and barriers for help-seeking behavior.[48] Conclusion The current review helps not only to collate the existing literature on the mental health of ST communities but also identify gaps in knowledge and provide some indications about the type of research that should be funded in future.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.Gururaj G, Girish N, Isaac MK. Mental. Neurological and Substance abuse disorders.

Strategies towards a systems approach. In. Burden of Disease in India. Equitable development â Healthy future New Delhi, India. National Commission on Macroeconomics and Health.

Ministry of Health and Family Welfare, Government of India. 2005. 2.Math SB, Srinivasaraju R. Indian Psychiatric epidemiological studies. Learning from the past.

Indian J Psychiatry 2010;52:S95-103. 3.Tewari A, Kallakuri S, Devarapalli S, Jha V, Patel A, Maulik PK. Process evaluation of the systematic medical appraisal, referral and treatment (SMART) mental health project in rural India. BMC Psychiatry 2017;17:385. 4.Ministry of Tribal Affairs, Government of India.

Report of the High Level Committee on Socio-economic, Health and Educational Status of Tribal Communities of India. New Delhi. Government of India. 2014. 5.Office of the Registrar General and Census Commissioner, Census of India.

New Delhi. Office of the Registrar General and Census Commissioner. 2011. 6.International Institute for Population Sciences and ICF. National Family Health Survey (NFHS-4), 2015-16.

India, Mumbai. International Institute for Population Sciences. 2017. 7.World Health Organization. The World Health Report 2001-Mental Health.

New Understanding, New Hope. Geneva, Switzerland. World Health Organization. 2001. 8.Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al.

Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004;291:2581-90. 9.Ministry of Health and Family Welfare, Government of India and Ministry of Tribal Affairs, Report of the Expert Committee on Tribal Health. Tribal Health in India â Bridging the Gap and a Roadmap for the Future. New Delhi.

Government of India. 2013. 10.Government of India, Rural Health Statistics 2016-17. Ministry of Health and Family Welfare Statistics Division. 2017.

11.Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994;272:1741-8. 12.Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, INDIGO Study Group.

Global pattern of experienced and anticipated discrimination against people with schizophrenia. A cross-sectional survey. Lancet 2009;373:408-15. 13.Armstrong G, Kermode M, Raja S, Suja S, Chandra P, Jorm AF. A mental health training program for community health workers in India.

Impact on knowledge and attitudes. Int J Ment Health Syst 2011;5:17. 14.Maulik PK, Kallakuri S, Devarapalli S, Vadlamani VS, Jha V, Patel A. Increasing use of mental health services in remote areas using mobile technology. A pre-post evaluation of the SMART Mental Health project in rural India.

J Global Health 2017;7:1-13. 15.16.Ganguly KK, Sharma HK, Krishnamachari KA. An ethnographic account of opium consumers of Rajasthan (India). Socio-medical perspective. Addiction 1995;90:9-12.

17.Chaturvedi HK, Mahanta J. Sociocultural diversity and substance use pattern in Arunachal Pradesh, India. Drug Alcohol Depend 2004;74:97-104. 18.Chaturvedi HK, Mahanta J, Bajpai RC, Pandey A. Correlates of opium use.

Retrospective analysis of a survey of tribal communities in Arunachal Pradesh, India. BMC Public Health 2013;13:325. 19.Mohindra KS, Narayana D, Anushreedha SS, Haddad S. Alcohol use and its consequences in South India. Views from a marginalised tribal population.

Drug Alcohol Depend 2011;117:70-3. 20.Sreeraj VS, Prasad S, Khess CR, Uvais NA. Reasons for substance use. A comparative study of alcohol use in tribals and non-tribals. Indian J Psychol Med 2012;34:242-6.

[PUBMED] [Full text] 21.Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders. Findings from the Global Burden of Disease Study 2010. Lancet 2013;382:1575-86. 22.Janakiram C, Joseph J, Vasudevan S, Taha F, DeepanKumar CV, Venkitachalam R.

Prevalence and dependancy of tobacco use in an indigenous population of Kerala, India. Oral Hygiene and Health 2016;4:1 23.Manimunda SP, Benegal V, Sugunan AP, Jeemon P, Balakrishna N, Thennarusu K, et al. Tobacco use and nicotine dependency in a cross-sectional representative sample of 18,018 individuals in Andaman and Nicobar Islands, India. BMC Public Health 2012;12:515. 24.Singh PK, Singh RK, Biswas A, Rao VR.

High rate of suicide attempt and associated psychological traits in an isolated tribal population of North-East India. J Affect Dis 2013;151:673-8. 25.Sushila J. Perception of Illness and Health Care among Bhils. A Study of Udaipur District in Southern Rajasthan.

2005. 26.Sobhanjan S, Mukhopadhyay B. Perceived psychosocial stress and cardiovascular risk. Observations among the Bhutias of Sikkim, India. Stress Health 2008;24:23-34.

27.Ali A, Eqbal S. Mental Health status of tribal school going adolescents. A study from rural community of Ranchi, Jharkhand. Telangana J Psychiatry 2016;2:38-41. 28.Diwan R.

Stress and mental health of tribal and non tribal female school teachers in Jharkhand, India. Int J Sci Res Publicat 2012;2:2250-3153. 29.Longkumer I, Borooah PI. Knowledge about attitudes toward mental disorders among Nagas in North East India. IOSR J Humanities Soc Sci 2013;15:41-7.

30.Lakhan R, Kishore MT. Down syndrome in tribal population in India. A field observation. J Neurosci Rural Pract 2016;7:40-3. [PUBMED] [Full text] 31.Nizamie HS, Akhtar S, Banerjee S, Goyal N.

Health care delivery model in epilepsy to reduce treatment gap. WHO study from a rural tribal population of India. Epilepsy Res Elsevier 2009;84:146-52. 32.Prabhakar H, Manoharan R. The Tribal Health Initiative model for healthcare delivery.

A clinical and epidemiological approach. Natl Med J India 2005;18:197-204. 33.Nimgaonkar AU, Menon SD. A task shifting mental health program for an impoverished rural Indian community. Asian J Psychiatr 2015;16:41-7.

34.Yalsangi M. Evaluation of a Community Mental Health Programme in a Tribal Area- South India. Achutha Menon Centre For Health Sciences Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Working Paper No 12. 2012. 35.Tripathy P, Nirmala N, Sarah B, Rajendra M, Josephine B, Shibanand R, et al.

Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India. A cluster-randomised controlled trial. Lancet 2010;375:1182-92. 36.Aparajita C, Anita KM, Arundhati R, Chetana P. Assessing Social-support network among the socio culturally disadvantaged children in India.

Early Child Develop Care 1996;121:37-47. 37.Chowdhury AN, Mondal R, Brahma A, Biswas MK. Eco-psychiatry and environmental conservation. Study from Sundarban Delta, India. Environ Health Insights 2008;2:61-76.

38.Jeffery GS, Chakrapani U. Eco-psychiatry and Environmental Conservation. Study from Sundarban Delta, India. Working Paper- Research Gate.net. September, 2016.

39.Ozer S, Acculturation, adaptation, and mental health among Ladakhi College Students a mixed methods study of an indigenous population. J Cross Cultl Psychol 2015;46:435-53. 40.Giri DK, Chaudhary S, Govinda M, Banerjee A, Mahto AK, Chakravorty PK. Utilization of psychiatric services by tribal population of Jharkhand through community outreach programme of RINPAS. Eastern J Psychiatry 2007;10:25-9.

41.Nandi DN, Banerjee G, Chowdhury AN, Banerjee T, Boral GC, Sen B. Urbanization and mental morbidity in certain tribal communities in West Bengal. Indian J Psychiatry 1992;34:334-9. [PUBMED] [Full text] 42.Hackett RJ, Sagdeo D, Creed FH. The physical and social associations of common mental disorder in a tribal population in South India.

Soc Psychiatry Psychiatr Epidemiol 2007;42:712-5. 43.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India. J Neurosci Rural Pract 2013;4:147-53. [PUBMED] [Full text] 44.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A.

Identifying risk for dementia across populations. A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India. Ann Indian Acad Neurol 2013;16:640-4. [PUBMED] [Full text] 45.Raina SK, Chander V, Raina S, Kumar D. Feasibility of using everyday abilities scale of India as alternative to mental state examination as a screen in two-phase survey estimating the prevalence of dementia in largely illiterate Indian population.

Indian J Psychiatry 2016;58:459-61. [PUBMED] [Full text] 46.Diwan R. Mental health of tribal male-female factory workers in Jharkhand. IJAIR 2012;2278:234-42. 47.Banerjee T, Mukherjee SP, Nandi DN, Banerjee G, Mukherjee A, Sen B, et al.

Psychiatric morbidity in an urbanized tribal (Santal) community - A field survey. Indian J Psychiatry 1986;28:243-8. [PUBMED] [Full text] 48.Leske S, Harris MG, Charlson FJ, Ferrari AJ, Baxter AJ, Logan JM, et al. Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States. Aust N Z J Psychiatry 2016;50:1040-54.

49.Pollock NJ, Naicker K, Loro A, Mulay S, Colman I. Global incidence of suicide among Indigenous peoples. A systematic review. BMC Med 2018;16:145. 50.Silburn K, et al.

Evaluation of the Cooperative Research Centre for Aboriginal Health (Australian institute for primary care, trans.). Melbourne. LaTrobe University. 2010. 51.

Correspondence Address:S V. Siddhardh Kumar DevarapalliGeorge Institute for Global Health, Plot No. 57, Second Floor, Corporation Bank Building, Nagarjuna Circle, Punjagutta, Hyderabad - 500 082, Telangana IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/psychiatry.IndianJPsychiatry_136_19 Figures [Figure 1] Tables [Table 1], [Table 2].

How to cite seroquel online canada this article:Singh OP. Psychiatry research in India. Closing the research gap seroquel online canada. Indian J Psychiatry 2020;62:615-6Research is an important aspect of the growth and development of medical science. Research in India in general and medical research in particular is always being criticized for seroquel online canada lack of innovation and originality required for the delivery of health services suitable to Indian conditions.

Even the Indian Council of Medical Research (ICMR) which is a centrally funded frontier organization for conducting medical research couldn't avert criticism. It has been criticized heavily for not producing quality research papers which are pioneering, ground breaking, or pragmatic solutions for health issues plaguing India. In the words of a leading daily, The ICMR could not even list one practical application of its hundreds of research papers published in various national and international research journals which helped cure any disease, or diagnose it with better accuracy or in less time, or even one new basic, applied or clinical research seroquel online canada or innovation that opened a new frontier of scientific knowledge.[1]This clearly indicates that the health research output of ICMR is not up to the mark and is not commensurate with the magnitude of the disease burden in India. According to the 12th Plan Report, the country contributes to a fifth of the world's share of diseases. The research conducted elsewhere may not seroquel online canada be generalized to the Indian population owing to differences in biology, health-care systems, health practices, culture, and socioeconomic standards.

Questions which are pertinent and specific to the Indian context may not be answered and will remain understudied. One of the vital elements in improving this situation is the need for relevant research base that would equip policymakers to take informed health policy decisions.The Parliamentary Standing Committee on Health and Family Welfare in the 100th report on Demand for Grants (2017â2018) of the Department of Health Research observed that âthe biomedical research output needs to be augmented substantially to cater to the health challenges faced by the country.â[1]Among the various reasons, lack of fund, infrastructure, and resources is the prime cause which is glaringly evident from the inadequate budget allocation for biomedical research. While ICMR has a budget of 232 million dollars per year on health research, it is zilch in comparison to the seroquel online canada annual budget expenditure of the National Institute of Health, USA, on biomedical research which is 32 billion dollars.The lacuna of quality research is not merely due to lack of funds. There are other important issues which need to be considered and sorted out to end the status quo. Some of the factors which need our immediate attention are:Lack of research training and teachingImproper allocation of research facilitiesLack of information about research work happening globallyLack of promotion, motivation, seroquel online canada commitment, and passion in the field of researchClinicians being overburdened with patientsLack of collaboration between medical colleges and established research institutesLack of continuity of research in successive batches of postgraduate (PG) students, leading to wastage of previous research and resourcesDifficulty in the application of basic biomedical research into pragmatic intervention solutions due to lack of interdisciplinary technological support/collaboration between basic scientists, clinicians, and technological experts.Majority of the biomedical research in India are conducted in medical institutions.

The majority of these are done as thesis submission for fulfillment of the requirement of PG degree. From 2015 onward, publication seroquel online canada of papers had been made an obligatory requirement for promotion of faculty to higher posts. Although it offered a unique opportunity for training of residents and stimulus for research, it failed to translate into production of quality research work as thesis was limited by time and it had to be done with other clinical and academic duties.While the top four medical colleges, namely AIIMS, New Delhi. PGIMER, Chandigarh. CMC, Vellore seroquel online canada.