Practice transformation in the safety net medical home initiative: a qualitative look.

Background: Transformation of primary care to patient-centered medical homes (PCMH) is challenging. Progress in transformation varied widely among practices involved in the Safety Net Medical Home Initiative.

Objective: To study 3 successful practices to identify common characteristics and approaches.

Unlocking the black box: supporting practices to become patient-centered medical homes.

Background: Despite widespread interest in supporting primary care transformation, few evidence-based strategies for technical assistance exist. The Safety Net Medical Home Initiative (SNMHI) sought to develop a replicable and sustainable model for Patient-centered Medical Home practice transformation.

Objectives: This paper describes the multimodal technical assistance approach used by the SNMHI and the participating practices' assessment of its value and helpfulness in supporting their transformation.

The safety net medical home initiative: transforming care for vulnerable populations.

Background: Despite findings that medical homes may reduce or eliminate health care disparities among underserved and minority populations, most previous medical home pilot and demonstration projects have focused on health care delivery systems serving commercially insured patients and Medicare beneficiaries.

Objectives: To develop a replicable approach to support medical home transformation among diverse practices serving vulnerable and underserved populations.

Design: Facilitated by a national program team, convening organizations in 5 states provided coaching and learning community support to safety net practices over a 4-year period.

The effect of hypocalcemia in early childhood on autism-related social and communication skills in patients with 22q11 deletion syndrome.

22q11 deletion syndrome (22qDS), also known as DiGeorge syndrome, is a copy number variant disorder that has a diverse clinical presentation including hypocalcaemia, learning disabilities, and psychiatric disorders. Many patients with 22q11DS present with signs that overlap with autism spectrum disorder (ASD) yet the possible physiological mechanisms that link 22q11DS with ASD are unknown. We hypothesized that early childhood hypocalcemia influences the neurobehavioral phenotype of 22q11DS.

Assessing anxiety in nonhuman primates.

Anxiety can be broadly described as a psychological state in which normally innocuous environmental stimuli trigger negative emotional expectations. Human anxiety disorders are multidimensional and may be organic or acquired, situational or pervasive. The broad ranging nature of the anxiety phenotype speaks to the need for models that identify its various components and root causes to develop effective clinical treatments.

Efficacy of a Ceftazidime-Avibactam combination in a murine model of Septicemia caused by Enterobacteriaceae species producing ampc or extended-spectrum β-lactamases.

Avibactam is a novel non-β-lactam β-lactamase inhibitor that has been shown in vitro to inhibit class A, class C, and some class D β-lactamases. It is currently in phase 3 of clinical development in combination with ceftazidime. In this study, the efficacy of ceftazidime-avibactam was evaluated in a murine septicemia model against five ceftazidime-susceptible (MICs of 0.

The educational value of improvisational actors to teach communication and relational skills: perspectives of interprofessional learners, faculty, and actors.

Objective: To assess the educational value of improvisational actors in difficult conversation simulations to teach communication and relational skills to interprofessional learners.

Methods: Surveys of 192 interprofessional health care professionals, and 33 teaching faculty, and semi-structured interviews of 10 actors. Descriptive statistics, Fisher's exact test and chi-square test were used for quantitative analyses, and the Crabtree and Miller approach was used for qualitative analyses.

The natural history of jaundice in predominantly breastfed infants.

Background And Objectives: Breastfed newborns are more likely to develop prolonged hyperbilirubinemia than those fed formula, but the prevalence of prolonged hyperbilirubinemia in a largely white, North American breastfed population is unknown. In this population, we documented the natural history of jaundice and the prevalence of prolonged hyperbilirubinemia, and we evaluated the utility of assessing the cephalocaudal progression of jaundice in office-based practices.

Methods: We measured transcutaneous bilirubin (TcB) levels during the first month in 1044 predominantly breastfed infants ≥35 weeks of gestation and assigned a cephalocaudal zone score to each infant at the time of the TcB measurement.

Ataluren treatment of patients with nonsense mutation dystrophinopathy.

Introduction: Dystrophinopathy is a rare, severe muscle disorder, and nonsense mutations are found in 13% of cases. Ataluren was developed to enable ribosomal readthrough of premature stop codons in nonsense mutation (nm) genetic disorders.

Methods: Randomized, double-blind, placebo-controlled study; males ≥ 5 years with nm-dystrophinopathy received study drug orally 3 times daily, ataluren 10, 10, 20 mg/kg (N=57); ataluren 20, 20, 40 mg/kg (N=60); or placebo (N=57) for 48 weeks.

Winter and spring controls on the summer food web of the coastal West Antarctic Peninsula.

Understanding the mechanisms by which climate variability affects multiple trophic levels in food webs is essential for determining ecosystem responses to climate change. Here we use over two decades of data collected by the Palmer Long Term Ecological Research program (PAL-LTER) to determine how large-scale climate and local physical forcing affect phytoplankton, zooplankton and an apex predator along the West Antarctic Peninsula (WAP). We show that positive anomalies in chlorophyll-a (chl-a) at Palmer Station, occurring every 4-6 years, are constrained by physical processes in the preceding winter/spring and a negative phase of the Southern Annular Mode (SAM).

Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system.

Background: A registry was created for patients having procedures for weight loss from 2004 to the present time at a large integrated healthcare system. The objective of this study was to compare findings to the literature and national quality monitoring databases and present 3-year weight loss outcomes.

Methods: Patients are passively enrolled in the registry with the following characteristics: a bariatric procedure for weight loss after January 1, 2004 and actively enrolled in the health plan at the time of surgery.

Relationships between androgens, serotonin gene expression and innervation in male macaques.

Androgen administration to castrated individuals was purported to decrease activity in the serotonin system. However, we found that androgen administration to castrated male macaques increased fenfluramine-induced serotonin release as reflected by increased prolactin secretion. In this study, we sought to define the effects of androgens and aromatase inhibition on serotonin-related gene expression in the dorsal raphe, as well as serotonergic innervation of the LC.

Endoscopic mucosal resection and snare polypectomy for treatment of a colorectal polypoid adenoma in a dog.

Case Description: An 11-year-old castrated male mixed-breed dog was examined for a 3-month history of hematochezia and tenesmus. Abdominal ultrasonography and rectal examination prior to referral had revealed a colorectal polyp, diagnosed as a benign colorectal polypoid adenoma after histologic examination of tissue samples. The patient was referred for treatment.

Hair loss and hypothalamic-pituitary-adrenocortical axis activity in captive rhesus macaques (Macaca mulatta).

Hair loss is a common problem in captive macaque colonies. A potential factor is the possible influence of stressful environments in the development of hair loss. We examined the relationship between hair loss and chronic hypothalamic-pituitary-adrenal (HPA) axis activity by measuring cortisol in hair.

Gender and racial/ethnic background predict weight loss after Roux-en-Y gastric bypass independent of health and lifestyle behaviors.

Our study investigated how demographic, health, and behavioral factors interacted to affect weight outcomes in bariatric patients. Roux-en-Y gastric bypass (RYGB) patients who were non-Hispanic black, Hispanic, or non-Hispanic white race/ethnicity, had no revisions to their RYGB during 2004-2009, and had at least 1 year of follow-up data for body weight after surgery (n = 860) were surveyed by phone about their health and behaviors. The main outcomes of interest were percent excess weight loss and percent of initial weight lost.

National prevalence of receipt of antidepressant prescriptions by persons without a psychiatric diagnosis.

Objective: The study addressed recent concerns regarding increasing prescription of antidepressant drugs to patients with no recorded psychiatric diagnosis.

Methods: Records from ten large integrated health systems in the Mental Health Research Network were used to examine diagnoses received by 1,011,946 health plan members who filled at least one antidepressant prescription in 2010.

Results: Among individuals filling antidepressant prescriptions, psychiatric diagnoses recorded during the year were depressive disorders (48%), anxiety disorders (27%), bipolar disorders (3%), and attention deficit disorders (3%).

Associations between physical activity and 30-day readmission risk in chronic obstructive pulmonary disease.

Rationale: Efforts to reduce 30-day readmission have mostly concentrated on addressing deficiencies in care transitions and outpatient management after discharge. There is growing evidence to suggest that physical inactivity is associated with increased hospitalizations.

Objectives: We examined whether or not a potentially modifiable factor such as regular physical activity at baseline was associated with lower risk of 30-day readmission in patients with chronic obstructive pulmonary disease (COPD).

In vitro and in vivo activities of HPi1, a selective antimicrobial against Helicobacter pylori.

A high-throughput screen (HTS) was performed to identify molecules specifically active against Helicobacter pylori, the causative agent of peptic ulcer and gastric carcinoma. Currently, treatment of H. pylori infection is suboptimal, with failure rates approaching 25%, despite triple therapy with two broad-spectrum antibiotics and a proton pump inhibitor or quadruple therapy with added bismuth.

Activities of ceftazidime and avibactam against β-lactamase-producing Enterobacteriaceae in a hollow-fiber pharmacodynamic model.

Avibactam is a novel non-β-lactam β-lactamase inhibitor that is currently undergoing phase 3 clinical trials in combination with ceftazidime. Ceftazidime is hydrolyzed by a broad range of β-lactamases, but avibactam is able to inhibit the majority of these enzymes. The studies described here attempt to provide insight into the amount of avibactam required to suppress bacterial growth in an environment where the concentrations of both agents are varying as they would when administered to humans.

Optimal management of diabetes among overweight and obese adults.

Objective: To explore potential weight-related disparities in the quality of care for adults with diabetes in a large managed care health plan according to recommended quality indicators.

Design: Cross-sectional analysis.

Methods: A total of 164,721 Kaiser Permanente Southern California members aged 18 to 75 years with diabetes who had 1 or more health encounters with a weight and height measurement between July 1, 2007, and June 30, 2008, were identified.

Family history of stroke among African Americans and its association with risk factors, knowledge, perceptions, and exercise.

Background: African Americans are at greater risk for stroke than whites are; however, it is unclear what role family history of stroke (FHS) plays in the adoption of healthier lifestyles among African Americans.

Objective: The aim of this study was to compare modifiable risk factors, knowledge of stroke risk factors, perceived threat of stroke, perceived control of stroke, and exercise behaviors and intentions in African Americans with a FHS and those without a FHS.

Methods: A cross-sectional study was conducted with rural African Americans aged 19 to 54 years participating in a mobile health clinic.

Healthcare experiences of gender diverse Australians: a mixed-methods, self-report survey.

Background: To date the healthcare experiences of gender diverse Australians have received little attention. Previous international research indicates a range of both negative and positive healthcare experiences amongst this diverse population, with negative experiences being those most frequently reported.

Method: An online survey was designed to examine the healthcare experiences of gender diverse Australians.

Heme oxygenase-1 promotes migration and β-epithelial Na+ channel expression in cytotrophoblasts and ischemic placentas.

Preeclampsia is thought to arise from inadequate cytotrophoblast migration and invasion of the maternal spiral arteries, resulting in placental ischemia and hypertension. Evidence suggests that altered expression of epithelial Na(+) channel (ENaC) proteins may be a contributing mechanism for impaired cytotrophoblast migration. ENaC activity is required for normal cytotrophoblast migration.

Establishing radiation therapy advanced practice in New Zealand.

Introduction:  Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005-2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development.