The Central Massachusetts Oral Health Initiative (CMOHI): a successful public-private community health collaboration.

Objectives: The Central Massachusetts Oral Health Initiative (CMOHI) aimed to improve access to quality oral health care in central Massachusetts.

Methods: A broad-based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school-based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health.

Results: A state legislative Oral Health Caucus helped secure sought-after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school-based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established.

Tapping youth as agents for change: evaluation of a peer leadership HIV/AIDS intervention.

Purpose: To evaluate the impact of a community-based HIV/AIDS peer leadership prevention program on newly enrolled peer leaders and youth enrolled as peer educators for one or more years (repeat peer leaders).

Methods: Quasi-experimental nonrandomized design with two intervention groups (newly enrolled and repeat peer leaders) and one comparison group. The sample consisted of 235 adolescents, 164 peer leaders, and 71 comparison youth, drawn from nine communities in Massachusetts.

Applying control charts to quality improvement.

This article reviews the definitions and principles that should guide the use of control charts in healthcare quality. Several examples from the literature are used to illustrate significant problems and issues in control chart construction.

A comparison of three measures of disease progression in ALS.

Effective clinical trials in neuromuscular research require accurate and sensitive methods to quantitate disease progression. The purpose of this study was to concurrently compare manual muscle testing (MMT), maximal voluntary isometric contraction (MVIC), and a functional scale (the ALS Score). Twenty patients with ALS were tested ten times at monthly intervals using each of the three methods.

Perspective: comparing two-sample tests and control charts.

For the task of monitoring a process, detecting change, and making correct attributions on a continuous basis, there is no better tool than the control chart, particularly where the data set is large and permits subgrouping. By using this technique, staff will get quicker answers or will have a smaller data requirement, and will arrive at more valid conclusions than with the two-sample method. (The two-sample approach is typically used when the data are not produced or collected in sequence is unknown.

The natural history of amyotrophic lateral sclerosis and the use of natural history controls in therapeutic trials.

We analyzed the natural history of amyotrophic lateral sclerosis in 277 patients. Our goal was to develop a better understanding of the clinical disease and thus improve the design of therapeutic trials. The Tufts Quantitative Neuromuscular Exam (TQNE) was used as the primary assessment instrument.

The use of control charts to improve healthcare quality.

Control charts are a basic tool for understanding variation in all healthcare processes. Control chart limits are not standards; rather, they divided variation into special and common cause, each of which requires a different management response. Each type of data--variables, count defect, or defectives data--requires a different type of chart (e.

Intrathecal thyrotropin-releasing hormone does not alter the progressive course of ALS: experience with an intrathecal drug delivery system.

Evidence that thyrotropin-releasing hormone (TRH) has prominent trophic effects on the motor system led to several negative therapeutic trials in amyotrophic lateral sclerosis, a disease of the motor system. Since TRH crosses the blood-brain barrier poorly, if at all, we postulated that the negative parenteral clinical trials could be a result of insufficient drug-receptor interaction. We thus carried out a blinded, placebo-controlled, crossover study of intrathecal TRH in 36 patients by delivery through an implanted, constant infusion pump achieving a steady-state CSF level comparable with that shown to be effective in tissue culture experiments.

Use of electrophysiologic tests to measure disease progression in ALS therapeutic trials.

A battery of electrophysiologic tests was developed to assess the relative degree of lower and upper motor neuron (spasticity) deficit in a group of ALS patients enrolled in a therapeutic trial. Test results were correlated with strength in the tibialis anterior muscle as determined by measurement of maximum voluntary isometric contraction (MVIC), using strain gauge tensiometers, and were also correlated with a clinical spasticity rating scale. Patients were tested every 6 to 8 weeks over more than 1 year.

The natural history of motoneuron loss in amyotrophic lateral sclerosis.

Using a quantitative, reliable, sensitive and valid measurement technique, we analyzed the rate and pattern of motor deterioration in 50 strictly defined ALS patients for up to 67 months. We observed that the rate of motoneuron loss was linear and symmetric. Bulbar function deteriorated more slowly than respiratory, arm, and leg function.

Use of composite scores (megascores) to measure deficit in amyotrophic lateral sclerosis.

The Tufts Quantitative Neuromuscular Exam (TQNE) consists of 28 items that were designed to measure voluntary motor deficit in amyotrophic lateral sclerosis (ALS) and related diseases. Individual raw data were converted to Z scores for standardization and then grouped into five megascores with statistical and clinical relevance. The derived megascores were Mega 1, pulmonary function; Mega 2, bulbar function; Mega 3, timed hand activities; Mega 4, isometric arm strength; and Mega 5, isometric leg strength.

Quantitative assessment of neuromuscular deficit in ALS.

Several criteria must be met in developing a test battery forr ALS. First, the test items should be designed to answer the specific questions being asked. If questions involve the amount and rate of deterioration, then the test items should generate interval data and show evidence that they reflect change in the disease itself.

Intrathecal administration of natural human interferon alpha in amyotrophic lateral sclerosis.

Ten patients with amyotrophic lateral sclerosis were given intrathecal injections of natural interferon alpha, 1 million units weekly for 7 to 24 weeks. Six patients completed the trial. Four voluntarily withdrew after 7 to 13 injections.

Quantitative motor assessment in amyotrophic lateral sclerosis.

Reliable measurements are needed to document the natural history of ALS and to determine therapeutic efficacy. We have devised a standardized protocol that generates interval data sensitive to change-the Tufts Quantitative Neuromuscular Exam (TQNE). The TQNE consists of the following four major categories: pulmonary function, oropharyngeal function, timed functional activities, and isometric strength using an electronic strain gauge.

Blood pressure reductions: correcting for regression to the mean.

Reductions in high blood pressure (BP) from participating in screening and treatment programs are often assessed by comparing BP measurements before and after participation. The interpretation of such changes in measured blood pressure is confounded by the tendency of high pressures to decline as a result of a statistical artifact--regression to the mean. The problem arises whenever baseline measurements are used both for selection of participants and for comparisons with pressures obtained later.