Diabetes INSIDE: Improving Population HbA Testing and Targets in Primary Care With a Quality Initiative.

Objective: To improve outcomes of patients with adult type 2 diabetes by decreasing HbA undertesting, reducing the proportion of patients with poor glycemic control, and lowering mean HbA levels using a quality improvement (QI) program.

Research Design And Methods: Six years of outpatient electronic health record (EHR) data were analyzed for care gaps before and 2 years after implementing a QI initiative in an urban academic medical center. QI strategies included ) individual provider and departmental outcome reports, ) patient outreach programs to address timely follow-up care, ) a patient awareness campaign to improve understanding of achieving clinical goals, ) improving EHR data capture to improve population monitoring, and ) professional education.

Life course health and healthcare utilization among adults with spina bifida.

Aim: To evaluate the prevalence of organ system disorders and describe healthcare utilization among adults with spina bifida at a regional clinic.

Method: This study was a structured chart review using the Rochester Health Status Survey-IV. 65 males, 57 females aged 16 to 59 years were seen at the Spina Bifida Center of Central New York between January 2007 and December 2008 (annual hospitalization rate was 15 out of 100).

Characterization of the genomic architecture and mutational spectrum of a small cell prostate carcinoma.

We present the use of a series of laboratory, analytical and interpretation methods to investigate personalized cancer care for a case of small cell prostate carcinoma (SCPC), a rare and aggressive tumor with poor prognosis, for which the underlying genomic architecture and mutational spectrum has not been well characterized. We performed both SNP genotyping and exome sequencing of a Virchow node metastasis from a patient with SCPC. A variety of methods were used to analyze and interpret the tumor genome for copy number variation, loss of heterozygosity (LOH), somatic mosaicism and mutations in genes from known cancer pathways.

Effect of health information technology interventions on lipid management in clinical practice: a systematic review of randomized controlled trials.

Background: Large gaps in lipid treatment and medication adherence persist in high-risk outpatients in the United States. Health information technology (HIT) is being applied to close quality gaps in chronic illness care, but its utility for lipid management has not been widely studied.

Objective: To perform a qualitative review of the impact of HIT interventions on lipid management processes of care (screening or testing; drug initiation, titration or adherence; or referrals) or clinical outcomes (percent at low density lipoprotein cholesterol goal; absolute lipid levels; absolute risk scores; or cardiac hospitalizations) in outpatients with coronary heart disease or at increased risk.

Spina bifida grown up.

The majority of people with spina bifida in the United States are now older than 18 years of age. Health care delivery for adults with this condition should include routine surveillance for common conditions such as hypertension, hyperlipidemia and cancer. It should also address spina bifida-related complications such as pressure sores, lymphedema, sexual dysfunction and infertility, and hydrocephalus, as well as chiari-related symptoms such as sleep apnea and urologic and renal functioning.