The Climate Change Conversation: Understanding Nationwide Medical Education Efforts.

Despite increasing awareness of the public and global health ramifications of climate change, there is a lack of curricula discussing climate change within medical education. Where greater societal awareness and improved scientific understanding have begun to grab the attention of members of the medical education community, there is the precedent, the desire, and the need to incorporate climate-health topics into medical education. We hosted semi-structured interviews (n=9) with faculty members at different institutions across the country who have been involved with climate change education.

Climate and health education: A critical review at one medical school.

Introduction: As medical schools continue to improve and refine their undergraduate curricula, they are also redefining the roadmap for preparing future generations of physicians. Climate change is a critical topic to integrate into medical education. This period of change for undergraduate medical education coincides with a surge in interest and design efforts for climate and health curricula in health professional education, but this nascent field has yet to be solidly institutionalized.

Dopaminergic modulation of reward discounting in healthy rats: a systematic review and meta-analysis.

Rationale: Although numerous studies have suggested that pharmacological alteration of the dopamine (DA) system modulates reward discounting, these studies have produced inconsistent findings.

Objectives: Here, we conducted a systematic review and pre-registered meta-analysis to evaluate DA drug-mediated effects on reward discounting of time, probability, and effort costs in studies of healthy rats. This produced a total of 1343 articles to screen for inclusion/exclusion.

Maryland's Global Hospital Budgets: Impacts on Medicare Cost and Utilization for the First 3 Years.

Background: Global budgets have been proposed as a way to control health care expenditures, but experience with them in the United States is limited. Global budgets for Maryland hospitals, the All-Payer Model, began in January 2014.

Objectives: To evaluate the effect of hospital global budgets on health care utilization and expenditures.

States Encouraging Value-Based Payment: Lessons From CMS's State Innovation Models Initiative.

Unlabelled: Policy Points Six states received $250 million under the federal State Innovation Models (SIM) Initiative Round 1 to increase the proportion of care delivered under value-based payment (VBP) models aligned across multiple payers. Multipayer alignment around a common VBP model occurred within the context of state regulatory and purchasing policies and in states with few commercial payers, not through engaging many stakeholders to act voluntarily. States that made targeted infrastructure investments in performance data and electronic hospital event notifications, and offered grants and technical assistance to providers, produced delivery system changes to enhance care coordination even where VBP models were not multipayer.

Corrigendum: Plasticity in One Hemisphere, Control From Two: Adaptation in Descending Motor Pathways After Unilateral Corticospinal Injury in Neonatal Rats.

[This corrects the article DOI: 10.3389/fncir.2018.

Plasticity in One Hemisphere, Control From Two: Adaptation in Descending Motor Pathways After Unilateral Corticospinal Injury in Neonatal Rats.

After injury to the corticospinal tract (CST) in early development there is large-scale adaptation of descending motor pathways. Some studies suggest the uninjured hemisphere controls the impaired forelimb, while others suggest that the injured hemisphere does; these pathways have never been compared directly. We tested the contribution of each motor cortex to the recovery forelimb function after neonatal injury of the CST.

The histamine-synthesizing enzyme histidine decarboxylase is upregulated by keratinocytes in atopic skin.

Background: Histamine is an abundant mediator accumulating in the skin of atopic patients, where it is thought to be derived from immune cells. While keratinocytes express histidine decarboxylase (HDC), levels of the enzyme in normal or diseased epidermis and factors that influence its expression in human keratinocytes are not known.

Objectives: To assess levels of HDC in inflammatory skin diseases and factors influencing its expression.

First time rounding experiences for nonclinicians: the Cleveland Clinic experience.

Clinical rounds serve several key objectives in academic medical centers: providing a forum for patient communication, clinical decision making, and teaching. Nonclinical colleagues ordinarily do not have the opportunity to round, and the idea of implementing a rounding program that includes nonclinical colleagues has received little attention to date. Reasoning that a rounding program with nonclinicians could enhance (1) understanding of the organization's clinical mission, (2) appreciation of caregivers' roles, and (3) engagement, the authors created such a program.

Communicating with graduate medical trainees: the Cleveland Clinic experience.

Optimizing communication with graduate medical trainees is critical, as they contribute importantly to the mission of academic medical centres. Yet, communication is challenged by their complex schedules, geographic separation, and time constraints. Few studies have examined this issue to offer valuable solutions.

Choroidal neovascularization regression on fluorescein angiography after VEGF blockade.

Background: Intravitreal vascular endothelial growth factor (VEGF) inhibitors stabilize vision in a majority of patients with neovascular age-related macular degeneration (AMD) and can improve vision in almost 40% of patients. However, some individuals who respond to anti-VEGF treatment still lose vision due to the formation of geographic atrophy (GA). While optical coherence tomography is often the primary imaging modality used, fluorescein angiography (FA) can provide useful information on GA development after choroidal neovascularization (CNV) regression.

The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures.

Background: In adults, pelvic and femoral fractures have a known association with venous thromboembolic disease and, thus, thromboprophylaxis is the standard of care. However, similar data for children are scarce, and recommendations for pediatric prophylaxis are less clear. Our goals were to: (1) analyze the predisposing risk factors, prevalence, and outcome (including mortality) of clinically significant venous thromboembolism; (2) investigate the use of thromboprophylaxis in pediatric trauma patients and ages at which it was given; and (3) determine the impact that central venous catheters had on the occurrence of venous thromboembolism.

The use of bedside electronic medical record to improve quality of care in nursing facilities: a qualitative analysis.

It appears that the implementation and use of a bedside electronic medical record in nursing homes can be a strategy to improve quality of care. Staff like using the bedside electronic medical record and believe it is beneficial. Information gleaned from this qualitative evaluation of four nursing homes that implemented complete electronic medical records and participated in a larger evaluation of the use of an electronic medical record will be useful to other nursing homes as they consider implementing bedside computing technology.

Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes.

Objective: There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes.

Methods: Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither.

ICOS controls effector function but not trafficking receptor expression of kidney-infiltrating effector T cells in murine lupus.

Renal pathology in systemic lupus erythematosus involves both autoantibody deposition and a cellular inflammatory response, both of which are mediated by effector CD4 T cells. MRL(lpr) mice spontaneously develop massive perivascular infiltrates, but the pathways that regulate the development, trafficking, and effector functions of kidney-infiltrating T cells are poorly defined. To address these questions, we first surveyed inflammatory chemokine protein levels in nephritic kidneys from lupus-prone MRL(lpr) mice.

Medicare part D data: major changes on the horizon.

Background: The 3 primary administrative data sets developed by the Centers for Medicare and Medicaid services (CMS) to support the Medicare Part D program implementation represent a valuable source of data for health services researchers. This paper describes the structure of the Medicare Part D program and the related databases, and discusses their utilization for research purposes.

Results: The Medicare Part D administrative data include information on plan benefits (integrated into the Health Plan Management System), beneficiary enrollment files, and prescription drug event (PDE) claims-type data.

Measures and predictors of Medicare knowledge: a review of the literature.

As the Medicare Program evolves, adding new insurance options like regional preferred provider organizations (PPOs) and prescription drug benefits, beneficiaries have an even greater need to understand the program. However, past research suggests that many beneficiaries have limited understanding of Medicare and related health insurance options. While improvements in beneficiary understanding of Medicare may be feasible, driven by new and varied efforts to provide the Medicare population with educational opportunities, is there evidence of factors that predict knowledge limitations? This article seeks to address this question by a thorough review of the literature on the measures and factors that influence beneficiary knowledge.

Medicare preferred provider organization demonstration: plan offerings and beneficiary enrollment.

As preferred provider organizations (PPOs) become the dominant model of managed health care in the private sector, policymakers have increasingly viewed PPOs as an attractive option for Medicare. In part to understand how PPOs might operate under the Medicare Program, CMS launched the Medicare PPO demonstration in January 2003. In this article, we examine how PPOs have operated so far under the demonstration, including PPO availability and market entry; premiums, benefits, and beneficiary cost sharing; and enrollment, market share, enrollee characteristics, and disenrollment to date.

Patient casemix classification for medicare psychiatric prospective payment.

Objective: For a proposed Medicare prospective payment system for inpatient psychiatric facility treatment, the authors developed a casemix classification to capture differences in patients' real daily resource use.

Method: Primary data on patient characteristics and daily time spent in various activities were collected in a survey of 696 patients from 40 inpatient psychiatric facilities. Survey data were combined with Medicare claims data to estimate intensity-adjusted daily cost.

Specialty versus community hospitals: referrals, quality, and community benefits.

In this paper we compare physician referral patterns, quality, patient satisfaction, and community benefits of physician-owned specialty versus peer competitor hospitals. Our results are based on evidence gathered from site visits to six markets, 2003 Medicare claims, patient focus groups, and Internal Revenue Service data. Although physician-owners are more likely than others to refer to their own facilities and treat a healthier population, there are rationales for these patterns aside from motives for profit.

Comparisons of survival predictions using survival risk ratios based on International Classification of Diseases, Ninth Revision and Abbreviated Injury Scale trauma diagnosis codes.

Background: We conducted a comparison of methods for predicting survival using survival risk ratios (SRRs), including new comparisons based on International Classification of Diseases, Ninth Revision (ICD-9) versus Abbreviated Injury Scale (AIS) six-digit codes.

Methods: From the Pennsylvania trauma center's registry, all direct trauma admissions were collected through June 22, 1999. Patients with no comorbid medical diagnoses and both ICD-9 and AIS injury codes were used for comparisons based on a single set of data.