Interview with a quality leader--Karen Davis, executive director of The Commonwealth Fund. Interview by Lecia A. Albright.

Karen Davis is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues. Dr. Davis is a nationally recognized economist, with a distinguished career in public policy and research.

Periodontal Treatment Protocol (PTP) for the general dental practice.

A sequence of interrelated steps is inherent to effective periodontal treatment: early and accurate diagnosis, comprehensive treatment, and continued periodontal maintenance and monitoring. A primary goal of periodontal therapy is to reduce the burden of pathogenic bacteria and thereby reduce the potential for progressive inflammation and recurrence of disease. Emerging evidence of possible perio-systemic links further reinforces the need for good periodontal health.

A profitable hygiene system: not an undervalued practice resource, part 2.

In this 2-part article, we have addressed the correct methods to use in selecting the right hygienist and the importance of creating a purposeful vision for your dental hygiene department. We have touched on the role of having the doctor discuss practice expectations, and the qualities and traits a dental hygienist should possess. Finally we have briefly reviewed some ideas regarding hygienist compensation as well as the integration of the new technologies to help you build a successful, productive, and profitable dental hygiene department.

Using Medicare payment policy to transform the health system: a framework for improving performance.

As the largest payer for health services in the United States, Medicare has the potential to use its payment policies to stimulate change in the organization of care to improve quality and mitigate cost growth. This paper proposes a framework in which Medicare would offer an array of new bundled payment options for physician group practices, hospitals, and delivery systems, with incentives to encourage greater integration in the organization of health care delivery and the provision of more coordinated care to beneficiaries. These changes could also serve as a model for other payers to improve quality and efficiency throughout the health system.

Aiming high for the U.S. health system: a context for health reform.

Policy officials often assert that the U.S. has the best health care system in the world, but a recent scorecard on U.

Two systems of resting state connectivity between the insula and cingulate cortex.

The insula and cingulate cortices are implicated in emotional, homeostatic/allostatic, sensorimotor, and cognitive functions. Non-human primates have specific anatomical connections between sub-divisions of the insula and cingulate. Specifically, the anterior insula projects to the pregenual anterior cingulate cortex (pACC) and the anterior and posterior mid-cingulate cortex (aMCC and pMCC); the mid-posterior insula only projects to the posterior MCC (pMCC).

Health information technology and physician perceptions of quality of care and satisfaction.

Objective: To examine across seven countries the relationship between physician office information system capacity and the quality of care.

Design: Multivariate analysis of a cross-sectional 2006 random survey of primary care physicians in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, United Kingdom, and United States.

Main Outcome Measures: coordination and safety of care, care for chronically ill patients, and satisfaction with practice of medicine.

The complex minds of teenagers: neuroanatomy of personality differs between sexes.

Extraversion and neuroticism influence behaviour and mood. Extreme expressions of these personality traits may predispose individuals to developing chronic functional pains and mood disorders that predominantly affect women. We acquired anatomical MRI scans and personality scores from healthy male and female adolescents and measured gray matter volume (GMV) and cortical thickness to test the hypothesis that neuroticism and extraversion contribute to sex differences in fronto-limbic cortical development during a crucial period of social and biological maturation.

Cortical plasticity following nerve transfer in the upper extremity.

With increasing clinical experience, peripheral nerve surgeons have come to appreciate the important role that cortical plasticity and motor relearning play in functional recovery following a nerve transfer. Neurostimulation (transcranial magnetic stimulation), and neuroimaging (functional MRI, structural MRI, magnetoencephalography) measure different aspects of cortical physiology and when used together are powerful tools in the study of cortical plasticity. The mechanisms of cortical plasticity, according to current and widely accepted opinions, involve the unmasking of previously ineffective connections or the sprouting of intact afferents from adjacent cortical or subcortical territories.

The building blocks of health reform: achieving universal coverage and health system savings.

The presidential election has focused public attention on the need for health system reform--to ensure health insurance for all, to make health care more accessible and responsive to patients, and to slow the growth in health care cost. This issue brief sets forth a framework for expanding health coverage that offers Americans a choice of a product modeled on Medicare to those under age 65, made available through a national insurance connector. Coupled with reforms to Medicare provider payment, expansion of preventive health care, and improved information, such a strategy has the potential to achieve near-universal coverage and improve quality and access, while generating health system savings of $1.

Continuous innovation in health care: implications of the Geisinger experience.

To achieve the diverse health care goals of the United States, health care value must increase. The capacity to create value through innovation is facilitated by an integrated delivery system focused on creating value, measuring innovation returns, and receiving market rewards. This paper describes the Geisinger Health System's innovation strategy for care model redesign.

Cingulotomy for psychiatric disease: microelectrode guidance, a callosal reference system for documenting lesion location, and clinical results.

Objective: To evaluate magnetic resonance imaging (MRI)- and microelectrode recording-guided cingulotomy for patients with psychiatric disorders and to develop a new method of mapping lesion location in anterior cingulate cortex that takes into account the significant interindividual variability in callosal morphometry.

Methods: MRI and microelectrode recording were used to guide placement of radiofrequency lesions in patients with obsessive-compulsive disorder (n = 21) or affective disorders (n = 5). Postoperative improvement was evaluated with the Yale-Brown Obsessive-Compulsive Scale in 15 of the 21 obsessive-compulsive disorder patients studied.

Stability of tactile- and pain-related fMRI brain activations: an examination of threshold-dependent and threshold-independent methods.

Functional MRI can be used to assess brain plasticity over time. To confidently attribute changes in activation patterns to cortical plasticity, it is important to establish the stability of cortical activation patterns. Because little is known concerning the stability of somatosensory-evoked brain responses, we assessed the reproducibility of within-subject responses in key somatosensory regions [thalamus, primary and secondary cortex (S1, S2)] to tactile and painful stimuli using threshold-dependent and threshold-independent analyses.

Effect of static and dynamic heat pain stimulus profiles on the temporal dynamics and interdependence of pain qualities, intensity, and affect.

Acute and chronic pains are characterized by a particular constellation of pain qualities, such as burning, aching, stinging, or sharp feelings. However, the temporal pattern of specific pain qualities and their relationship with pain and affect is not well understood. In addition, little is known about how the temperature time course of the stimulus impacts the temporal dynamics of pain qualities and the relationship between pain qualities.

Factors affecting survival to intestinal transplantation in the very young pediatric patient.

Background: Very young pediatric patients awaiting intestinal transplantation have a high mortality rate due to long waiting times, scarcity of appropriate size donor organs, and mortality due to sepsis and liver failure. To investigate specific risk factors impacting survival to intestinal transplantation, we performed a 4-year institutional retrospective study comparing children who received grafts by age 18 months with children 18 months or younger who died while on the waiting list.

Patients And Methods: Twelve children comprised the transplanted group and had the underlying diagnoses: necrotizing enterocolitis, gastroschisis, Hirschsprung's disease, and omphalocele.

Building blocks for reform: achieving universal coverage with private and public group health insurance.

This paper presents a framework for universal health insurance that builds on the current U.S. mixed private-public system by expanding group coverage through private markets and publicly sponsored insurance.