Co-designing Medication Optimization Patient-Centered Outcomes Research With Older People and Caregivers as Research Partners.

Additional evidence is required to address the unintended consequences of medication use in older people and the required caregiver support. To inform priorities for future research efforts, different stakeholder perspectives are needed, including those of older people, caregivers, clinicians, and researchers. To develop a co-designed medication-related research agenda.

Community Culture Survey - Revised: Measuring neighborhood culture and exploring geographic, socioeconomic, and cultural determinants of health in samples across the United States and in Thailand.

Objectives: Research on links between social, geographic, and cultural determinants of health has been thwarted by inadequate measures of culture. The purpose of this study was to improve the measurement of community culture, defined as shared patterns of attitudes and behaviors among people within a neighborhood that distinguish it from others, and to examine dimensions of culture, independent of socioeconomic and demographic factors, and their relationships with health.

Study Design: A survey research design with correlational analyses was used.

Handlebar Injuries: Not Always the Pancreas.

This case report highlights a rare traumatic gallbladder rupture secondary to a handlebar impact to the abdomen. Traumatic gallbladder rupture is only seen in 1.9-2.

Social determinants predict whether Medicare beneficiaries are offered a Comprehensive Medication Review.

Background: Medication reviews through Medicare's Medication Therapy Management (MTM) program may improve patient outcomes and lower health system costs, but these effects could be limited by a program design that does not address social determinants of health.

Objective: To analyze the effects of social determinants of health on the odds of an eligible Medicare beneficiary not being offered Comprehensive Medication Review (CMR).

Methods: Using the full 100% sample of the 2016 Part D Medication Therapy Management Data File linked to Medicare Master Beneficiary Summary File, a retrospective, cross-sectional analysis was conducted to determine which social and demographic variables are most strongly associated with being eligible for a CMR but not being offered one.

Understanding the Socioeconomic and Geographical Characteristics of Beneficiaries Receiving a Comprehensive Medication Review.

Background: Medicare Part D sponsors are required to offer medication therapy management (MTM) programs to eligible beneficiaries. Recent studies have demonstrated that there have been racial/ethnic disparities in MTM eligibility criteria. For example, compared with non-Hispanic White beneficiaries, Hispanic and non-Hispanic Black beneficiaries are less likely to be eligible for MTM.

Findings from a National Survey of Medicare Beneficiary Perspectives on the Medicare Part D Medication Therapy Management Standardized Format.

Background: The Medication Therapy Management (MTM) Program Standardized Format (SF) is a written summary of a comprehensive medication review (CMR) that must be provided to Medicare Part D beneficiaries. Concerns have been raised regarding the number of pages of the SF, mailing costs, the static nature of the document, and the lack of integration into beneficiaries' electronic health records. To date, limited research exists on beneficiaries' perceptions of the SF.

Community-acquired and hospital-acquired medication harm among older inpatients and impact of a state-wide medication management intervention.

Background: We previously reported reduction in the rate of hospitalisations with medication harm among older adults with our 'Pharm2Pharm' intervention, a pharmacist-led care transition and care coordination model focused on best practices in medication management. The objectives of the current study are to determine the extent to which medication harm among older inpatients is 'community acquired' versus 'hospital acquired' and to assess the effectiveness of the Pharm2Pharm model with each type.

Methods: After a 3-year baseline, six non-federal general acute care hospitals with 50 or more beds in Hawaii implemented Pharm2Pharm sequentially.

Socioeconomic variables explain rural disparities in US mortality rates: Implications for rural health research and policy.

Objectives: Rural disparities in age-adjusted mortality are growing in the United States. While socioeconomic variables have been found to explain significant variation in life expectancy across US counties, previous research has not examined the role of socioeconomic variables in explaining rural mortality disparities. The purpose of this study was to quantify the rural mortality disparity after controlling for socioeconomic variables.

A Statewide Medication Management System: Health Information Exchange to Support Drug Therapy Optimization by Pharmacists across the Continuum of Care.

Background: While evidence generally supports the use of medication management technology, systems are typically implemented and evaluated piecemeal rather than as part of a comprehensive model for medication management. Systems to support drug therapy optimization, increasingly a key role of pharmacists in our healthcare system, have not yet been reported.

Objective: Our objective is to describe the design, implementation, and use of health information technology to support the hospital and community pharmacists' management of medications for high-risk patients statewide in the "Pharm2Pharm" model of care.

Potentially preventable medication-related hospitalizations: A clinical pharmacist approach to assessment, categorization, and quality improvement.

Objectives: The primary objective of this report is to describe a quality improvement practice designed to identify and categorize potentially preventable medication-related hospital admissions. The secondary objective is to present data collected from this practice and describe how it was used to improve a pharmacist intervention focused on reducing medication-related readmissions.

Setting: This practice was developed as part of the quality improvement system supporting a pharmacist-led care transition model that was implemented across rural and urban counties in Hawaii.

Reductions in Medication-Related Hospitalizations in Older Adults with Medication Management by Hospital and Community Pharmacists: A Quasi-Experimental Study.

Objectives: To evaluate the association between a system of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm) and rates and costs of medication-related hospitalization in older adults.

Design: Quasi-experimental interrupted time series design comparing intervention and nonintervention hospitals using a mixed-effects analysis that modeled the intervention as a time-dependent variable.

Setting: Sequential implementation of Pharm2Pharm at six general nonfederal acute care hospitals in Hawaii with more than 50 beds in 2013 and 2014.

Recruitment of rural healthcare professionals for live continuing education.

Introduction: The availability of rural healthcare is a growing concern in the United States as fewer healthcare providers choose to work in rural areas. Accessing quality continuing education (CE) for rural healthcare practitioners (HCPs) remains a challenge and may pose a barrier to quality care.

Methods: To maximize attendance at a live, in-person, free CE program focusing on geriatric medication and issues specifically targeted to HCPs in rural areas, two methods were implemented sequentially.

Association between sugar cane burning and acute respiratory illness on the island of Maui.

Background: Sugar cane harvesting by burning on Maui island is an environmental health issue due to respiratory effects of smoke. Volcanic smog ("vog") from an active volcano on a neighboring island periodically blankets Maui and could confound a study of cane smoke's effects since cane burning is not allowed on vog days. This study examines the association between cane burning and emergency department (ED) visits, hospital admissions, and prescription fills for acute respiratory illnesses.

Improving Accuracy and Relevance of Race/Ethnicity Data: Results of a Statewide Collaboration in Hawaii.

Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area.

Cost-effective strategies for rural community outreach, Hawaii, 2010-2011.

Three strategies designed to maximize attendance at educational sessions on chronic disease medication safety in older adults in rural areas were implemented sequentially and compared for cost-effectiveness: 1) existing community groups and events, 2) formal advertisement, and 3) employer-based outreach. Cost-effectiveness was measured by comparing overall cost per attendee recruited and number of attendees per event. The overall cost per attendee was substantially higher for the formal advertising strategy, which produced the lowest number of attendees per event.

Sprengel deformity presenting as a post-traumatic injury in an afghan boy: a case report.

Sprengel deformity is a rare congenital anomaly that involves the shoulder joint and scapula. We treated a young Afghan boy who was presented to the German Level II Provincial Reconstructive Team in Kunduz, Afghanistan, with the complaint of a shoulder deformity evolving after an accident that occurred several years before the presentation of the patient to clinic. Physicians maximized the available resources for the diagnostic workup by arranging for his computed tomography scan at the German Level III Hospital at Mazar-e-Sharif and then reviewing the study through teleradiology.

A brief survey to identify priorities for improving clinician recruitment and retention: results from Hawai'i Island physicians.

Background: In light of the documented physician shortage on Hawai'i Island, the Hawai'i Clinician Recruitment and Retention survey was designed and implemented to assess perceptions of quality of life and the work environment among clinicians on Hawai'i Island and to identify aspects of the environment on Hawai'i Island that predict responses to questions regarding recruitment and retention.

Methods: The respondents were 127 Hawai'i Island clinicians, specifically 96 physicians, 15 nurses, five pharmacists, four physician assistants, two social workers, and five "other" healthcare workers. The internal reliability of the survey was high (alpha=.

Demystifying and improving organizational culture in health-care.

Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly.

Patient satisfaction among combat veterans receiving specialty PTSD treatment.

Background: Despite the difficulties with successfully developing effective treatments for posttraumatic stress disorder (PTSD), very little research has been conducted on veterans' perceptions of satisfaction with the treatments they receive through the VA.

Objective: Our objective was to evaluate combat veterans' satisfaction with Veterans Affairs (VA) services and to evaluate the reliability and preliminary validity of a measure of patient satisfaction, the Charleston Psychiatric Outpatient Satisfaction Scale-VA PTSD Version, which was originally designed for general psychiatric outpatients.

Method: Fifty-one combat veterans currently receiving specialty mental health care at a VA outpatient PTSD clinic were asked to complete two instruments designed to assess their satisfaction with services provided within the VA mental health and primary care clinics.

Enhanced enzymatic degradation of tryptophan by indoleamine 2,3-dioxygenase contributes to the tryptophan-deficient state seen after major trauma.

Decreased lymphocyte proliferation, lymphopenia, immunodepression, and opportunistic infections are common after major trauma. Early alimentation in these patients corrects lymphopenia, enhances immunity, and reduces the incidence of infections, but the underlying mechanisms are poorly understood. Tryptophan is essential for the production and function of rapidly proliferating cells such as lymphocytes.

Absenteeism and productivity among mental health employees.

We examined archival data to test the hypothesis that absenteeism is inversely related to work productivity among mental health employees at a Veterans Affairs Medical Center outpatient clinic. Results provided partial support for this hypothesis in that there was an inverse correlation between one measure of productivity and the percentage of sick and family care leave taken on Mondays and Fridays (r=.54).