Providing medication for opioid use disorder and HIV pre-exposure prophylaxis at syringe services programs via telemedicine: a pilot study.

Background: People who inject drugs (PWID) are at high risk for opioid overdose and infectious diseases including HIV. We piloted PARTNER UP, a telemedicine-based program to provide PWID with medication for opioid use disorder (MOUD) with buprenorphine/naloxone (bup/nx) and oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine through two syringe services programs (SSP) in North Carolina. We present overall results from this project, including participant retention rates and self-reported medication adherence.

Low barrier medication for opioid use disorder at a federally qualified health center: a retrospective cohort study.

Background: Medication for opioid use disorder (MOUD) reduces mortality, but few patients access MOUD. At a Federally Qualified Health Center (FQHC), we implemented a low barrier model of MOUD, including same-day MOUD initiation and a harm reduction philosophy.

Objective: To investigate whether low barrier MOUD improved retention in care compared to traditional treatment.

Implementation of a comprehensive hospitalist-led initiative to improve care for patients with opioid use disorder.

Background: As opioid-related hospitalizations rise, hospitals must be prepared to evaluate and treat patients with opioid use disorder (OUD). We implemented a hospitalist-led program, Project Caring for patients with Opioid Misuse through Evidence-based Treatment (COMET) to address gaps in care for hospitalized patients with OUD.

Objective: Implement evidence-based treatment for inpatients with OUD and refer to postdischarge care.

Democratizing health system data to impact social and environmental health contexts: a novel collaborative community data-sharing model.

Background: Community health data are infrequently viewed in the context of social and environmental health determinants. We developed a novel data-sharing model to democratize health system data and to facilitate community and population health improvement.

Methods: Durham County, the City of Durham in North Carolina, Durham health systems and other stakeholders have developed a data-sharing model to inform local community health efforts.

North Carolina surgical workforce trends.

Between 1997 and 2008, the number of general surgeons in North Carolina increased and shifted demographically, geographically, and by specialty. However, surgeon numbers--overall and by specialty--do not appear to have increased as quickly or to have shifted in the same ways as North Carolina's general population.

Increasing the number of trainees in general surgery residencies: is there capacity?

Purpose: General surgeons have decreased as a proportion of the total U.S. surgical workforce.

Surgical workforce in the American South.

There exists a geographic maldistribution of surgeons with significant regional characteristics, which is associated with surgical access differentials that may be contributing to existing health disparities in the United States. We sought to evaluate the trends in the surgical workforce in southern states of the United States from 1981 to 2006 using the American Medical Association Masterfile data. Our study revealed that the general surgery workforce growth peaked in 1986 and has had negative growth per capita as a result of the consistent population growth, unlike other regions in the country.

Continuing effects of Medicare Part D on rural independent pharmacies who are the sole retail provider in their community.

Background: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established funding to allow Medicare beneficiaries to enroll in plans providing outpatient prescription drug coverage beginning in January 2006. The Medicare Part D program has changed the means by which beneficiaries purchase prescription drugs, impacting the business operations of pharmacies.

Objectives: To describe the experiences of rural independently owned pharmacies that are the sole retail pharmacy in their community 1 year after implementation of Medicare Part D, in order to learn if the initial financial and administrative problems associated with the implementation of the program in 2006 resolved over time.

The effect of rural hospital closures on community economic health.

Objective: To examine the effect of rural hospital closures on the local economy.

Data Sources: U.S.

Choosing to convert to critical access hospital status.

The authors profile facilities converting to critical access hospitals (CAHs) from 1998-2000, comparing characteristics of their communities, operations, and finances to those of other small rural providers. Counties where CAHs are located are more sparsely populated, but do not have substantially different sociodemographic profiles than other rural counties. Converting hospitals' acute daily census averaged well below the statutory limit of 15, but over one-half reduced unused bed capacity to meet CAH size limitations.

Tracking Medicaid managed care in rural communities: a fifty-state follow-up.

This study updates a 1997 study examining implementation of rural Medicaid managed care programs. Most states operate Medicaid managed care programs for their beneficiaries, but the types of programs vary across urban and rural settings. Over the past four years the number of rural counties covered by Medicaid managed care, including fully capitated programs, has grown, although primary care case management (PCCM) remains the predominant program type in rural areas.

Laboratory diagnosis of heparin-induced thrombocytopenia: advantages of a functional flow cytometric test in comparison to the heparin-induced platelet-activation test.

Nearly one third of patients with heparin-induced thrombocytopenia (HIT) will progress to overt thrombosis. Owing to the severity of HIT, a reliable prompt diagnosis is mandatory. In this study 248 consecutive samples from patients referred to our laboratory for HIT diagnosis and 97 specimens from normal controls were prospectively evaluated in parallel using the heparin-induced platelet aggregation (HIPA) test and a flow cytometric (FC) test.

Serum thymidine kinase in non-Hodgkin lymphomas with special regard to multiple myeloma.

S-TK (Serum thymidine kinase) levels were determined by means of a radioenzyme assay (REA). In 95% of healthy controls (n = 97), S-TK values were below 8.5 U/L.

Evaluation of serum neural cell adhesion molecule as a prognostic marker in multiple myeloma.

Serum neural cell adhesion molecule (NCAM), a possible prognostic marker for multiple myeloma (MM), was determined by means of an enzyme immunoassay, which showed good linearity and high precision. In 95% of healthy controls (n = 70), NCAM values were below 18.7 U/mL.

Protein C, protein S and antithrombin III levels in the course of bone marrow and subsequent liver transplantation due to veno-occlusive disease.

Veno-occlusive disease (VOD) of the liver is one of the most frequent fatal complications after bone marrow transplantation (BMT). A decrease of natural anticoagulants, in particular protein C (PC), has been assumed to be involved in the pathogenesis of the disease. We determined PC and antithrombin III (AT III) levels in two patients undergoing BMT and subsequent liver transplantation due to VOD.

Comparison of CYFRA 21-1, TPA and TPS in lung cancer, urinary bladder cancer and benign diseases.

Recently CYFRA 21-1, a new tumor marker measuring a fragment of cytokeratin 19, was introduced and proved to be suitable for therapy monitoring and follow-up of non-small cell lung carcinomas (NSCLC), in particular squamous cell carcinomas. Besides CYFRA 21-1 there are two other tumor markers, tissue polypeptide antigen (TPA) and tissue polypeptide-specific antigen (TPS), which also measure various cytokeratins in serum. In a retrospective study we investigated the clinical significance of these three cytokeratin markers in lung cancer and in carcinoma of the urinary bladder.