Intraosseous infusions through non-styletted needles

This pilot study investigated the potential use of non-styletted needles for intraosseous infusion using a cadaver model. The results suggested that, in emergency situations, fluids may be successfully infused intraosseously using non-styletted needles.     

The Central Massachusetts Oral Health Initiative (CMOHI): a successful public–private community health collaboration

Objectives: The Central Massachusetts Oral Health Initiative (CMOHI) aimed to improve access to quality oral health care in central Massachusetts. Methods: A broad‐based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school‐based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health. Results: A state legislative Oral Health Caucus helped secure sought‐after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school‐based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established. Conclusions: Significant sustainable gains in oral health care access were created through our multifaceted approach, ongoing evaluation and communication, coordination of CMOHI partner resources, and collaboration with other involved parties.     

The influence of ethnicity on Gleason score

BackgroundTo determine if Gleason score exhibits any significant variation between African-Americans and Caucasian men with prostate cancer.MethodsWe conducted a retrospective cohort study. Inclusion required diagnosis of prostate cancer and reporting it to the TriHealth tumor registry from 1995–2005. We excluded individuals of any other ethnicity than the two of interest (N = 15) and individuals without a reported Gleason score (N = 82). For each patient we collected data on ethnicity, Gleason score, age, American Joint Committee on Cancer (AJCC) stage, insurance status, and surgery. Gleason score was divided into low-grade (1–6) and high-grade disease (7–10). Institutional Review Board approval was obtained prior to data collection.ResultsA total of 1916 patients, (1476 Caucasians, 440 African-Americans) were eligible for inclusion in the study. There was no significance difference between either ethnicity for age, insurance status, and the percentage of men needing a transurethral resection of the prostate (TURP). There was no difference between either ethnicity for stages 0, 1, and 4. African-Americans were more likely to have stage 2 disease, while Caucasian men possessed more stage 3 disease (p<0.05). African-Americans were significantly more likely to not have any prostate surgery (p<0.05). Caucasian men were more likely to have a prostatectomy. African-American men with prostate cancer were significantly more likely to have a high-grade Gleason score compared to Caucasian men (OR = 1.22, 95% CI = 1.11–1.35).ConclusionAfrican-American race is a predictor of more advanced Gleason score at the time diagnosis of prostate cancer.     

The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process

BACKGROUND

The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized.

OBJECTIVE

To describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project.

DESIGN

Individual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania.

PARTICIPANTS

A total of 118 individual interviews were conducted with clinicians (N?=?47), patient educators (N?=?4), office administrators (N?=?12), medical assistants (N?=?26), front office staff (N?=?7), nurses (N?=?4), care managers (N?=?11), social workers (N?=?4), and other stakeholders (N?=?3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation.

KEY RESULTS

Three central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice–patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care.

CONCLUSIONS

Key factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, self-assessment, and the development of shared decision-making. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of team-based care.