Medicine and Health Sciences Commons^™

Contracting For Quality: Medicare's Quality Improvement Organizations, Lisa Sprague

National Health Policy Forum

This paper examines the role of quality improvement organizations (QIOs, formerly known as PROs, or peer review organizations) in improving the quality of medical care delivered to Medicare beneficiaries in both fee-for-service and managed care environments. It looks at the expansion of the QIOs' portfolio in their seventh contract cycle to include quality improvement activities in nursing homes, home health services, and physicians' offices as well as responsibilities for public education. The paper explores the evolution of QIOs, changes in their priorities over time, and the projects in which they are engaged. It also considers their role in the formulation …

Ada News - 06/03/2002, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Treatment With Soluble Interleukin-15ralpha Exacerbates Intracellular Parasitic Infection By Blocking The Development Of Memory Cd8+ T Cell Response, Imtiaz A. Khan, Magali Moretto, Xiao-Qing Wei, Martha Williams, Joseph D. Schwartzman, F Y. Liew

Dartmouth Scholarship

Interferon (IFN)-γ–producing CD8⁺ T cells are important for the successful resolution of the obligate intracellular parasite Toxoplasma gondii by preventing the reactivation or controlling a repeat infection. Previous reports from our laboratory have shown that exogenous interleukin (IL)-15 treatment augments the CD8⁺ T cell response against the parasite. However, the role of endogenous IL-15 in the proliferation of activated/memory CD8⁺ T cells during toxoplasma or any other infection is unknown. In this study, we treated T. gondii immune mice with soluble IL-15 receptor α (sIL-15Rα) to block the host endogenous IL-15. The treatment markedly reduced the ability …

The Impact Of The State Children's Health Insurance Program (Schip) On Community Health Centers, Lea Nolan, Jennel Harvey, Karen Jones, Lissette Vaquerano, Ann Zuvekas

Health Policy and Management Faculty Publications

Nearly 12 million children in the United States do not have health insurance, and therefore often lack access to health care. In response, Congress enacted the State Children’s Health Insurance Program (SCHIP) in August 1997, the largest expansion of health insurance coverage since the inception of the Medicare and Medicaid programs. The SCHIP provides states with federal matching funds for children’s insurance either by expanding the existing Medicaid program, by creating a separate state program, or a combination of both.

The George Washington University’s Center for Health Services Research and Policy (CHSRP) was funded by the Health Resources and Services …

Children With Specific Language Impairment, Lynne Elizabeth Hewitt

Communication Sciences and Disorders Faculty Publications

Laurence Leonard is one of the most prolific and well-respected researchers in the area of specific language impairment (SLI) in children, and he is well qualified to write a book surveying the topic. SLI is a disorder of unknown origin, which appears to have a genetic component, causing delays and disorders of language development in children of normal nonverbal intelligence with no significant medical, emotional, or sensory deficits. The primary purpose of this book is to provide a comprehensive review of research in the field of SLI, and Leonard has the minute knowledge necessary to succeed at the task. The …

Effect Of Student Involvement On Patient Perceptions Of Ambulatory Care Visits, Todd W. Gress, John A. Flynn, Haya R. Rubin, Lisa Simonson, Stephen Sisson, Traci Thompson, Frederick L. Brancati

Internal Medicine

OBJECTIVE: To determine if patient satisfaction with ambulatory care visits differs when medical students participate in the visit.

DESIGN: Randomized controlled trial.

SETTING: Academic general internal medicine practice.

PARTICIPANTS: Outpatients randomly assigned to see an attending physician only (N = 66) or an attending physician plus medical student (N = 68).

MEASUREMENTS AND MAIN RESULTS: Patient perceptions of the office visit were determined by telephone survey. Overall office visit satisfaction was higher for the “attending physician only” group (61% vs 48% excellent), although this was not statistically significant (P = .16). There was no difference between the …

Evaluation Of Florida’S Mental Health And Substance Abuse System Redesign Strategies: Year 1 Report, Jordan Neil, Julienne Giard, Pat Robinson, Rebecca Larsen, Mary Rose

Mental Health Law & Policy Faculty Publications

Under contract with the Department of Children and Families (DCF) and in accordance with the requirements of Senate Bill (SB)1258, the Louis de la Parte Florida Mental Health Institute (FMHI), University of South Florida, is conducting an ongoing formative evaluation of the financing strategies authorized to be implemented by the legislation. The demonstration sites that were selected were DCF District 1, including Escambia, Okaloosa, Santa Rosa and Walton Counties and DCF District 8, including Charlotte, Collier, Glades, Hendry and Lee Counties. FMHI’s role is to help identify the most effective methods and techniques used to manage, integrate, and deliver behavioral …

Macular Hemorrhage Secondary To Increased Intrathoracic Pressure And Difficult Intubation, A Abbas, G Hyman

Section of Ophthalmology

No abstract provided.

Evaluation Of Florida’S Mental Health And Substance Abuse System Redesign Strategies: Year 1 Report, Neil Jordan, Julienne Giard, Pat Robinson, Rebecca Larsen, Mary R. Murrin

Mental Health Law & Policy Faculty Publications

No abstract provided.

View Box Case--6 Giant Cell Tumor, I Masroor, R Hashmi

Department of Radiology

No abstract provided.

Effect Of Electrically Mediated Intratumor And Intramuscular Delivery Of A Plasmid Encoding Ifn Α On Visible B16 Mouse Melanomas, Loree C. Heller, Stephanie F. Ingram, M. Lee Lucas, Richard A. Gilbert, Richard Heller

Bioelectrics Publications

Interferon α may be used as a single agent therapy for metastatic malignant melanoma or as an adjuvant to chemotherapy. Delivery of interferon α by gene therapy offers an alternative to recombinant protein therapy. Electrically mediated delivery enhances plasmid expression in a number of tissues, for instance skin, liver, muscle and tumors including melanomas. Here we compare the effect of delivery of a plasmid encoding mouse interferon α on growth of visible B16 mouse melanomas following electrically mediated delivery to muscle or directly to the tumor. Intratumoral delivery of interferon α plasmid not only slows melanoma growth, but induces complete, …

Framework And Architecture For The Management Of Event-Condition-Action (Eca) Rule Based Clinical Protocols, Kudakwashe Dube, Bing Wu, Jane Grimson

Conference papers

Computer-based support for the incorporation of clinical practice guidelines and protocol into daily practice has recently attracted a lot of research interest within the healthcare informatics area. The aim is not only to provide support for the flexible specification and execution of clinical guidelines or protocols but also the dynamic management of these guidelines or protocols. This paper presents a framework and architecture for the management of clinical protocols whose specification and execution models are based on the event-condition-action (ECA) rule paradigm.

Transportation: A Crucial Issue For Adult Day Care In Vermont, Francis G. Caro, Regula H. Robnett, Jennifer Higgins

Gerontology Institute Publications

Transportation arrangements are an integral but fragile element in the effectiveness of adult day care services in Vermont and nationwide. Almost by definition, adult day center participants generally cannot drive due to cognitive and/or physical limitations. Since adult day care services are congregate in nature and serve community-residing elders, this long-term care option is feasible only when there are arrangements to transport elders to and from service centers. Transportation is therefore a major issue for adult day care services.

The aim of this report is to call attention to transportation issues in adult day care services in Vermont. The report …

Too Many Of A Good Thing? The Effects Of Multiple Motivations On Stress, Cost, Fulfillment, And Satisfaction , Marc T. Kiviniemi, Mark Snyder, Allen M. Omoto

Department of Psychology: Faculty Publications

Individuals engage in behaviors to satisfy motivations and can engage in the same behavior to satisfy a variety of different motivations. Previous research has examined how differences in the overall amount of motivation influence outcomes but has not addressed how differences in the number of conceptually distinct motivations one has for a particular action influence outcomes. In two longitudinal field studies, individuals with more than one motivation for volunteering experienced greater negative outcomes than did those who volunteered to satisfy a single motivation. A laboratory study manipulated the number of motivations individuals had for engaging in a volunteer activity. Individuals …

Blending The Roles Of Home Care Nursing And Cardiovascular Specialties: A Model For Nursing Practice In The Community, Margaret A. Guthaus, Diane White

Peer Reviewed Articles

Changes in reimbursement and advances in technology have resulted in a decreased hospital stay for patients undergoing cardiac surgery. These patients are being discharged into the community setting earlier, resulting in an increased demand for transitional specialty home care. This article relates the experience of a Midwest home care agency charged with the development of specialty home care for these complex patients. It offers a new practice model for professional nursing staff delivering this level of care. This model challenges traditional beliefs that cardiac specialty home care can best be provided by nurses with critical care or acute care cardiology …

What Do We Assess When We Assess A Big 5 Trait? : A Content Analysis Of The Affective, Behavioral, And Cognitive Processes Represented In Big 5 Personality Inventories, Lisa M. Pytlik Zillig, Scott H. Hemenover, Richard A. Dienstbier

Department of Psychology: Faculty Publications

What are personality traits? Are all “broad” traits equally broad in the constructs they encompass and in the pervasiveness of their effects? Or are some traits more or less affective, behavioral, or cognitive in nature? The present study examined these issues as they applied to the Big 5 traits of Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. Expert and novice raters judged the extent to which items from four popular Big 5 inventories contain behavioral, cognitive, or affective components. Traits and inventories were then compared in terms of their relative assessment of these components. Results indicate convergence among inventories but remarkable …

Evaluation Of A Comprehensive Diabetes Disease Management Program: Progress In The Struggle For Sustained Behavior Change, Janice Clarke, Albert Crawford, David B. Nash

College of Population Health Faculty Papers

The successful management of diabetes with a goal of achieving near-normoglycemia requires patients to make multiple lifestyle changes as part of an intensive, complex, and coordinated therapeutic regimen aimed at reducing the risk of complications associated with the disease. The difficulty in creating and sustaining these lifestyle behavior changes is a major stumbling block in achieving the desired therapeutic goal. An underlying assumption of comprehensive disease management is that regular, personal contact with nurses and ancillary health professionals will facilitate these lifestyle behavior changes for program participants. The results of a survey of self-reported data from 750 participants in a …

Stretch-Induced Calcium Release In Smooth Muscle., Guangju Ji, Robert J Barsotti, Morris E Feldman, Michael I Kotlikoff

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Smooth muscle cells undergo substantial increases in length, passively stretching during increases in intraluminal pressure in vessels and hollow organs. Active contractile responses to counteract increased transmural pressure were first described almost a century ago (Bayliss, 1902) and several mechanisms have been advanced to explain this phenomenon. We report here that elongation of smooth muscle cells results in ryanodine receptor-mediated Ca(2+) release in individual myocytes. Mechanical elongation of isolated, single urinary bladder myocytes to approximately 120% of slack length (DeltaL = 20) evoked Ca(2+) release from intracellular stores in the form of single Ca(2+) sparks and propagated Ca(2+) waves. Ca(2+) …

Effect Of Added Mass On Human Unipedal Hopping, Gary P. Austin, Gladys E. Garrett, David Tiberio

All PTHMS Faculty Publications

Although hopping is considered a children's activity, it can be used to provide insight into the neuromuscular and biomechanical performance of adults. This study investigated whether mass added during unipedal hopping altered the vertical stiffness, hopping period, and angular kinematics of the lower exteremity of adults. Measures of two-dimensional kinematics and vertical force were made from 10 healthy men during hopping at a preferred period under three conditions: Body Mass, Body Mass +10%, and Body Mass +20%. Adding mass significantly increased hopping period and hip flexion without significantly affecting vertical stiffness, ankle dorsiflexion, or knee flexion. Overall, the findings agreed …

Effect Of Frequency On Human Unipedal Hopping, Gary P. Austin, David Tiberio, Gladys E. Garrett

All PTHMS Faculty Publications

All mature forms of locomotion involve periods of unilateral stance. Unipedal hopping may provide useful information about the neuromuscular and biomechanical capabilities of a single lower extremity in adults. This study investigated whether hopping influenced vertical stiffness and lower extremity angular kinematics during human unipedal hopping. Vertical force and two-dimensional kinematics were measured in 10 healthy males hopping at three frequencies: preferred, +20%, and -20%. At +20%, compared to preferred, vertical stiffness increased 55% as hip flexion, knee flexion, and ankle dorsiflexion decreased, while at -20%, vertical stiffness decreased 39.4% as hip flexion, knee flexion, and ankle dorsiflexion increased. As …

A Problem-Based Learning Approach To Facilitate Evidence-Based Practice In Entry-Level Health Professional Education, Michelle M. Lusardi, Pamela Levangie, Beverly D. Fein

All PTHMS Faculty Publications

This article will provide an overview of the problem-based learning process, and an illustration of how problem-based learning can facilitate development of critical appraisal necessary for evidence-based practice. It will trace the development of problem-based learning as an educational methodology for entry-level health professional education. The information seeking and appraisal themes common to both problem-based learning and evidence-based practice will be examined, along with the roles and responsibilities of faculty and tutors who are part of problem-based learning courses or curricula. Examples of strategies for student assessment will be discussed, for both mastery of didactic content and for contribution to …

Jefferson Alumni Bulletin - Volume 51, Number 3, June 2002

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

Jefferson Alumni Bulletin – Volume 51, Number 3, June 2002 New Appointments; Page 4 Gift of Health: Herbert Kean Endows Chair in Otolaryngology; Page 6 Investigations: Zebrafish: A Potential Community Outreach Program; Page 7 Hospital Appointments; Page 10 Match Day; Page 12 Profile: Urologic Surgery’s “Real Deal”; Page 14 Profile: When Terror Hit the Pentagon, Stephen Frost’s Reaction Was: Tend the Injured; Page 16 Profile: Searching for the Cause of the Rash That’s Itching Pupils; Page 17 In Memoriam; Page 18 Class Notes; Page 19 Building on Knowledge of Angiogenesis, Invention Provides Hope to the Obese; Page 22 Griffith Heads …

Takayasu's Arteritis Presenting As Ischemic Stroke--Case Report, B A. Khealani, S M. Baig

Section of Neurology

Takayasu’s Arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large blood vessels such as aorta and its branches.1 Neurological symptoms occur in about 50% of cases but stroke occurs in about 10% of patients with Takayasu’s Arteritis2 . We report two such cases and emphasize the need for thorough evaluation of young patients with stroke to establish the underlying etiology.

Whose Duty Is It Anyway?: The Kennedy Krieger Opinion And Its Implications For Public Health Research, Diane E. Hoffmann, Karen H. Rothenberg

Faculty Scholarship

In this article, the authors discuss the Maryland Court of Appeals decision in the case of Grimes v. Kennedy Krieger Institute, Inc. and its implications for the tort duty owed by researchers, in particular public health researchers, to their subjects. The Opinion resulted from two lawsuits alleging lead poisoning of children enrolled in a study conducted by the Kennedy Krieger Institute, a world renown pediatric research and treatment facility. The opinion shocked the research establishment with its scathing characterization of researchers and its apparent holding that in Maryland a parent cannot consent to the participation of a child in "nontherapeutic …

Current Practice Regarding The Use Of Fatty Livers: A Trans-Atlantic Survey., Charles J. Imber, Shawn D. St Peter, Inigo Lopez, Lynden Guiver, Peter J. Friend

Manuscripts, Articles, Book Chapters and Other Papers

A strong association exists between the presence of steatosis in a donor liver for transplantation and the development of primary nonfunction in the recipient. Despite this, appraisal of the donor remains one of the least scientific aspects of the transplantation process, and many centers base their practice on subjective opinion, rather than objective data. We conducted this survey to illuminate controversial issues and highlight the variation of opinion and practice policies both between and within the United Kingdom and the United States. A simple, anonymous, one-page, 10-question survey with tick-box answers was sent to every practicing liver transplant surgeon in …

Mandible Cleft: Report Of A Case And Review Of The Literature, Luis Eduardo Almeida, Lucienne Ulbrich, Fabricio Togni

School of Dentistry Faculty Research and Publications

Median cleft of the lower lip and associated structures is a relatively rare condition. We report the case of a patient with mandibular cleft. Unlike other reported cases of similar disorders, there was no cleft of the lower lip. The literature on median clefts of the lower lip and mandible is reviewed, and the etiology and treatment are discussed.

Cancer Patterns In Karachi Division (1998-1999), Y. Bhurgri, S. Naseeruddin, S. A. H. Zaidi, A. Bhurgri, Z. A. Zaidi, S. H. Hasan, A. Usman, N. Faridi, K. Z. Hashmi, H. Ahsan, J. Malik, M. Khurshid, Shahid Pervez, Naila Kayani, S. M. H. Zaidi, I. Bashir, Z. Isani, F. Sethna, S. M. Aiam

Department of Pathology and Laboratory Medicine

Objective: A minimal cancer incidence data for Karachi, the largest city of Pakistan, is being presented here, for the years 1998-1999. The city has a population of 9,802,134; males 5,261,712 (52.6%) and females 4,540,422 (47.4%); census 19981.

Methodology: A predominantly mixed (passive and active) registration system has evolved in Karachi, the data sources being the hospitals within the Karachi Division. The reported/retrieved cancer data sets at the Karachi Cancer Registry are checked, coded, computerised in an analytical format and analysed.

Results: The incident cancer cases registered in Karachi, during the 2-year period, 1st January 1998 to 31st December 1999 were …

The Federal-State Struggle Over Medicaid Matching Funds: An Update, Karen Matherlee

National Health Policy Forum

This background paper updates NHPF Issue Brief No. 760, "The Federal-State Medicaid Match: An Ongoing Tug-of-War over Practice and Policy," December 15, 2000. The paper presents actions taken since then by the Centers for Medicare and Medicaid Services, Department of Health and Human Services, to address what the Bush administration calls abusive funding practices used by states to draw federal Medicaid matching funds. Tracing the Clinton and Bush administrations' policies, the document reviews final regulations, published in January 2001 and January 2002, on these practices. The paper also reports on a lawsuit filed in federal court to block …

Development Of Dose Coefficients For Radionuclides Produced In Spallation Neutron Sources, Phillip W. Patton

Transmutation Sciences Physics (TRP)

A research consortium comprised of representatives from several universities and national laboratories has been established as part of this on-going project to generate internal and external dose conversion coefficients for radionuclides produced in spallation neutron sources. Information obtained from this multi-year study will be used to support the siting and licensing of future accelerator-driven nuclear initiatives within the U.S. Department of Energy complex, including the Spallation Neutron Source (SNS) and Accelerator Production of Tritium (APT) Projects. Determination of these coefficients will also fill data gaps for several hundred radionuclides that exist in Federal Guide Report No. 11 and in Publications …

Characterization Of Subcellular Localization And Stability Of A Splice Variant Of G Alpha I2., Philip B Wedegaertner

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: Alternative mRNA splicing of alpha(i2), a heterotrimeric G protein alpha subunit, has been shown to produce an additional protein, termed salpha(i2). In the salpha(i2) splice variant, 35 novel amino acids replace the normal C-terminal 24 amino acids of alpha(i2). Whereas alpha(i2) is found predominantly at cellular plasma membranes, salpha(i2) has been localized to intracellular Golgi membranes, and the unique 35 amino acids of salpha(i2) have been suggested to constitute a specific targeting signal. RESULTS: This paper proposes and examines an alternative hypothesis: disruption of the normal C-terminus of alpha(i2) produces an unstable protein that fails to localize to plasma …