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Surendran, Shilpa, Chuan De Foo, Chen Hee Tam, Elaine Qiao Ying Ho, David Bruce Matchar, Josip Car, and Gerald Choon Huat Koh. "The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context." International Journal of Environmental Research and Public Health 18, no. 4 (February 13, 2021): 1817. http://dx.doi.org/10.3390/ijerph18041817.
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In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limited. We conducted 10 semi-structured in-depth interviews with general practitioners working in seven out of the nine PCMHs. Audio recordings were transcribed and analyzed by two study team members in NVivo 12 Software using grounded theory techniques. Power dynamics between the stakeholders and lack of shared decision-making among them in selecting the locale of the PCMH and formulating the practice fee and pharmacy structure were the key factors which negatively affected the implementation of PCMHs on a larger scale. Over time, lack of funding to hire dedicated staff to transfer patients and misalignment of various stakeholders’ interest to other right-siting programs also resulted in low number of patients with chronic conditions and revenue. Countries seeking to implement a successful PCMH may benefit from building trust and relationship between stakeholders, engaging in shared decision-making, ongoing cost-efficiency efforts, and formulating a clear delineation of responsibilities between stakeholders. For a healthcare delivery model to succeed in the primary care landscape, policies should be developed keeping mind the realities of primary care practice.
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Gregg, Abbey, Li-Wu Chen, Jungyoon Kim, Hyo Jung Tak, and Melissa Tibbits. "Patient-Centered Medical Home Measurement in School-Based Health Centers." Journal of School Nursing 35, no. 3 (December 13, 2017): 189–202. http://dx.doi.org/10.1177/1059840517746728.
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School-based health centers (SBHCs) have been suggested as potential medical homes, yet minimal attention has been paid to measuring their patient-centered medical home (PCMH) implementation. The purposes of this article were to (1) develop an index to measure PCMH attributes in SBHCs, (2) use the SBHC PCMH Index to compare PCMH capacity between PCMH certified and non-PCMH SBHCs, and (3) examine differences in index scores between SBHCs based in schools with and without adolescents. A total of six PCMH dimensions in the SBHC PCMH Index were identified through factor analysis. These dimensions were collapsed into two domains: care quality and comprehensive care. SBHCs recognized as PCMHs had higher scores on the index, both domains, and four dimensions. SBHCs based in schools with just young children and those with adolescents scored similarly on the overall index, but analysis of individual index items shows their strengths and weaknesses in PCMH implementation.
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Maeng, Daniel D., Thomas R. Graf, Duane E. Davis, Janet Tomcavage, and Frederick J. Bloom. "Can a Patient-Centered Medical Home Lead to Better Patient Outcomes? The Quality Implications of Geisinger’s ProvenHealth Navigator." American Journal of Medical Quality 27, no. 3 (August 18, 2011): 210–16. http://dx.doi.org/10.1177/1062860611417421.
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One of the primary goals of the patient-centered medical home (PCMH) is to provide higher quality care that leads to better patient outcomes. Currently, there is only limited evidence regarding the ability of PCMHs to achieve this goal. This article demonstrates the effect of PCMHs in improving certain clinical outcomes, as shown by the ProvenHealth Navigator (PHN), an advanced PCMH model developed and implemented by Geisinger Health System. In this study, the authors examined the claims data from Geisinger Health Plan between 2005 and 2009 and estimated the effect of PHN on reducing amputation rates among patients with diabetes, end-stage renal disease, myocardial infarction, and stroke. The results show that, despite its relatively short period of existence, PHN has led to significant improvements in certain outcomes, further illustrating its potential as a care delivery model to be adopted on a wider scale.
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Angelotti, Marietta, Kathryn Bliss, Dana Schiffman, Erin Weaver, Laura Graham, Thomas Lemme, Veronica Pryor, and Foster C. Gesten. "Transforming the Primary Care Training Clinic: New York State’s Hospital Medical Home Demonstration Pilot." Journal of Graduate Medical Education 7, no. 2 (June 1, 2015): 247–52. http://dx.doi.org/10.4300/jgme-d-14-00782.1.
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Abstract Background Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Objective Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. Methods The 2013–2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. Results A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P ≤ .001, and 11%, P = .011, respectively). Conclusions A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes.
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Raphael, Jean L., and Suzette O. Oyeku. "Sickle cell disease pain management and the medical home." Hematology 2013, no. 1 (December 6, 2013): 433–38. http://dx.doi.org/10.1182/asheducation-2013.1.433.
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Abstract Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.
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Raphael, Jean L., and Suzette O. Oyeku. "Sickle cell disease pain management and the medical home." Hematology 2013, no. 1 (December 6, 2013): 433–38. http://dx.doi.org/10.1182/asheducation.v2013.1.433.3850724.
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Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.
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El Rayess, Fadya, Roberta Goldman, Christopher Furey, Rabin Chandran, Arnold R. Goldberg, and Gowri Anandarajah. "Patient-Centered Medical Home Knowledge and Attitudes of Residents and Faculty: Certification Is Just the First Step." Journal of Graduate Medical Education 7, no. 4 (December 1, 2015): 580–88. http://dx.doi.org/10.4300/jgme-d-14-00597.1.
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ABSTRACT Background The patient-centered medical home (PCMH) is an accepted framework for delivering high-quality primary care, prompting many residencies to transform their practices into PCMHs. Few studies have assessed the impact of these changes on residents' and faculty members' PCMH attitudes, knowledge, and skills. The family medicine program at Brown University achieved Level 3 PCMH accreditation in 2010, with training relying primarily on situated learning through immersion in PCMH practice, supplemented by didactics and a few focused clinical activities. Objective To assess PCMH knowledge and attitudes after Level 3 PCMH accreditation and to identify additional educational needs. Methods We used a qualitative approach, with semistructured, individual interviews with 12 of the program's 13 postgraduate year 3 residents and 17 of 19 core faculty. Questions assessed PCMH knowledge, attitudes, and preparedness for practicing, teaching, and leading within a PCMH. Interviews were analyzed using the immersion/crystallization method. Results Residents and faculty generally had positive attitudes toward PCMH. However, many expressed concerns that they lacked specific PCMH knowledge, and felt inadequately prepared to implement PCMH principles into their future practice or teaching. Some exceptions were faculty and resident leaders who were actively involved in the PCMH transformation. Barriers included lack of time and central roles in PCMH activities. Conclusions Practicing in a certified PCMH training program, with passive PCMH roles and supplemental didactics, appears inadequate in preparing residents and faculty for practice or teaching in a PCMH. Purposeful curricular design and evaluation, with faculty development, may be needed to prepare the future leaders of primary care.
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Dettloff, Richard W., Patricia Glosner, and Susannah Motl Moroney. "Establishing the Role of the Pharmacist in the Patient-Centered Medical Home… The Opportunity is Now." Journal of Pharmacy Technology 25, no. 5 (September 2009): 287–91. http://dx.doi.org/10.1177/875512250902500502.
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The patient-centered medical home (PCMH) is an approach to delivering comprehensive, continuous, coordinated care across all life stages and has been hypothesized to be one potential solution to the discrepancy between the high cost but low quality of health care in the US. Although a plethora of literature exists on how pharmacy interventions can improve the quality of patient care through medication therapy management programs, there is a paucity of data supporting pharmacists' involvement in PCMHs. Pharmacists are uniquely trained and positioned to make important contributions to PCMHs as medication care coordinators. The opportunity is now for pharmacists to establish their role within this medical setting.
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Butler, Danielle, Anton Clifford-Motopi, Saira Mathew, Carmel Nelson, Renee Brown, Karen Gardner, Lyle Turner, et al. "Study protocol: primary healthcare transformation through patient-centred medical homes—improving access, relational care and outcomes in an urban Aboriginal and Torres Strait Islander population, a mixed methods prospective cohort study." BMJ Open 12, no. 9 (September 2022): e061037. http://dx.doi.org/10.1136/bmjopen-2022-061037.
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IntroductionFor over 40 years, Aboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) in Australia have led strategic responses to address the specific needs of Aboriginal and Torres Strait Islander populations. Globally, there has been rapid growth in urban Indigenous populations requiring an adaptive primary healthcare response. Patient-centred medical homes (PCMH) are an evidenced-based model of primary healthcare suited to this challenge, underpinned by principles aligned with the ACCHS sector—relational care responsive to patient identified healthcare priorities. Evidence is lacking on the implementation and effectiveness of the PCMH model of care governed by, and delivered for, Aboriginal and Torres Strait Islander populations in large urban settings.Method and analysisOur multiphased mixed-methods prospective cohort study will compare standard care provided by a network of ACCHS to an adapted PCMH model of care. Phase 1 using qualitative interviews with staff and patients and quantitative analysis of routine primary care health record data will examine the implementation, feasibility and acceptability of the PCMH. Phase 2 using linked survey, primary care and hospitalisation data will examine the impact of our adapted PCMH on access to care, relational and quality of care, health and wellbeing outcomes and economic costs. Phase 3 will synthesise evidence on mechanisms for change and discuss their implications for sustainability and transferability of PCMHs to the broader primary healthcare systemEthics and disseminationThis study has received approval from the University of Queensland Human Research Ethics Committee (2021/HE00529). This research represents an Aboriginal led and governed partnership in response to identified community priorities. The findings will contribute new knowledge on how key mechanisms underpinning the success and implementation of the model can be introduced into policy and practice. Study findings will be disseminated to service providers, researchers, policymakers and, most importantly, the communities themselves.
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Heisey-Grove, Dawn, and Vaishali Patel. "National findings regarding health IT use and participation in health care delivery reform programs among office-based physicians." Journal of the American Medical Informatics Association 24, no. 1 (May 16, 2016): 130–39. http://dx.doi.org/10.1093/jamia/ocw065.
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Objective: Our objective was to characterize physicians’ participation in delivery and payment reform programs over time and describe how participants in these programs were using health information technology (IT) to coordinate care, engage patients, manage patient populations, and improve quality. Materials and Methods: A nationally representative cohort of physicians was surveyed in 2012 (unweighted N = 2567) and 2013 (unweighted N = 2399). Regression analyses used those survey responses to identify associations between health IT use and participation in and attrition from patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and pay-for-performance programs (P4Ps). Results: In 2013, 45% of physicians participated in PCMHs, ACOs, or P4Ps. While participation in each program increased (P < .05) between 2012 and 2013, program attrition ranged from 31–40%. Health IT use was associated with greater program participation (RR = 1.07–1.16). PCMH, ACO, and P4P participants were more likely than nonparticipants to perform quality improvement and patient engagement activities electronically (RR = 1.09–1.14); only ACO participants were more likely to share information electronically (RR = 1.07–1.09). Discussion: Participation in delivery and payment reform programs increased between 2012 and 2013. Participating physicians were more likely to use health IT. There was significant attrition from and switching between PCMHs, ACOs, and P4Ps. Conclusion: This work provides the basis for understanding physician participation in and attrition from delivery and payment reform programs, as well as how health IT was used to support those programs. Understanding health IT use by program participants may help to identify factors enabling a smooth transition to alternative payment models.
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Rahmanian, H. "Health screening audit – south Barnet PCMH pilot." European Psychiatry 41, S1 (April 2017): S700. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1239.
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Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement.AimsThe aim of this project was to improve the physical health monitoring for patients with mental health illness. The patients group was under the care of south Barnet primary care mental health pilot (SB PCMH Pilot). SB PCMH pilot is a multidisciplinary team that includes: consultant psychiatrist mental health nurse and psychologist.ResultsBetween November to December 2014, 60 patients were discharged from SB PCMHT and the electronic case notes of 38 of them who had an assessment/intervention by the service were reviewed. Results showed that 82% of the records verified that discussion and screening of physical health, smoking, drugs and alcohol had been completed. The data was discussed in team meetings with all team members. After thorough team discussions and brainstorming; the team agreed that an improvement in the process of monitoring was needed to work towards ensuring these matters are discussed with 100% patients and that this is accurately recorded. It was agreed to re-audit in 3 months.Re-auditA re-audit completed between January to April 2015 confirmed an improvement as 98% of patients seen for an assessment by SB PCMH pilot have had their annual health checks and appropriate health screenings discussed and recorded routinely.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hasley, Peggy B., Deborah Simak, Elan Cohen, and Raquel Buranosky. "Training Residents to Work in a Patient-Centered Medical Home: What Are the Outcomes?" Journal of Graduate Medical Education 8, no. 2 (May 1, 2016): 226–31. http://dx.doi.org/10.4300/jgme-d-15-00281.1.
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ABSTRACT The patient-centered medical home (PCMH) provides a setting to enhance resident training in systems-based practice. Few studies have addressed the impact of PCMHs on resident knowledge and confidence.Background The goal of this study was to evaluate resident knowledge, confidence, behavior, and patient outcomes in a PCMH.Objective Our curriculum emphasized patient panel report card interpretation, a telephone medicine curriculum, and interdisciplinary team-based care of chronic medical conditions. We measured resident satisfaction, knowledge, and confidence. Patient outcomes included hemoglobin A1c (HbA1c) and blood pressures. Prescores and postscores were compared using paired t tests for continuous measures and McNemar's test for binary measures.Methods A total of 154 residents were eligible for the curriculum. All residents participated in the curriculum, though not all residents completed the evaluation. Completion rates for paired pre-post knowledge and confidence surveys were 38% and 37%, respectively. Nearly 80% (69 of 87) of residents indicated that the curriculum was above average or outstanding. Our evaluation revealed very small immediate improvements in knowledge and confidence. No significant improvement in patients' HbA1cs or blood pressures occurred after the curriculum.Results Explicit training to work in a PCMH was feasible and resulted in high levels of resident satisfaction and immediate small improvements in knowledge and confidence.Conclusions
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Kieber-Emmons, Autumn M., and William L. Miller. "The Patient-Centered Medical Home (PCMH) Framing Typology for Understanding the Structure, Function, and Outcomes of PCMHs." Journal of the American Board of Family Medicine 30, no. 4 (July 2017): 472–79. http://dx.doi.org/10.3122/jabfm.2017.04.170058.
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Castelli, Gregory, Jennifer L. Bacci, Sarah Krahe Dombrowski, Maria Osborne, Aaron Difilippo, Patricia M. Klatt, and Melissa Somma McGivney. "Pharmacist-Delivered Comprehensive Medication Management Within Family Medicine Practices." Family Medicine 50, no. 8 (September 6, 2018): 605–12. http://dx.doi.org/10.22454/fammed.2018.391124.
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Background and Objectives: Pharmacist inclusion in patient-centered medical home (PCMH) teams has been shown to benefit both patients and practices. However, pharmacists’ inclusion on these teams is not widespread, partly because the work they do is not well known. The Successful Collaborative Relationships to Improve PatienT care (SCRIPT) project was started in August 2009 to understand the clinical and economic impact of pharmacists providing direct patient care. The objective of this study was to describe the work of pharmacists practicing as integrated members of the patient care team within PCMHs through retrospective analysis of their patient care documentation over a 4-year time frame. Two pharmacists were placed into four suburban medical home practices in Pittsburgh, Pennsylvania to perform comprehensive medication management (CMM). These pharmacists documented their CMM encounters in an electronic health record and a database for reporting purposes. Methods: This study is a retrospective, descriptive analysis of pharmacist-documented CMM encounters from February 2010 through February 2014. Pharmacists’ work—including patient demographics, disease states, and medication therapy problems—was recorded in a Microsoft Access database and tabulated. Results: The pharmacists conducted 11,206 CMM encounters with 3,777 unique patients during the study period. The pharmacists identified 9,375 medication therapy problems (MTPs) and performed 14,092 interventions. Pharmacists most commonly worked with patients with diabetes, hypertension, pain, and hyperlipidemia. Physician and patient acceptance of the pharmacists’ work was high. Conclusions: Pharmacists working in family medicine offices contribute to patient care through identification and resolution of MTPs and also by collaborating with PCMH teams.
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Williams-Livingston, Arletha, Tabia Henry Akintobi, and Ananya Banerjee. "Community-Based Participatory Research in Action: The Patient-Centered Medical Home and Neighborhood." Journal of Primary Care & Community Health 11 (January 2020): 215013272096845. http://dx.doi.org/10.1177/2150132720968456.
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Background: The Morehouse School of Medicine Patient Centered Medical Home and Neighborhood Project was developed to implement a community-based participatory research driven, integrated patient-centered medical home and neighborhood (PCMH) pilot intervention. The purpose of the PCMHN was to develop a care coordination program for underserved, high-risk patients with multiple morbidities served by the Morehouse Healthcare Comprehensive Family Health Clinic. Measures: A community needs assessment, patient surveys and provider interviews were administered. Results: Among a panel of 367 high-risk patients and potential participants, 93 participated in the intervention and 42 patients completed the intervention. The patients self-reported increased utilization of community support, increased satisfaction with health care options, and increased self-care management ability. Conclusion: The results were largely attributable to the efforts of community health workers and targeted community engagement. Lessons learned from implementation and integration of a community-based participatory approach will be used to train clinicians and small practices on how to affect change using a care coordination model for underserved, high-risk patients emphasizing CBPR.
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Reeve, C. D., M. A. Carver, and D. J. Hopper. "Stereochemical aspects of the oxidation of 4-ethylphenol by the bacterial enzyme 4-ethylphenol methylenehydroxylase." Biochemical Journal 269, no. 3 (August 1, 1990): 815–19. http://dx.doi.org/10.1042/bj2690815.
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The O2-independent hydroxylase 4-ethylphenol methylenehydroxylase (4EPMH) from Pseudomonas putida JD1 catalysed the complete conversion of 4-ethylphenol into 1-(4-hydroxyphenyl)ethanol together with a small amount of 4-hydroxyacetophenone, but with no formation of the side product 4-vinylphenol reported to be formed when the similar enzyme p-cresol methylhydroxylase (PCMH) catalyses this reaction. The enantiomer of 1-(4-hydroxyphenyl)ethanol produced by 4EPMH was R(+) when horse heart cytochrome c or azurin was used as electron acceptor for the enzyme. PCMHs from various bacterial strains produced the S(-)-alcohol. Both enantiomers of 1-(4-hydroxyphenyl)ethanol were substrates for conversion into 4-hydroxyacetophenone by 4EPMH, but the S(-)-isomer was preferred. The Km and kcat. were 1.2 mM and 41 s-1 respectively for the S(-)-alcohol and 4.7 mM and 22 s-1 for the R(+)-alcohol. In addition to the 1-(4-hydroxyphenyl)ethanol dehydrogenase activity of 4-EPMH, NAD(+)-linked dehydrogenase activity for both enantiomers of the alcohol was found in extracts of Ps. putida JD1.
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Possis, Elizabeth, Beret Skroch, Samuel Hintz, Carrie Bronars, Michael Mallen, Haley Crowl, Kelly Moore, Heather Bemmels, and Douglas Olson. "Examining and Improving Provider Adherence to the Primary Care Mental Health Integration Model." Military Medicine 185, no. 9-10 (July 3, 2020): e1411-e1416. http://dx.doi.org/10.1093/milmed/usaa140.
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Abstract Introduction The Veterans Health Administration (VHA) is a national leader in integrated care, known in the VHA as the Primary Care Mental Health Integration (PCMHI) model. This model is associated with improved quality of services and same-day access for veterans. There has been some recent development of PCMHI/integrated care competencies within VHA and across the nation. To fully implement these competencies, however, PCMHI providers must not only be trained, but their adherence to the PCMHI model must also be assessed. While there have been recent advances, there has been little research that has examined the adherence of PCMHI providers to the model or methods to improve adherence. Materials and Methods The present study sought to examine and improve the clinical practice of a team of eight PCMHI providers to make practice more adherent to the PCMHI model. This study was conducted at a large Midwestern VA Medical Center using interventions based in assessment, feedback, and training—measured at three points in time. The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ; Beehler GP, Funderburk JS, Possemato K, et al.: Psychometric assessment of the primary care behavioral health provider adherence questionnaire (PPAQ). Transl Behav Med 2013; 3: 379–91.) was used to assess provider adherence and the PPAQ toolkit was used to provide tailored recommendations for improving provider practice. In addition, the VHA “Foundations Manual” and Functional Tool outlined essential behavioral targets that are consistent with the PCMHI model and the “essential provider behaviors” from the PPAQ. A combination of individual and group interventions was presented and adherence, pre and post, was assessed with the PPAQ and with evaluation of clinical practice data. Results Results indicated that the behavior of PCMHI providers changed over time, with providers exhibiting more PCMHI consistent behaviors and fewer inconsistent behaviors. Adherence to the PCMHI model increased. Conclusion Providing assessment, feedback, and training in the PCMHI model changed the clinical practice of PCMHI providers and resulted in improved adherence. Clinical and research implications are discussed.
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Mendoza, Karla, Arianna Ulloa, Nayelhi Saavedra, Jorge Galván, and Shoshana Berenzon. "Predicting Women’s Utilization of Primary Care Mental Health Services in Mexico City." Journal of Primary Care & Community Health 8, no. 2 (November 17, 2016): 83–88. http://dx.doi.org/10.1177/2150131916678497.
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Objective: To analyze factors associated with and predicting Mexican women seeking primary care mental health services (PCMHS) and provide suggestions to increase PCMHS utilization. Method: We administered a questionnaire to (N = 456) female patients in Mexico City primary care clinics. We conducted chi-square analyses of seeking PCMHS and sociodemographic variables, perceptions of and experiences with PCMHS. Our results and literature review guided our logistic regression model. Results: Women referred to a mental health provider (MHP; odds ratio [OR] = 10.81, 95% CI = 3.59-32.51), whose coping mechanisms included talking to a MHP (OR = 5.53, 95% CI = 2.10-14.53), whose primary worry is loneliness (OR = 8.15, 95% CI = 1.20-55.10), and those who follow doctor’s orders; were more likely to seek PCMHS (OR = 0.28, 95% CI = 0.09-0.92). Conclusions: Primary care providers play a fundamental role in women’s decisions to seek PCMHS. Proper referrals to PCMHS should be encouraged.
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Kim, Jungyoon, Valerie Pacino, Hongmei Wang, April Recher, Isha Jain, Vaibhavi Mone, Jihyun Ma, et al. "System Redesign: The Value of a Primary Care Liaison Model to Address Unmet Social Needs among Older Primary Care Patients." International Journal of Environmental Research and Public Health 18, no. 21 (October 23, 2021): 11135. http://dx.doi.org/10.3390/ijerph182111135.
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Assessing and addressing social determinants of health can improve health outcomes of older adults. The Nebraska Geriatrics Workforce Enhancement Program implemented a primary care liaison (PCL) model of care, including training primary care staff to assess and address unmet social needs, patient counseling to identify unmet needs, and mapping referral services through cross-sectoral partnerships. A PCL worked with three patient-centered medical homes (PCMHs) that are part of a large integrative health system. A mixed-methods approach using a post-training survey and a patient tracking tool, was used to understand the reach, adoption, and implementation of the PCL model. From June 2020 to May 2021, the PCL trained 61 primary care staff to assess and address unmet social needs of older patients. A total of 327 patients, aged 65 years and older and within 3–5 days of acute-care hospital discharges, were counseled by the PCL. For patients with unmet needs, support services were arranged through community agencies: transportation (37%), in-home care (33%), food (16%), caregiver support (2%), legal (16%), and other (16%). Our preliminary results suggest that the PCL model is feasible and implementable within PCMH settings to address unmet social needs of older patients to improve their health outcomes.
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Yeom, Inji, Kiduk Kim, Junhwan Choi, and Dong-Mi Yoo. "Experiences and perspectives on patient-centered education of medical students in Korea." Korean Journal of Medical Education 34, no. 4 (December 1, 2022): 259–71. http://dx.doi.org/10.3946/kjme.2022.235.
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Purpose: This study analyzed the current status of and correlations between Korean medical students’ experiences and perspectives surrounding patient-centered medical education (PCME).Methods: A structured PCME questionnaire composed of three categories, understanding patients within social and cultural contexts, understanding patients’ individual health contexts through communication, and placement of patients at the center of medical education, was used. The students were stratified into pre-medical (Pre-med), medical (Med), and policlinic (PK) groups because of curriculum differences by grade. The χ<sup>2</sup> test was applied to analyze the association between students’ experiences with and perspectives on PCME. A Cramer’s V of 0.200 was considered a large effect size for any association between experiences with and perspectives on PCME.Results: Among the respondents, 50.6% answered that they did not know about patient-centered medicine before the survey. With increasing school years went up from Pre-med to PK, fewer students agreed that PCME should be added to pre-clinical medicine curricula (p<0.001), that patients should be in the center throughout medical education (p=0.011), and that patients’ personal histories, values, and objectives are important PCME (p=0.001). Students who said they learned PCME for each category were more likely to consider PCME important (Cramer’s V was 0.219 and 0.271 for “with,” and “for the patients” respectively, p<0.001 for “about/with/for the patients”). Students in all groups chose clinical practice as the best method for PCME (p=0.021). Med group chose the lectures as the most effective tool to learn about the importance of communication (p<0.001).Conclusion: Students who experienced PCME were likely to perceive PCME as important and it showed that experiences of PCME had positive effects on PCME perceptions. Despite students’ preferences for clinical practice as the best method for PCME, PK reported that they did not learn PCME, and regarded PCME as less important compared to students at earlier stages of their medical education. Therefore, more intensive and holistic PCME curricula rather than only clinical practice exposure may be necessary.
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Aaronson, Alexander, Asaf Achiron, and Raimo Tuuminen. "Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac." Journal of Clinical Medicine 9, no. 9 (September 21, 2020): 3034. http://dx.doi.org/10.3390/jcm9093034.
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Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
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Chen, Xiu, Meng Hong Yuan, Yong Bin Lai, Yin Nan Yuan, Xing Qiao, Ling Ling Cai, and Yu Qi Zhang. "Viscosity-Temperature Characteristic of Biodiesel Derived from Pistacia Chinensis Oil." Advanced Materials Research 1033-1034 (October 2014): 138–41. http://dx.doi.org/10.4028/www.scientific.net/amr.1033-1034.138.
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The chemical compositions and viscosity-temperature characteristic of Pistacia Chinensis methyl ester (PCME) are investigated. Viscosity-temperature equations are proposed for predicting kinematic viscosity of PCME,PCME/0 petrodiesel (0PD) and PCME/-10 petrodiesel (-10PD) at different temperature. The objective is to show that PCME is mainly composed of fatty acid methyl esters of 14-24 even-numbered C atoms: C14:0-C24:0, C16:1-C22:1, C18:2-C20:2 and C18:3. The kinematic viscosity (40 °C) of PCME is 5.99mm2/s. PCME has higher kinematic viscosity and unfavorable viscosity temperature characteristic. An approach to reduce viscosity and enhance viscosity-temperature characteristic is put forward: blending with 0 PD or-10PD.
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Farhat, Nada M., Jolene R. Bostwick, and Stuart D. Rockafellow. "Improving Ambulatory Care Resident Training: Preparing for Opportunities to Treat Mental Illness in the Primary Care Setting." Journal of Pharmacy Practice 31, no. 5 (September 11, 2017): 497–502. http://dx.doi.org/10.1177/0897190017729598.
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Purpose: The development of an outpatient psychiatry clinical practice learning experience for PGY2 ambulatory care pharmacy residents in preparation for the treatment of psychiatric disorders in the primary care setting is described. Summary: With the increased prevalence of psychiatric disorders, significant mortality, and limited access to care, integration of mental health treatment into the primary care setting is necessary to improve patient outcomes. Given the majority of mental health treatment occurs in the primary care setting, pharmacists in patient-centered medical homes (PCMHs) are in a unique position with direct access to patients to effectively manage these illnesses. However, the increased need for pharmacist education and training in psychiatry has prompted a large, Midwestern academic health system to develop an outpatient psychiatry learning experience for PGY2 (Postgraduate Year 2) ambulatory care pharmacy residents in 2015. The goal of this learning experience is to introduce the PGY2 ambulatory care residents to the role and impact of psychiatric clinical pharmacists and to orient the residents to the basics of psychiatric pharmacotherapy to be applied to their future practice in the primary care setting. Conclusion: The development of an outpatient psychiatry learning experience for PGY2 ambulatory care pharmacy residents will allow for more integrated and comprehensive care for patients with psychiatric conditions, many of whom are treated and managed in the PCMH setting.
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Zhang, Kaidi, Wei Wei, Yuwei Sun, Qiang Wu, Min Tang, and Mingjian Lu. "Design and Optimization of the Inlet Header Structure in Microchannel Heat Exchanger Based on Flow Distribution Uniformity." Applied Sciences 12, no. 13 (June 29, 2022): 6604. http://dx.doi.org/10.3390/app12136604.
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The flow distribution in a printed circuit heat exchanger (PCHE) is of great theoretical and practical significance in the Brayton cycle power generation system. For the straight barrel inlet header PCHE, when S-CO2 flows in the PCHE, the structural types and working parameters of the inlet header and diversion zone may lead to differences in the flow distribution in each channel of the PCHE. This flow distribution difference affects the thermal hydraulic characteristics of the PCHE. A numerical simulation method was applied to explore the flow uniformity of the PCHE and the overall performance and analyze the influence of the type of straight barrel inlet header PCHE. Within each layer, the flow showed an uneven flow distribution, and the optimized inlet header was the tapered type. The results showed that when the taper angle varies from 6° to 9°, the flow distribution in each layer is relatively uniform. The comprehensive heat transfer performance of the straight-channel PCHE can be improved by 17.3–19.7%. Finally, the response surface and a genetic algorithm were combined to optimize the inlet header. The heat transfer performance of the optimized PCHE was improved by 19.7%.
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Quigley, Denise D., Nabeel Qureshi, Luma Al Masarweh, and Ron D. Hays. "Practice Leaders Report Targeting Several Types of Changes in Care Experienced by Patients During Patient-Centered Medical Home Transformation." Journal of Patient Experience 7, no. 6 (June 23, 2020): 1509–18. http://dx.doi.org/10.1177/2374373520934231.
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Patient-centered medical home (PCMH) has spurred primary care reform and improvements in patient care quality. Very little is known about the differences practices implement during PCMH transformation. We examined 105 primary care practice leader experiences during PCMH transformation, asking in semi-structured interviews about the changes they targeted. We used content analysis to classify these PCMH changes and examined how they aligned with what is measured on PCMH-recommended patient experience surveys. During PMCH transformation, practices most commonly targeted changes in care coordination (30%), access to care (25%), and provider communication (24%). Reported areas of PCMH transformation were measured by Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CAHPS), PCMH CAHPS, or supplemental CAHPS survey items, including team-based care (35%), providing more services on site (28%), care management (22%), patient-centered culture (18%), and chronic condition health education (13%). Many PCMH changes are captured by CAHPS patient experience items; some are not. For some uncaptured areas, patients are not the best source of information. To provide practice leaders information they need for PCMH transformation, CAHPS items need to measure care management to support medical and chronic conditions, and chronic condition health education.
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Kuma, Dominic Nkwantabisa, Alex Boye, Godwin Kwakye-Nuako, Yaw Duah Boakye, Justice Kwaku Addo, Ernest Amponsah Asiamah, Eugene Agyei Aboagye, Orleans Martey, Mainprice Akuoko Essuman, and Victor Yao Atsu Barku. "Wound Healing Properties and Antimicrobial Effects of Parkia clappertoniana Keay Fruit Husk Extract in a Rat Excisional Wound Model." BioMed Research International 2022 (July 23, 2022): 1–18. http://dx.doi.org/10.1155/2022/9709365.
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Background. Parkia clappertoniana Keay (Family: Fabaceae) (P. clappertoniana) fruit husk is commonly used in northern Ghana for wound treatment. However, this folk claim remains to be confirmed scientifically. Objective. This study investigated wound healing and antimicrobial effects of P. clappertoniana fruit husk extract (PCFHE) by using excision wound model in rats. Materials and Methods. After preparation and phytochemical analysis of PCFHE, it was reconstituted in purified water and emulsifying ointment yielding a wound healing formula (0.3, 1, and 3%). Excision wounds were established in healthy male Sprague-Dawley rats (aged 8-10 weeks; weighing 150–200 g). Rats were randomly assigned into six groups (model, 1% silver sulfadiazine [SSD], vehicle, and PCFHE [0.3, 1, and 3%, respectively]) and topically treated daily until complete wound healing. The endpoints (period of epithelialization, wound contraction, collagen content, erythema index, oedema index, inflammatory cell infiltration, and antimicrobial activity) were assessed for all groups. Minimum fungicidal concentration (MFC), minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and time-kill were assessed. Results. Quercetin and catechin were detected in PCFHE. Compared to model and vehicle groups, PCFHE-treatment groups improved wound healing and antimicrobial (MBC, MFC, and MIC) endpoints. PCFHE demonstrated bacteriostatic and fungicidal effects against identified wound contaminants (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Candida albicans). Conclusion. P. clappertoniana fruit husk possesses wound healing and antimicrobial effects in excisional wounds in rats that confirms its folk use, and the reported pharmacological properties of PCFHE are attributable to its quercetin and catechin phyto-constituents.
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Andreozzi, Elisa, and Gaylen A. Uhlich. "PchE Regulation of Escherichia coli O157:H7 Flagella, Controlling the Transition to Host Cell Attachment." International Journal of Molecular Sciences 21, no. 13 (June 28, 2020): 4592. http://dx.doi.org/10.3390/ijms21134592.
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Shiga toxins and intimate adhesion controlled by the locus of enterocyte effacement are major enterohemorrhagic Escherichia coli (EHEC) virulence factors. Curli fimbriae also contribute to cell adhesion and are essential biofilm components. The transcriptional regulator PchE represses the expression of curli and their adhesion to HEp-2 cells. Past studies indicate that pchE also represses additional adhesins that contribute to HEp-2 cell attachment. In this study, we tested for pchE regulation of several tissue adhesins and their regulators. Three adhesin-encoding genes (eae, lpfA1, fliC) and four master regulators (csgD, stpA, ler, flhDC) were controlled by pchE. pchE over-expression strongly up-regulated fliC but the marked flagella induction reduced the attachment of O157:H7 clinical isolate PA20 to HEp-2 cells, indicating that flagella were blocking cell attachments rather than functioning as an adhesin. Chemotaxis, motor, structural, and regulatory genes in the flagellar operons were all increased by pchE expression, as was PA20 motility. This study identifies new members in the pchE regulon and shows that pchE stimulates flagellar motility while repressing cell adhesion, likely to support EHEC movement to the intestinal surface early in infection. However, induced or inappropriate pchE-dependent flagellar expression could block cell attachments later during disease progression.
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RUSTEMEIJER, C., J. A. SCHOUTEN, H. J. VOERMAN, A. C. BEYNEN, A. J. M. DONKER, and R. J. HEINE. "Is pseudocholinesterase activity related to markers of triacylglycerol synthesis in Type II diabetes mellitus?" Clinical Science 101, no. 1 (May 23, 2001): 29–35. http://dx.doi.org/10.1042/cs1010029.
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Hypertriglyceridaemia is a risk factor for cardiovascular disease in patients suffering from Type II diabetes mellitus, and is due to enhanced synthesis and/or impaired clearance of triacylglycerol-rich lipoproteins. In the present study we investigated whether pseudocholinesterase (PChE) activity could serve as a marker for the rate of triacylglycerol synthesis in these patients. Patients were stratified according to their apolipoprotein E (apoE) phenotype, i.e. E3E2, E3E3 or E3E4. In study I, the relationship between PChE activity and serum triacylglycerols was investigated in 224 insulin-treated patients with Type II diabetes. In study II, which had a cross-over design, PChE activity was measured in 45 dyslipidaemic, insulin-treated patients with Type II diabetes that were treated with bezafibrate or pravastatin. In study I, PChE activity was correlated positively with serum triacylglycerol concentrations, but did not differ significantly between apoE phenotypes. The strongest relationship was found in the E3E4 group (r = 0.50; P = 0.001), the phenotype for which hypertriglyceridaemia is expected to be the result of increased triacylglycerol synthesis. In a stepwise multiple regression analysis, serum triacylglycerol concentrations were found to be the strongest predictor of PChE activity in the E3E4 group. In study II, PChE activity decreased as a result of bezafibrate treatment in all three apoE groups. The decrease in PChE activity with bezafibrate treatment paralleled the decrease in serum triacylglycerol concentrations in the apoE subgroups. Pravastatin treatment did not significantly affect PChE activity. Thus the present study suggests an association between PChE activity and the rate of triacylglycerol synthesis. Measurement of PChE activity may therefore be a useful tool in the choice of drug for treatment of hypertriglyceridaemia in patients with Type II diabetes.
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Parikh, Mamta, Ekaette E. Ebong, Erin Harris, and Brittany Barnes. "Evaluation of clinical pharmacy services within the primary care–mental health integration model at the Tuscaloosa Veterans Affairs Medical Center." Mental Health Clinician 6, no. 5 (September 1, 2016): 260–65. http://dx.doi.org/10.9740/mhc.2016.09.260.
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Abstract Introduction: The purpose of this review is to evaluate the direct delivery of health care to veterans before and after incorporating clinical pharmacy services within primary care mental health integration (PCMHI) at the Tuscaloosa Veterans Affairs Medical Center. Prior to establishing the role of the clinical pharmacy specialist (CPS) within PCMHI, the primary care providers deferred all mental health assessments to specialty mental health. As the demands of the service grew exponentially, assistance from clinical pharmacy was critical. Methods: A randomized, computer-generated list of 114 patients selected for the retrospective chart review was used to evaluate clinical outcomes in patients enrolled in the PCMHI clinic 1 year preincorporation and postincorporation of CPS. Outcome measures included the number of patients discharged from the PCMHI clinic upon achieving therapeutic goals or discharged to specialty mental health due to therapeutic failure or adverse drug events with first- and second-line psychotropic agents. Results: When contrasting the end points, there was a 60% increase in the number of patients who achieved therapeutic goal and a 32% decrease in the number of patients discharged to specialty mental health clinic postincorporation of CPS into PCMHI as compared to preincorporation of CPS (P = .024). Discussion: The results support the significance of CPS in the PCMHI in providing pharmacotherapy, patient education, and medication monitoring for managing psychiatric conditions, such as depression, anxiety, and insomnia. In addition, patients had greater accessibility to medication and frequent monitoring and follow-up, ultimately improving patient outcomes.
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Chang, Cheng-Yen, Wei-Hsin Chen, Lip Huat Saw, Arjay Avilla Arpia, and Manuel Carrera Uribe. "Performance Analysis of a Printed Circuit Heat Exchanger with a Novel Mirror-Symmetric Channel Design." Energies 14, no. 14 (July 14, 2021): 4252. http://dx.doi.org/10.3390/en14144252.
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The printed circuit heat exchanger (PCHE) is a promising waste heat recovery technology to improve energy efficiency. The current investigation presents the experimental results on the thermal performance of a novel PCHE for low-temperature waste heat recovery. The novel PCHE was manufactured using precision machining and diffusion bonding. The thermal performances, such as effectiveness and NTU values at different temperatures, are evaluated, and water is used as a working fluid. The experimental results indicate that the PCHE’s effectiveness is around 0.979 for an inlet flow temperature of 95 °C. The predominant factors affecting the thermal performance of the PCHE are the inlet flow temperature and the flow rate of the working fluid. In addition, a comparison of the experimental results and the literature shows that the effectiveness of the PCHE is better than the others, which have fewer layers of PCHE fins.
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Weiss, Linda, Kerry Griffin, Meng Wu, Ellie DeGarmo, Foram Jasani, and José A. Pagán. "Transforming Primary Care in New York Through Patient-Centered Medical Homes: Findings From Qualitative Research." Journal of Primary Care & Community Health 13 (January 2022): 215013192211125. http://dx.doi.org/10.1177/21501319221112588.
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Background: The patient-centered medical home (PCMH) model, an important component of healthcare transformation in the United States, is an approach to primary care delivery with the goal of improving population health and the patient care experience while reducing costs. PCMH research most often focuses on system level indicators including healthcare use and cost; descriptions of patient and provider experience with PCMH are relatively sparse and commonly limited in scope. This study, part of a mixed-methods evaluation of a multi-year New York State initiative to refine and expand the PCMH model, describes patient and provider experience with New York State PCMH and its key components. Methods: The qualitative component of the evaluation included focus groups with patients of PCMH practices in 5 New York State counties (n = 9 groups and 67 participants) and interviews with providers and practice administrators at New York State PCMH practices (n = 9 interviews with 10 participants). Through these focus groups and interviews, we elicited first-person descriptions of experiences with, as well as perspectives on, key components of the New York State PCMH model, including accessibility, expanded use of electronic health records, integration of behavioral health care, and care coordination. Results: There was evident progress and some satisfaction with the PCMH model, particularly regarding integrated behavioral health and, to some extent, expanded use of electronic health records. There was less evident progress with respect to improved access and reasonable wait times, which caused patients to continue to use urgent care or the emergency department as substitutes for primary care. Conclusions: It is critical to understand the strengths and limitations of the PCMH model, so as to continue to improve upon and promote it. Strengths of the model were evident to participants in this study; however, challenges were also described. It is important to note that these challenges are difficult to separate from wider healthcare system issues, including inadequate incentives for value-based care, and carry implications for PCMH and other models of healthcare delivery.
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Grzybowski, Andrzej, and Piotr Kanclerz. "The Role of Steroids and NSAIDs in Prevention and Treatment of Postsurgical Cystoid Macular Edema." Current Pharmaceutical Design 24, no. 41 (March 20, 2019): 4896–902. http://dx.doi.org/10.2174/1381612825666190206104524.
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Background: Pseudophakic cystoid macular edema (PCME) remains one of the most common visionthreatening complication of phacoemulsification cataract surgery (PCS). Pharmacological therapy is the current mainstay of both prophylaxis, and treatment of PCME in patients undergoing PCS. We aimed to review pharmacological treatment options for PCME, which primarily include topical steroids, topical nonsteroidal antiinflammatory drugs (NSAIDS), periocular and intravitreal steroids, as well as anti-vascular endothelial growth factor therapy. Methods: The PubMed and Web Of Science web platforms were used to find relevant studies using the following keywords: cataract surgery, phacoemulsification, cystoid macular edema, and pseudophakic cystoid macular edema. Of articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Other studies were also considered as a potential source of information when referenced in relevant articles. The search revealed 193 publications. Finally 82 articles dated from 1974 to 2018 were assessed as significant and analyzed. Results: Based on the current literature, we found that corticosteroids remain the mainstay of PCME prophylaxis in uncomplicated cataract surgery, while it is still unclear if NSAID can offer additional benefits. In patients at risk for PCME development, periocular subconjunctival injection of triamcinolone acetonide may prevent PCME development. For PCME treatment the authors recommend a stepwise therapy: initial topical steroids and adjuvant NSAIDs, followed by additional posterior sub-Tenon or retrobulbar corticosteroids in moderate PCME, and intravitreal corticosteroids in recalcitrant PCME. Intravitreal anti-vascular endothelial growth factor agents may be considered in patients unresponsive to steroid therapy at risk of elevated intraocular pressure, and with comorbid macular disease. Conclusion: Therapy with topical corticosteroids and NSAIDs is the mainstay of PCME prophylaxis and treatment, however, periocular and intravitreal steroids should be considered in refractory cases.
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Gahramanov, Hafiz, Gabil Zulfiyev, Jahid Shahbazov, and Elgun Aghayev. "Optical Coherence Tomography-guided intravitreal bevacizumab in the treatment of refractory pseudophakic cystoid macular edema – case study." InterConf, no. 32(151) (April 20, 2023): 442–51. http://dx.doi.org/10.51582/interconf.19-20.04.2023.046.
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One of the serious vision threatened complications of cataract surgery is refractory PCME. That is why this complication has to be managed in time and adequately. Non steroidal and steroidal antiinflammatory and anti VEGF agents like bevazicumab are useful for refractory PCME. OCT has an important role in detecting PCME and measurement of central macular thickness to control the treatment of PCME. In this case study patient after rutin uncomplicated FACO surgery with refractory PCME at postop 4-th week is described. Despite of using of topical NSAID+steroidal antiinflammatory treatment there was no improvement in decreased vision and CMT was remained stable increased (811 mmk). Vision was increased only after 2 week of i/v bevazicumab injection, macular edema resolved and CMT decreased (280 mmk) which was revealed by OCT. In conclusion, OCT quided i/v bevacizumab is safe and well tolerated treatment option for refractory PCME.
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Park, Ji Young, Mei Hong, Qi Jia, Young-Chul Lee, Taddesse Yayeh, Eujin Hyun, Dong-Mi Kwak, Jae Youl Cho, and Man Hee Rhee. "Pistacia chinensisMethanolic Extract Attenuated MAPK and Akt Phosphorylations in ADP Stimulated Rat PlateletsIn Vitro." Evidence-Based Complementary and Alternative Medicine 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/895729.
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Pistacia chinensis(Chinese pistache) is a widely grown plant in southern China where the galls extract is a common practice in folk medicine. However, extracts from this plant have never been attempted for their cardiovascular protective effects in experimental setting. Here therefore we aimed to investigate the antiplatelet activity ofPistacia chinensismethanolic extract (PCME) in ADP stimulated rat plateletsin vitro. PCME (2.5–20 μg/mL) inhibited ADP-induced platelet aggregation. While PCME diminished [Ca2+]i, ATP, and TXA2 release in ADP-activated platelets, it enhanced cAMP production in resting platelets. Likewise, PCME inhibited fibrinogen binding toαIIbβ3 and downregulated JNK, ERK, and Akt phosphorylations. Thus, PCME contains potential antiplatelet compounds that could be deployed for their therapeutic values in cardiovascular pathology.
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Kitzman, Heather, Kristen Tecson, Abdullah Mamun, Briget Da Graca, Samrat Yeramaneni, Kenneth Halloran, and Donald Wesson. "Integrating Population Health Strategies into Primary Care: Impact on Outcomes and Hospital Use for Low-Income Adults." Ethnicity & Disease 32, no. 2 (April 21, 2022): 91–100. http://dx.doi.org/10.18865/ed.32.2.91.
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Objective: Our objectives were two-fold: 1) To evaluate the benefits of population health strategies focused on social determinants of health and integrated into the primary care medical home (PCMH) and 2) to determine how these strategies impact diabetes and cardiovascular disease outcomes among a low-income, primarily minority community. We also investigated associations between these outcomes and emergency department (ED) and inpatient (IP) use and costs.Design: Retrospective cohort.Setting: Community-based PCMH: Baylor Scott & White Health and Wellness Center (BSW HWC).Patients/Participants: All patients who attended at least two primary care visits at BSW HWC within a 12-month time span from 2011-2015.Methods: Outcomes for patients participating in PCMH only (PCMH) as compared to PCMH plus population health services (PCMH+PoPH) were compared using electronic health record data.Main Outcomes: Diastolic and systolic blood pressure, hemoglobin A1c, ED visits and costs, and IP hospitalizations and costs were examined.Results: From 2011-2015, 445 patients (age=46±12 years, 63% African American, 61% female, 69.5% uninsured) were included. Adjusted regression analyses indicated PCMH+PoPH had greater improvement in diabetes outcomes (prediabetes HbA1c= -.65[SE=.32], P=.04; diabetes HbA1c= -.74 [SE=.37], P<.05) and 37% lower ED costs than the PCMH group (P=.01). Worsening chronic disease risk factors was associated with 39% higher expected ED visits (P<.01), whereas improved chronic disease risk was associated with 32% fewer ED visits (P=.04).Conclusions: Integrating population health services into the PCMH can improve chronic disease outcomes, and impact hospital utilization and cost in un- or under-insured populations. Ethn Dis. 2022;32(2):91-100; doi:10.18865/ed.32.2.91
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List, Wolfgang, Gernot Steinwender, Wilfried Glatz, Regina Riedl, Andreas Wedrich, and Domagoj Ivastinovic. "The impact of surgeon’s experience and sex on the incidence of cystoid macular edema after uneventful cataract surgery." PLOS ONE 17, no. 12 (December 27, 2022): e0279518. http://dx.doi.org/10.1371/journal.pone.0279518.
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Purpose To assess the rate of pseudophakic cystoid macular edema (pCME) in uneventful cataract surgery in surgeons in training vs experienced surgeons and to analyze the rate of pCME according to surgeon’s sex. Methods Medical reports post phacoemulsification between 2010 and 2018 at the Department of Ophthalmology, Medical University of Graz, Austria, were reviewed for pCME. A running lifetime number of preceding cataract surgeries was used to express hands-on experience. A cut-off number of 300 surgeries was defined to distinguish between surgeons in training and experienced surgeons. Outcome parameters were incidence of pCME, patient’s sex and age, laterality of eye, coexistence of pseudoexfoliation syndrome (PEX), duration of surgery and surgeon’s sex. Results 25.422 surgeries on 18.266 patients were included. The majority was performed by experienced surgeons (23.139, 91.0%) vs 2.283 (9.0%) by surgeons in training (25 surgeons, 9 (36%) female and 16 (64%) male). pCME occurred in 32 eyes (1.4%) following surgery by surgeons in training and in 152 eyes (0.7%) following surgery by experienced surgeons. Chance for pCME was 1.57 higher in training surgeries (95% CI 1.03–2.41, p = 0.034) and longer duration (OR = 1.04; 95% CI 1.02–1.07, p = 0.001). After excluding the first 100 surgeries for every surgeon in training similar results were observed. No difference in risk for pCME was found between female and male surgeons in both groups (training and experienced surgeons). Conclusion In conclusion, the rate for pCME after uneventful cataract surgery is significantly higher for surgeons in training but steadily decreasing and associated to surgical time. No difference in the risk for pCME was found between female and male surgeons.
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Yayeh, Taddesse, Mei Hong, Qi Jia, Young-Chul Lee, Hyun-Jin Kim, Eujin Hyun, Tae-Wan Kim, and Man Hee Rhee. "Pistacia chinensisInhibits NO Production and Upregulates HO-1 Induction via PI-3K/Akt Pathway in LPS Stimulated Macrophage Cells." American Journal of Chinese Medicine 40, no. 05 (January 2012): 1085–97. http://dx.doi.org/10.1142/s0192415x12500802.
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Pistacia chinensis has been used for various purposes in China including as an understock for grafting Pistacia vera. However, little attention was given to its health promoting effects. Therefore, in this study, we investigated the effect of Pistacia chinensis methanolic extract (PCME) containing resorcinol class of phenolic lipids on pro-inflammatory mediators and heme oxygenase-1(HO-1) in lipopolysaccharide stimulated RAW264.7 cells. While PCME (2.5–10 μg/ml) inhibited mRNA expressions of inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and interleukin (IL)-6, it up-regulated HO-1 expression. Likewise, PCME inhibited iNOS protein expression, but not COX-2, and reduced nitric oxide (NO) release. Moreover, Phosphorylated c-Jun N-terminal Kinase (JNK) was attenuated dose-dependently in PCME pre-treated RAW264.7 cells. In addition, PCME up-regulated HO-1 protein expression was diminished by pre-treatment of PI-3K inhibitor. Furthermore, nuclear factor erythroid 2 related factor 2 (Nrf2) repressor was attenuated time-dependently during PCME treatment. Taken together, our study showed (for the first time) that PCME inhibited NO production and up-regulated HO-1 induction via PI-3K/Akt pathway, suggesting the role of Pistacia chinensis as potential sources of anti-inflammatory and antioxidant natural compounds.
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Hearld, Kristine R., Larry R. Hearld, Amy Y. Landry, and Henna Budhwani. "Evidence that patient-centered medical homes are effective in reducing emergency department admissions for patients with depression." Health Services Management Research 32, no. 1 (August 27, 2018): 26–35. http://dx.doi.org/10.1177/0951484818794340.
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The patient-centered medical home (PCMH) has increasingly been touted as one means of integrating behavioral health and primary care and more holistically caring for patients with chronic disease. With its whole person orientation, the PCMH presents an opportunity to reduce emergency department visits for patients with depression by focusing on the patient and his/her health care needs, facilitating communication among providers and patients, and improving patients’ access to care providers across settings. This study examines the relationship between PCMH capacity – defined as the ability to offer a service identified as a component part of the PCMH – and the number of emergency department visits for patients with depression. Health plan claims data, self-report data from physician practices on their PCMH characteristics, and the Area Resource File were analyzed. Results show that overall PCMH capacity is associated with fewer emergency department visits for patients with depression, and interpersonal aspects of the PCMH in particular, were associated with fewer emergency department visits while technical capabilities were not. Interpersonal activities that facilitate care coordination, patient engagement, and connect patients with community resources might be more effective in keeping patients out of the emergency department for unnecessary reasons as compared to technical activities focused on reporting and information management.
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Green, Ellen P., John Wendland, M. Colette Carver, Cortney Hughes Rinker, and Seong K. Mun. "Lessons Learned from Implementing the Patient-Centered Medical Home." International Journal of Telemedicine and Applications 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/103685.
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The Patient-Centered Medical Home (PCMH) is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA). Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients’ needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.
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Jeong, Jee Hyun, Kyung Tae Kang, You Hyun Lee, and Yu Cheol Kim. "Correlation between Severity of Idiopathic Epiretinal Membrane and Irvine–Gass Syndrome." Journal of Personalized Medicine 13, no. 9 (August 30, 2023): 1341. http://dx.doi.org/10.3390/jpm13091341.
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A higher risk of pseudophakic cystoid macular edema (PCME) has been reported in patients with preoperative idiopathic epiretinal membrane (ERM); however, whether the formation of PCME depends on the grade of ERM has not been well established. We conducted a retrospective case–control study of 87 eyes of 78 patients who were preoperatively diagnosed with idiopathic ERM and had undergone cataract surgery. Patients were divided into two groups: PCME and non-PCME groups. After cataract surgery, the ERM status was graded using the Gass and Govetto classifications. Both the central macular thickness (CMT) and ERM grade increased after surgery, and higher preoperative CMT and ERM grades were found in the PCME group. The association between higher-grade ERM and the development of PCME was significant in the Govetto classification (grade 2, odds ratio (OR): 3.13; grade 3, OR: 3.93; and grade 4, OR: 16.07). The study results indicate that close attention should be given to patients with ERM with the presence of an ectopic inner foveal layer before cataract surgery.
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Serra, Rita, Alexandre Sellam, Florence Coscas, Elsa Bruyère, André Sieiro, Gabriel J. Coscas, and Eric H. Souied. "Evaluation of pseudophakic cystoid macular edema using optical coherence tomography angiography." European Journal of Ophthalmology 28, no. 2 (January 11, 2017): 234–40. http://dx.doi.org/10.5301/ejo.5001068.
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Purpose: To compare the optical coherence tomography angiography (OCT-A) findings of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in eyes with pseudophakic cystoid macular edema (PCME) with those of fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) and to compare PCME vascular density values of the SCP and DCP with those of healthy eyes. Methods: In this retrospective observational study, 13 eyes (12 patients) with PCME underwent comprehensive ophthalmologic examinations including visual acuity, FA, SD-OCT, and OCT-A. The vascular density of the SCP and DCP were measured using AngioAnalytics software in all PCME eyes and compared with 46 healthy eyes of 25 subjects. Results: In patients with PCME, at the level of SCP, the mean vascular density in the whole en face image was 44.48 ± 3.61% while it was 50.27 ± 5.30% at the level of the DCP. In contrast, the vascular density in the whole en face image was 50.35 ± 3.22 at the level of SCP while it was 56.15 ± 3.28 at the level of DCP in 46 healthy eyes of 25 subjects. The vascular density of patients with PCME was significantly lower than in healthy subjects at the SCP (p<0.0001) and at the DCP (p<0.0001). Conclusion: We report the OCT-A appearance of PCME and vascular density map with values that can be easily interpreted for quantitative evaluation of retina perfusion status using OCT-A. This approach might be the first step in helping us fully understand the pathophysiologic mechanisms underlying PCME.
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Abid Ali, Sheikh, Refaz Ahmad, Nazir Ahmad, Mudasir Makhdoomi, and Qazi Parvaiz. "Augmentation of immunocytes functions by prunus cerasus fruit and its biotherapeutic potential in mice model." Biomedical and Pharmacology Journal 12, no. 04 (December 25, 2019): 2071–81. http://dx.doi.org/10.13005/bpj/1841.
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A substantial and growing body of scientific research has linked Sour cherries to various biotherapeutic properties and suggested as a candidate for immunomodulation. The effects of graded doses of a chemically standardized methanolic fruit extract (PcMFE) of Prunus cerasus on the immune system and anti-oxidative status of SRBC immunized BALB/c mice were investigated. Oral administration of PcMFE (100-250 mg/kg) enhanced the expression pattern of IgM and IgG titres, stimulated cell mediated immunity reaching peak value with 200 mg/kg b. wt. Flowcytometric analysis of surface markers of T cells (CD4+ and CD8+) and B cells (CD 19+) indicated prominent enhancement in proliferation and differentiation of these lymphocytes. The extract enhanced expression of T helper cells Th1 cytokines interferon (IFN)-γ and interleukin-12 (IL-12) in the sera of treated mice compared with the control group. In vivo studies showed PcMFE increased spleen and thymus indices, activated macrophage functions ex-vivo as indicated by nitroblue tetrazolium reduction potential, inducible nitric oxide synthase activity and bactericidal property significantly. Furthermore, the oxidative stress marker studies revealed that the administration of PcMFE significantly decreased levels of LPO, increased the activities of SOD, CAT and GSH-Px as compared to the control group. These findings indicate PcMFE has immunomodulatory activity in vivo and might play an important role in prevention of oxidative damage in immunological system.
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Hearld, Larry R., Kristine R. Hearld, and Claudia Guerrazzi. "Patient-Centered Medical Home Capacity and Ambulatory Care Utilization." American Journal of Medical Quality 32, no. 5 (November 16, 2016): 508–17. http://dx.doi.org/10.1177/1062860616677319.
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The patient-centered medical home (PCMH) has increasingly received attention as a model of care to potentially remedy the cost and quality problems that confront the US health care system, including and especially ambulatory care–related issues. This study examined the association between physician practices’ PCMH capacity and 3 indicators of ambulatory care utilization: (1) emergency department utilization, (2) ambulatory care sensitive hospitalization rate, and (3) 30-day all-cause readmission rate. Results show that overall PCMH capacity is associated with lower rates, and technical aspects of the PCMH in particular were associated with lower utilization rates while interpersonal capabilities were not.
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Liu, Hu, Yankang Zhang, Pengfei Yu, Jingwen Xue, Lei Zhang, and Defu Che. "Numerical Investigation on Thermal–Hydraulic Performance of a Printed Circuit Heat Exchanger for Liquid Air Energy Storage System." Energies 15, no. 17 (August 31, 2022): 6347. http://dx.doi.org/10.3390/en15176347.
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A printed circuit heat exchanger (PCHE) is utilized to cool the compressor inlet air to increase the compression efficiency in a liquid air energy storage and liquid natural gas (LNG) coupled system, which can offer large-scale energy storage with significantly improved exergy efficiency and round-trip efficiency. In this work, the effect of pressure of air, incline angle, and hydraulic diameter on the performance of a compressed air–water PCHE with a semicircle cross-section was studied. The results show that PCHE can realize the intermediate cooling of air compression in the liquid air energy storage system, and the pressure variation of air shows a limited effect on the heat transfer of PCHE; however, the hydraulic diameter and the incline angle both affect the heat transfer and the flow resistance of PCHE, and the best incline angle is 15°.
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O'Loughlin, Mary, Jane Mills, Robyn McDermott, and Linton Harriss. "Review of patient-reported experience within Patient-Centered Medical Homes: insights for Australian Health Care Homes." Australian Journal of Primary Health 23, no. 5 (2017): 429. http://dx.doi.org/10.1071/py17063.
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Understanding patient experience is necessary to advance the patient-centred approach to health service delivery. Australia’s primary healthcare model, the ‘Health Care Home’, is based on the ‘Patient-Centered Medical Home’ (PCMH) model developed in the United States. Both these models aim to improve patient experience; however, the majority of existing PCMH model evaluations have focussed on funding, management and quality assurance measures. This review investigated the scope of evidence reported by adult patients using a PCMH. Using a systematic framework, the review identified 39 studies, sourced from 33 individual datasets, which used both quantitative and qualitative approaches. Patient experience was reported for model attributes, including the patient–physician and patient–practice relationships; care-coordination; access to care; and, patient engagement, goal setting and shared decision-making. Results were mixed, with the patient experience improving under the PCMH model for some attributes, and some studies indicating no difference in patient experience following PCMH implementation. The scope and quality of existing evidence does not demonstrate improvement in adult patient experience when using the PCMH. Better measures to evaluate patient experience in the Australian Health Care Home model are required.
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Lai, Yong Bin, Bo Wang, Xiu Chen, Xin Jin, Yu Qi Zhang, Jia Min Hu, Jun Feng Shu, and Meng Hong Yuan. "Investigation of Kinematic Viscosity of Pistacia Chinensis-Based Biodiesel Fuel." Advanced Materials Research 953-954 (June 2014): 1117–20. http://dx.doi.org/10.4028/www.scientific.net/amr.953-954.1117.
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The compositions and kinematic viscosity of Pistacia Chinensis-based biodiesel (PCME) are investigated. Viscosity temperature equations are proposed for predicting kinematic viscosity of PCME and its blends with 0 petrodiesel (0PD) /-10 petrodiesel (-10PD) at different temperature. In this work, we show that PCME is mainly composed of fatty acid methyl esters of 14-24 even-numbered C atoms: C14:0-C24:0, C16:1-C22:1, C18:2-C20:2 and C18:3. PCME has higher kinematic viscosity and unfavorable viscosity temperature property, its kinematic viscosity (40 °C) is 5.99 mm2/s. An approach to reduce viscosity and enhance viscosity temperature property is put forward: blending with 0 PD/-10PD.
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Garmavy, Hishyar Mohammed Salih, Ammar Ahmed Mohammed, Hussein Mohammed Rashid, and Fouad Kasim Mohammad. "A meta-analysis of normal human blood cholinesterase activities determined by a modified electrometric method." Journal of Medicine and Life 16, no. 1 (January 2023): 22–34. http://dx.doi.org/10.25122/jml-2022-0215.
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Measurements of blood cholinesterase (ChE) activities, including those of erythrocytes (EChE), plasma or serum (PChE), and whole blood (WBChE), are used to assess exposure to ChE-inhibiting pesticides. The purpose of this review was to report normal reference ChE activities in the blood of healthy adult humans, as determined by a modified electrometric method. We performed a systematic review following PRISMA guidelines. Single-group meta-analysis of means of PChE, EChE, and WBChE activities of adult healthy subjects was conducted using the random effects model. The programs used were Open-Meta Analyst and Meta-Essentials Version 1.5. Studies selected for analysis comprised 21, 19, and 4 reports of normal reference/baseline PChE, EChE, and WBChE activities in 690, 635, and 121 healthy adult males and/or females, respectively. The meta-analysis showed normal reference values of the means (effect sizes) with 95% CI of PChE, EChE, and WBChE activities of healthy adult subjects, which were 1.078 (1.015, 1.142), 1.075 (1.024, 1.125) and 1.331 (1.226, 1.436), respectively. By the subgroup analysis, heterogeneity (I2>89%) was considerably reduced in females to 4.4% and 30.1% for PChE and EChE, respectively. Funnel plots indicated no publication bias. However, Egger's regression confirmed the symmetry of the data points for PChE and WBChE activities with a significant effect on EChE. This meta-analysis showed normal reference values of PChE, EChE, and WBChE activities, measured by a modified electrometric method, in healthy adult humans.
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Richardson, Joshua E., Joshua R. Vest, Cori M. Green, Lisa M. Kern, and Rainu Kaushal. "A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes." Journal of the American Medical Informatics Association 22, no. 4 (March 21, 2015): 815–20. http://dx.doi.org/10.1093/jamia/ocu039.
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Abstract Objective We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. Materials and Methods A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Results Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. Discussion The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. Conclusions New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables.
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GG, Kaushik, and Soni Reena. "PSEUDOCHOLINESTERASE AS A PREDICTOR MARKER IN HYPOTHYROID PATIENTS." International Journal of Clinical and Biomedical Research 4, no. 3 (July 31, 2018): 27–29. http://dx.doi.org/10.31878/ijcbr.2018.43.06.
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Introduction: Hypothyroidism is due to decreased circulating levels of Thyroid hormones and is caused by inadequate functioning of thyroid gland. Pseudocholinesterase (PCHE) is a nonspecific cholinesterase enzyme that hydrolyses choline based esters in plasma. The purpose of this study was to evaluate the serum level of PCHE in hypothyroid patients. Methodology: The present study was conducted on 100 newly diagnosed hypothyroid patients attending the Medical OPD. The results of patients were compared with 100 healthy controls of either sex of similar age group. Anthropometric measurements, T3, T4, TSH, PCHE & Cholesterol estimations were performed. Results: The mean serum PCHE (decrease) level was observed statistically highly significant (p<0.001) in hypothyroid patients as compared with healthy control subjects. A highly significant positive correlation between PCHE with T3 & T4 (p< 0.001) in hypothyroid cases. Conclusion: Serum Pseudocholinesterase may be helpful as biomarker in screening test for hypothyroidism along with thyroid stimulating hormone.
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Han, Jeoh, Sang-Ji Kim, Young-Kook Lee, and Do-Haeng Hur. "Chemical Cleaning of Magnetite Deposits on the Flow Mini-Channels of a Printed Circuit Heat Exchanger in an EDTA-Based Solution." Materials 15, no. 4 (February 16, 2022): 1471. http://dx.doi.org/10.3390/ma15041471.
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The dissolution behavior of magnetite deposited on flow mini-channel surfaces within a printed circuit heat exchanger (PCHE) and the corrosion behavior of a STS 316L PCHE material were investigated in an ethylendiaminetetraacetic acid (EDTA)-based chemical cleaning solution at 93 °C. The fouling in the PCHE was simulated using a water-steam circulation loop system. Most of the magnetite deposits were rapidly dissolved in the early stage of the circulation chemical cleaning. An empirical equation for estimating the dissolution percentage was derived as a function of cleaning time. The PCHE material showed excellent corrosion resistance during the chemical cleaning tests. These results indicate the fouling layers in the PCHEs can be removed efficiently by the chemical cleaning process without concern about base metal corrosion.