Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients

Patients with hypertension and other comorbidities have complex health care needs that are challenging to manage in primary care. However, there is strong evidence suggesting that patient-centered approaches in primary care are effective in managing complex multimorbidity. We aim to evaluate the effectiveness of a patient-centered medical home model called ‘WellNet’ versus that of standard care on blood pressure (BP) outcomes among hypertensive patients. We used a cohort study design with a comparison group and case-series design to assess the ‘between-group’ and ‘within-group’ effectiveness of the WellNet program delivered across six general practices in Sydney, Australia. The treatment group included 447 eligible patients who provided consent and who received general practitioner-led care with the integration of care coordinators. The comparison group included 5237 matched patients receiving usual care at four geographically comparable general practices. To assess changes over time, paired, and independent samples t-tests were used to determine significant differences. In addition, analysis of covariance (ANCOVA) was used to identify any significant differences after adjusting for potential covariates. The adjusted model showed significant reductions in systolic BP (−3.4 mmHg; 95% CI −5.1, −1.7; p value < 0.001) in the treatment group at follow-up. However, no significant mean change was observed in diastolic BP. The proportion of patients within the recommended range was found to be significantly higher in the treatment group than in the comparison group (13.6% versus 6.4%). WellNet patients experienced statistically significant and clinically meaningful improvement in BP during the follow-up. The findings of this study may be beneficial to both patients and providers in terms of improved health outcomes and delivery of care, respectively

Tracing the cellular origin of cancer

Although many genes that lead to different types of cancer when mutated have been identified, the cells that initiate tumour formation following accumulation of these mutations have, until recently, remained elusive. This review explores how mouse genetic lineage-tracing experiments that allow the expression of oncogenes and/or the deletion of tumour suppressor genes in defined cell lineages have been instrumental in defining the cellular origin of different solid tumours in mouse models for various human cancers. © 2013 Macmillan Publishers Limited. All rights reserved.SCOPUS: re.jinfo:eu-repo/semantics/publishe