Acute changes in myo-inositol uptake and 22Na+ flux in murine neuroblastoma cells (N1E-115) following insulin

Abstractmyo-Inositol uptake was investigated in a murine neuroblastoma clone (N1E-115) to determine the effect of altered Na+,K+-ATPase activity. The Na+ ionophone monensin, and veratridine, an alkaloid affecting voltage-dependent Na+ entry, increased acute 22Na+ uptake and 22Na+ efflux from pre-loaded cells, concomitant with enhanced myo-inositol uptake. This effect was also seen following insulin. Insulin-stimulated myo-inositol uptake was inhibited by amiloride, ouabain and pyrithiamine. Amiloride inhibition suggests that activation of Na+/H+ exchange preceding Na+,K+-ATPase activation is involved in insulin stimulation of myo-inositol uptake. Pyrithiamine inhibition is an indication of prior activation of the Na+,K+-ATPase α+ catalytic subunit by insulin. The results provide evidence that insulin contributes to the maintenance of Na+, K+-ATPase in neuronal tissue

Engaging rural communities health policy

Aims & Rationale: The Alma-Ata Declaration espouses participation as a right for all citizens and important in the provision of primary health care. Australian health policy discourse encourages citizen engagement, but the extent to which this actually occurs remains unclear. Citizen engagement potentially offers considerable benefits for rural communities – a population with known health disadvantages. Drawing on results of a research project exploring the health policy implications for rural maternity care, this paper aims to (a) discuss the extent of community participation found in four rural north Queensland towns; and (b)consider how policy discourse around citizen engagement may be applied to rural health policies. Methods: Case studies of four rural north Queensland towns were completed. Observational, interview and documentary data were collected and qualitatively analysed via an inductive thematic technique. Findings: The case studies provided little indication of formal mechanisms through which community members could provide input to local health service delivery. Two communities demonstrated rapid mobilisation to rally and apply political pressure when their health services were threatened, but a distinction must be made between community action and true engagement processes. While mindful of the benefits, interviewees at all sites were particularly concerned about the barriers to successful community engagement, including: (i) overcoming community scepticism; (ii) concerns about representativeness; and (iii) community capacity. Benefits to the community: For rural communities, citizen engagement may have particular advantages in enhancing the appropriateness and responsiveness of local health services. Recommendations are made for improving rural communities' input to health policies which affect them

Health policy: understanding outcomes for rural maternity care

Aims and rationale: Despite government commitments to improve rural residents' access to health services, 42% of rural maternity units throughout Queensland have closed over the last 10 years. Such closures raise concerns about equity of access and quality of maternity care for rural communities. There is little literature available which discusses the impact of health policies on rural residents' experiences of accessing maternity care, or the experiences of the health professionals who provide these services. The aims of this study are twofold: (a) critically review government health policies relevant to rural maternity care; and (b) investigate the correlation between health policy discourse and the lived experiences of rural communities in providing and accessing maternity services. Approaches: Relevant Commonwealth and Queensland health policies were identified and critically reviewed. A case study approach was then used to explore the lived experiences of both providers (midwives, GP proceduralists, hospital administrators) and users (community members) of maternity care in four rural, north Queensland towns. Data comprised documentary evidence, interviews with service providers and focus groups with community members. Findings: The reduction of rural maternity services was found to have profound, multifaceted effects on local communities. Lived experiences and policy-related outcomes are discussed within four topic areas: workforce; community engagement; quality and safety of care. Benefits to the community: Understanding policy outcomes for rural maternity units should inform the development of future health policies. Recommendations are aimed at enhancing maternity care provision and access in rural communities

Health policy: outcomes for rural residents’ access to maternity care

Regular health care during pregnancy, birthing and the postnatal period is recommended for improving maternal and neonatal outcomes and accessing such care has become a common expectation for Australian families. Studies have highlighted the relative safety of birthing in rural hospitals even though these units are typically associated with low volumes of deliveries. Yet, in Queensland, the location and number of public maternity units shows a clear trend towards centralisation of services. During 1995- 2005, 43% of Queensland public maternity units closed, with the remaining units predominantly located in coastal and more populated locations. The closure of rural maternity units is not restricted to Queensland: the National Rural Health Alliance estimated 130 rural maternity units had closed across Australia throughout the decade 1996-20065. Growing numbers of closed rural maternity units raises considerable questions regarding the care accessed by rural residents. This paper presents findings from research conducted in north Queensland which examined the impact of health policy on an issue that is of central importance to rural communities—access to birthing services. A multi-dimensional understanding of access to maternity services was adopted in this study, a view which goes beyond measuring access only in terms of geographic distance. Gulliford et al have provided a constructive discussion of the multifaceted nature of access, particularly the differentiation between ‘having access’ and ‘gaining access’ to health care. Having access implies that a person has the opportunity to use a health service if they need or want it. This type of access is often measured in terms of doctors or hospital beds per capita and is dependent on the provision, and geographical allocation of resources, as well as the actual configuration of the network of health services. The authors draw attention to Mooney’s proposition that equal costs in using a service (eg costs of care, costs of travel, lost work) indicates equal access to services. On the other hand, gaining access to health care can be complicated by a variety of barriers including those of a personal nature (eg patients recognising their need to access health care); financial (that is, costs to be borne by the potential patient) or organisational (eg waiting lists)

Health policy and rural health services: using qualitative methodologies in policy analysis

Background: Equity, access, safety and quality are prominent themes in rural health policies at a national level. These policies often contain objectives around improving rural health services and the health status of rural Australians. It is important to consider whether these objectives are being met for rural populations to discern the appropriateness of current policies and the potential need for changes in policy approach. Objective: To understand the influence of policy on provision of, and access to, rural maternity care. Design: Analysis of policy and case studies. Setting: Four north Queensland rural towns. Participants: (a) Rural residents who recently accessed maternity care; and (b) health care professionals involved in the provision of maternity services including midwives, procedural medical practitioners and GPs. Main outcome measures: Identification of predominant themes in government policies that relate to rural maternity care and identification of outcomes for local maternity services. These findings were supplemented by insights to rural citizens’ experiences in accessing maternity care and rural clinicians’ experience in providing care. Results: The findings indicate a dearth of specific policies to support the development and continuation of rural maternity care services. Conclusions: Without detailed policy support for rural maternity care, services at each of the four case study towns appeared more vulnerable to the effects of other non-specific policies and negative environmental factors

Medical education: its role in addressing health inequities in north Queensland

Since its establishment, the School of Medicine and Dentistry (SMD)at James Cook University (JCU) has sought to facilitate the development of a high quality medical workforce equipped and inclined to practise in underserved areas. As a foundation school of the Towards Health Equity Network (THEnet), the socially accountable mandate of the medical school has been recognised and the school seeks to continue engaging with external stakeholders to achieve health equity outcomes for underserved populations. With even greater numbers of medical students in the university system there is now a unique opportunity to redress longstanding workforce shortages in north Queensland. However, to maximize this opportunity, we must ensure that there is vertical integration of training (including between prevocational and vocational), increased training volume and appropriate breadth of specialist training options in the region. This paper will discuss undergraduate and postgraduate activities aimed at increasing the workforce in north Queensland, including: -A review of strategies employed by JCU SMD to encourage growth of a medical workforce which is responsive to the health needs of regional populations including: (a) selection processes which favour rural-origin and Indigenous students; (b) curricular emphasis on rural, remote, Indigenous and tropical health; and (c) lengthy, frequent exposure to practise in rural and remote areas. -A brief overview of the latest JCU graduate outcomes. -Development of the Northern Clinical Training Network (NCTN). The NCTN is a collaborative that spans sectors (university, public and private health services) and geographic regions across north Queensland. Priorities for the NCTN include supporting high quality medical training in the northern region and developing strong vertical integration throughout undergraduate, prevocational and specialist training. These training-based activities across the continuum demonstrate the commitment of various sectors in north Queensland to redressing workforce inadequacies and health inequities in the region

The northern clinical training network and social accountability in medical training

Background: The School of Medicine and Dentistry at James Cook University, Queensland Health and private sector stakeholders have collaborated to develop the Northern Clinical Training Network (NCTN) in north Queensland. The objectives of the NCTN include: (i) supporting the provision of integrated medical education across the training continuum; (ii) encouraging expanded settings for clinical training; and (iii) developing a medical workforce which is responsive to the health needs of northern Queensland populations, many of which are underserved. Purpose I Objectives: The primary purpose of this presentation will be to discuss the opportunities for continuing socially accountable medical education from undergraduate through to junior doctor and vocational training. As background to the discussion, a brief outline will be provided of the guiding objectives, early development and current structure of the NCTN as well as how the NCTN links to current social accountability initiatives within the James Cook University School of Medicine and Dentistry curriculum. Issues I questions for exploration or ideas for discussion: What opportunities are there for continuing socially accountable education into postgraduate medical training? What initiatives for socially accountable postgraduate medical education currently exist? What benefits might be expected of socially accountable medical education that spans the training continuum

Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature

Background A national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector. Aim The literature review aims to answer the following: to what extent does the implementation of the International Organisation for Standardization 9001:2008 quality management system (QMS) facilitate efficiency and sustainability in the ACCHS sector? Methods Thematic analysis of peer-reviewed and grey literature was undertaken from Australia and New Zealand PHC sector with a focus on First Nations people. The databases searched included Medline, Scopus and three Informit sites (AHB-ATSIS, AEI-ATSIS and AGIS-ATSIS). The initial search strategy included quality improvement, continuous quality improvement, efficiency and sustainability. Results Sixteen included studies were assessed for quality using the McMaster criteria. The studies were ranked against the criteria of credibility, transferability, dependability and confirmability. Three central themes emerged: accreditation (n=4), quality improvement (n=9) and systems strengthening (n=3). The accreditation theme included effects on health service expenditure and clinical outcomes, consistency and validity of accreditation standards and linkages to clinical governance frameworks. The quality improvement theme included audit effectiveness and value for specific population health. The theme of systems strengthening included prerequisite systems and embedded clinical governance measures for innovative models of care. Conclusion The ACCHS sector warrants reliable evidence to understand the value of QMSs and enhancement tools, particularly given ACCHS (client-centric) services and their specialist status. Limited evidence exists for the value of standards on health system sustainability and efficiency in Australia. Despite a mandatory second certification standard, no studies reported on sustainability and efficiency of a QMS in PHC

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

BackgroundFederally Qualified Health Centers (FQHCs) deliver care to 26 million Americans living in underserved areas, but few offer telemental health (TMH) services. The social missions of FQHCs and publicly funded state medical schools create a compelling argument for the development of TMH partnerships. In this paper, we share our experience and recommendations from launching TMH partnerships between 12 rural FQHCs and 3 state medical schools.ExperienceThere was consensus that medical school TMH providers should practice as part of the FQHC team to promote integration, enhance quality and safety, and ensure financial sustainability. For TMH providers to practice and bill as FQHC providers, the following issues must be addressed: (1) credentialing and privileging the TMH providers at the FQHC, (2) expanding FQHC Scope of Project to include telepsychiatry, (3) remote access to medical records, (4) insurance credentialing/paneling, billing, and supplemental payments, (5) contracting with the medical school, and (6) indemnity coverage for TMH.RecommendationsWe make recommendations to both state medical schools and FQHCs about how to overcome existing barriers to TMH partnerships. We also make recommendations about changes to policy that would mitigate the impact of these barriers. Specifically, we make recommendations to the Centers for Medicare and Medicaid about insurance credentialing, facility fees, eligibility of TMH encounters for supplemental payments, and Medicare eligibility rules for TMH billing by FQHCs. We also make recommendations to the Health Resources and Services Administration about restrictions on adding telepsychiatry to the FQHCsâ Scope of Project and the eligibility of TMH providers for indemnity coverage under the Federal Tort Claims Act.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149739/1/jrh12323_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149739/2/jrh12323.pd

A framework for feature extraction from hospital medical data with applications in risk prediction

Background: Feature engineering is a time consuming component of predictive modeling. We propose a versatile platform to automatically extract features for risk prediction, based on a pre-defined and extensible entity schema. The extraction is independent of disease type or risk prediction task. We contrast auto-extracted features to baselines generated from the Elixhauser comorbidities. Results: Hospital medical records was transformed to event sequences, to which filters were applied to extract feature sets capturing diversity in temporal scales and data types. The features were evaluated on a readmission prediction task, comparing with baseline feature sets generated from the Elixhauser comorbidities. The prediction model was through logistic regression with elastic net regularization. Predictions horizons of 1, 2, 3, 6, 12 months were considered for four diverse diseases: diabetes, COPD, mental disorders and pneumonia, with derivation and validation cohorts defined on non-overlapping data-collection periods. For unplanned readmissions, auto-extracted feature set using socio-demographic information and medical records, outperformed baselines derived from the socio-demographic information and Elixhauser comorbidities, over 20 settings (5 prediction horizons over 4 diseases). In particular over 30-day prediction, the AUCs are: COPD-baseline: 0.60 (95% CI: 0.57, 0.63), auto-extracted: 0.67 (0.64, 0.70); diabetes-baseline: 0.60 (0.58, 0.63), auto-extracted: 0.67 (0.64, 0.69); mental disorders-baseline: 0.57 (0.54, 0.60), auto-extracted: 0.69 (0.64,0.70); pneumonia-baseline: 0.61 (0.59, 0.63), auto-extracted: 0.70 (0.67, 0.72). Conclusions: The advantages of auto-extracted standard features from complex medical records, in a disease and task agnostic manner were demonstrated. Auto-extracted features have good predictive power over multiple time horizons. Such feature sets have potential to form the foundation of complex automated analytic tasks