Mental Health Care Transitions from Incarceration

The scope of the problem of mental health and incarceration Case & Consideration 1: Severe Mental Illness ○ Brief history of de institutionalization and re institutionalization ○ Philadelphia’s jails at a glance Case & Consideration 2: Violence and trauma Consideration & Consideration 3: Addiction and substance use Models of transitions of care for reentry Community teams and resources Next steps for a Family Medicine physicia

Think Twice before Prescribing Antibiotics for That Swollen Knee: The Influence of Antibiotics on the Diagnosis of Periprosthetic Joint Infection.

Periprosthetic joint infection (PJI) is a rare but devastating complication after total joint arthroplasty. An estimated 7-12% of patients have negative cultures despite clear clinical evidence of infection. One oft-cited reason for this occurrence is the administration of antibiotics in the weeks prior to obtaining cultures. This article reviews the influence of antibiotics on the diagnosis of PJI. Specifically, we examine the effect of prophylactic and therapeutic antibiotic administration on the diagnostic accuracy of microbiological cultures as well as serum and synovial biomarkers. We also explore the potential of molecular techniques in overcoming these limitations in patients who have received antibiotics before specimen collection and propose areas for future research

Team-based Outreach to Improve Colorectal Cancer Screening Rates in an Urban Family Medicine Practice

Aims for Improvement Aim to increase CRCS rates for our resident team patients by 5% by May, 2021 Target Population (n=99): Age 50-74, due for CRCS, office visit within last 2 years, team resident listed as PCP, active on MyChart, and speak Englis

Informed Consent in a Clinical Trial: Participants Satisfaction of the Consent Process and Voluntariness of Participation

A study was conducted among participants in an antiretroviral therapy (ART) clinical trial to determine how voluntary their participation was and their satisfaction to the consent process. A semi structured questionnaire was administered to 88 of the 180 people enrolled in the study at the time of interview and who were willing to participate. Participation in the study was driven mainly by unmet health needs and participant reported benefits (free drug and tests) as the primary motive to participate in the research. The absence of alternatives to access medical services creates challenges to voluntary participation. Most of the participants saw the consent process as satisfactory, the satisfaction might be based on the hope the treatment is giving them and on the trust they have on investigators and the institution. It is then of importance that research participants be given enough time to reflect on the information provided during the consent process before obtaining consent from them

Improving Blood Pressure Control Through Blood Pressure Measurement in an Ambulatory Urban Family Medicine Clinic

Aim Statement: To increase the percentage of patients over the age of 18 with BP controlled to a goal of \u3c140/90 from a baseline of 58% to 68% by April 2020

Increasing Tumor Volume Is Predictive of Poor Overall and Progression-Free Survival: Secondary Analysis of the Radiation Therapy Oncology Group 93-11 Phase I-II Radiation Dose-Escalation Study In Patients With Inoperable Non-Small-Cell Lung Cancer

Purpose Patients with non–small-cell lung cancer (NSCLC) in the Radiation Therapy Oncology Group (RTOG) 93-11 trial received radiation doses of 70.9, 77.4, 83.8, or 90.3 Gy. The locoregional control and survival rates were similar among the various dose levels.We investigated the effect of the gross tumor volume (GTV) on the outcome. Methods and Materials The GTV was defined as the sum of the volumes of the primary tumor and involved lymph nodes. The tumor response, median survival time (MST), and progression-free survival (PFS) were analyzed separately for smaller (≤45 cm3) vs. larger (\u3e45 cm3) tumors. Results The distribution of the GTV was as follows: ≤45 cm3 in 79 (49%) and \u3e45 cm3 in 82 (51%) of 161 patients. The median GTV was 47.3 cm3. N0 status and female gender were associated with better tumor responses. Patients with smaller (≤45 cm3) tumors achieved a longer MST and better PFS than did patients with larger (\u3e45 cm3) tumors (29.7 vs. 13.3 months, p \u3c 0.0001; and 15.8 vs. 8.3 months, p \u3c 0.0001, respectively). Increasing the radiation dose had no effect on the MST or PFS. On multivariate analysis, only a smaller GTV was a significant prognostic factor for improved MST and PFS (hazard ratio [HR], 2.12, p = 0.0002; and HR, 2.0, p = 0.0002, respectively). The GTV as a continuous variable was also significantly associated with the MST and PFS (HR, 1.59, p \u3c 0.0001; and HR, 1.39, p \u3c 0.0001, respectively). Conclusions Radiation dose escalation up to 90.3 Gy did not result in improved MST or PFS. The tumor responses were greater in node-negative patients and women. An increasing GTV was strongly associated with decreased MST and PFS. Future radiotherapy trials patients might need to use stratification by tumor volume. Int. J. Radiation Oncology Biol. Physics, Volume 70, No. 2, pp. 385-390, 200

Structure-function analysis of the Bacillus megaterium GerUD spore germinant receptor protein.

Germination of Bacillus spores is triggered by the interaction of germinant molecules with specialized receptor proteins localized to the spore inner membrane. Germinant receptors (GRs) are comprised typically of three interacting protein subunits, each of which is essential for receptor function. At least some GRs appear to have a fourth component, referred to as a D-subunit protein. A number of D-subunit proteins were shown previously to be capable of modulating the activity of associated GRs. Here, we investigate the topology and structure-function relationships of the Bacillus megaterium QM B1551 GerUD protein, which is associated with the GerU GR. The presented data demonstrate that GerUD can be subjected to relatively extensive structural modifications while retaining function. Indeed, the presence of either of the two transmembrane spanning domains is sufficient to modulate an efficient GerU-mediated germinative response. The precise function of D-subunit proteins has yet to be established, although they may act as molecular chaperones within the spore inner-membrane environment.S.G was the recipient of a RA Fisher bursary award from Gonville and Caius College, University of Cambridge. X.Z is the recipient of an EPSRC Doctoral Training Grant.This is the final version of the article. It was first available from OUP via http://dx.doi.org/10.1093/femsle/fnv21

Medical Stereotypes: Assessing the Use of Race as a Risk Factor

Discussion Objectives: Introduction to issues of race as a risk factor (VBAC Calculator) Race is a social construct, not genetic Unclear causality of observed disparities Possible medical consequences for patients Patient and community trust/mistrust Evaluating the VBAC Calculator Theory/Research into Causes of Health Disparities Ecosocial Theory Racism as opposed to race Evaluating race use in eGFR algorithms Evidence Causal mechanism Effect on health equity/patients Next step

5 Analytics Imperatives for 21st Century Population Health

Dr. Graham Hughes is the Chief Medical Officer within SAS Institute’s Center for Health Analytics & Insights. He is responsible for identifying and developing opportunities to create novel analytics solutions that help health and life science organizations improve care quality, clinical operations and patient outcomes. This forum presentation describes the difference between traditional healthcare business intelligence and a more comprehensive view of the spectrum of analytics. It discusses the importance of having an appreciation for how other industries leverage advanced analytics and how the same techniques can rapidly be applied to healthcare. Lastly, it identifies the 5 key analytic areas the healthcare organizations need to consider in the Population Health management initiatives. Presentation: 52 minutes PowerPoint slides at bottom of page