NYS PROMISE Learning Community Group Concept Mapping: Fall 2016 Case Manager Experience - Final Report

Beginning in 2014, the Federal Government provided funding to New York State as part of an initiative to improve services that lead to sustainable outcomes for youth receiving Supplemental Security Income (SSI) benefits. As part of the NYS PROMISE initiative, Concept Systems, Inc. worked with the Learning Community to develop learning needs frameworks using the Group Concept Mapping methodology (GCM). The GCM projects gather, aggregates, and integrate the specific knowledge and opinions of the Learning Community members. This allows for their guidance and involvement in supporting NYS PROMISE as a viable community of practice. This work also increases the responsiveness of NYS PROMISE to the Learning Community members’ needs by inspiring discussion during the semi-annual in-person meetings. As of the end of year three, three GCM projects have been completed with the PROMISE Learning Community. These projects focused on Outreach and Recruitment Project 1), Case Management and Service Delivery (Project 2), and Case Manager Experience (Project 3). This report discusses the data collection method and participation in the Case Manager Experience GCM project, as well as providing graphics, statistical reports, and a summary of the analysis

Learning Community Group Concept Mapping: Fall 2014 Outreach and Recruitment, Spring 2015 Case Management and Service Delivery. Final Reports

Beginning in 2014, the Federal Government provided funding to New York State as part of an initiative to improve services that lead to sustainable outcomes for youth receiving Supplemental Security Income (SSI) benefits. As part of the NYS PROMISE initiative, Concept Systems, Inc. worked with the Learning Community to develop learning needs frameworks using the Group Concept Mapping methodology (GCM). This GCM project gathers, aggregates, and integrates the specific knowledge and opinions of the Learning Community members and allows for their guidance and involvement in supporting NYS PROMISE as a viable community of practice. This work also increases the responsiveness of NYS PROMISE to the Learning Community members’ needs by inspiring discussion during the semi-annual in-person meetings. As of the end of year two, two GCM projects have been completed with the PROMISE Learning Community. These projects focused on Outreach and Recruitment and Case Management and Service Delivery. This report discusses the data collection method and participation in both GCM projects, as well as providing graphics, statistical reports, and a summary of the analysis. In this report we refer to the Fall 2014 project as Project 1, and the Spring 2015 project as Project 2

Discovery and Strategic Partnership Group Concept Mapping: 2014-2015 Progress Report

In 2014, New York State received funding from the U.S. Department of Education, Office of Special Education and Rehabilitative Services to begin the NYS PROMISE (Promote the Readiness of Minors in Supplemental Security Income) research initiative. The goal of this initiative is to coordinate the system of support surrounding these youths to better catalyze their potential to transition from Supplemental Security Income (SSI) to a sustainable future of living and earning as independent adults. To guide strategy and support PROMISE priorities over the course of the initiative, NYS PROMISE convened the NYS PROMISE Steering Committee, comprised of appointed liaisons from agencies who are connected to the NYS PROMISE initiative. To support sustainable partnership development for greater progress and impact on the goals of NYS PROMISE, the Steering Committee engaged in a structured, time sensitive strategic planning and partnership framework development effort. To develop the elements of a prioritized strategy, the group used Group Concept Mapping (GCM), and constructed a visual framework, or concept map, that served as the basis for prioritization and strategy development throughout the process. The GCM approach employs a group process to capture individual contributions for consensus around a given topic, using a structured approach with a specific sequence of steps that support timely and consistent engagement in the process. GCM incorporates opinions and values, and presents the results in ways that are understandable and usable. 25 individuals from 8 member agencies took part in the concept map development, contributing elements in response to the following prompt: “To yield enduring individual outcomes, a viable system to support youth with disabilities in their transition from high school to successful adult lives needs to include…

NYS PROMISE Case Management: A Field Guide for Case Managers and Family Coaches

Case management services under NYS PROMISE are provided by a robust and diverse network of case managers and family coaches. Case managers work predominantly with youth in the research demonstration sites, while family coaches work exclusively with the families of intervention group youth enrolled in NYS PROMISE through regional Parent Training Centers. Regardless of the title of the practitioner, or their organizational placement, they provide similar critical care, coordination and access to the core services and supports provided under the NYS PROMISE intervention, as well as information and referral for other needed services and supports. In addition, they provide intermittent “light touch” data gathering on control group youth and families. While “field guides” have traditionally been employed in the study of plants and fauna, they have increasingly been created to support practitioners in an array of professional fields as they face the obstacles and challenges that can arise while accomplishing specific tasks. The NYS PROMISE Case Management Field Guide was designed for the express purpose of assisting case managers and family coaches in navigating their day-to-day roles, functions, and expectations, while adhering to high quality standards, and managing the impact of their work on their own health and wellbeing. The aim is to ensure that all NYS PROMISE case managers and family coaches (case management practitioners) are equipped to perform their job in a manner that leads to the expected youth and family outcomes of the NYS PROMISE intervention—holding to a common measure of fidelity. While the aim for each case management practitioner will employ different strategies, based on the heterogeneity of the NYS PROMISE population, they will draw from a common set of strategies to ensure consistency in delivery of services and supports. This field guide is presented in modules and is indexed to assist case management practitioners in easily accessing the information they need, when they need it. Following is a summary of the specific modules included in this field guide

Reactivity of pulmonary circulation and right ventricle function to inhaled nitric oxide in systemic sclerosis patients

Systemic sclerosis (SSc) is complicated by pulmonary hypertension and right ventricle (RV) failure in approximately 10% of the patients. Factors influencing the reactivity of pulmonary circulation to vasodilators are not established, while the examination of vasoreactivity is important in determining the treatment, because systemic administration of oral vasodilators can induce severe adverse events in nonresponders. The mechanism of RV failure in SSc is unclear and may result either from increased RV afterload or intrinsic myocardial disease. The aim of the study was to assess the reactivity of pulmonary circulation to inhaled nitric oxide (iNO) and to evaluate its influence on RV function in SSc patients with elevated right ventricle systolic pressure (RVSP). In 60 SSc patients aged 24–73 (58 females, two males; 33 patients with limited SSc and 27 with diffuse SSc), echocardiographic examination with tissue Doppler echocardiography (TDE) was performed. RV function was measured by systolic (S) and early diastolic (E) velocity of tricuspid annulus by TDE. In patients with RVSP >45 mmHg, the reactivity of pulmonary circulation was assessed by iNO test. High-resolution computerized tomography (HRCT) was performed to assess the extent of pulmonary fibrosis. Of 14 SSc subjects with elevated RVSP (13 females, one male; RVSP 47–62 mmHg), positive reaction to iNO was observed in five (RVSP decreased from 51.6 ± 3.7 to 32.24 ± 2.3 mmHg); nine patients were not reactive (RVSP 53.5 ± 5.7 mmHg before iNO vs. 49.6 ± 6.7 mmHg). RV systolic function was decreased in patients with elevated RVSP as compared to the patients with normal pulmonary pressure (S velocity 13.2 ± 1.3 vs. 14.4 ± 1.6 cm/s, respectively, p < 0.05). Significant increase of RV systolic function during iNO test was found in reactive patients only (S velocity before iNO 12.8 ± 1.2 cm/s, during iNO 14.5 ± 1.5 cm/s, p < 0.01). RVSP decrease strongly correlated with S velocity increase (r = 0.95, p < 0.0001). Response to iNO was found only in limited form of SSc; diffuse SSc patients showed no response. Pulmonary fibrosis on HRCT was more frequent in subjects nonreactive to iNO (67% of patients) than in the reactive group (40% of patients). The reactivity of pulmonary circulation to iNO in SSc patients with elevated RVSP was found predominantly in limited form of the disease. Pulmonary fibrosis typical for diffuse SSc was more frequent in nonreactive subjects. Elevated pulmonary pressure plays an important role in RV systolic dysfunction. Pulmonary pressure decrease during iNO test leads to the improvement of RV systolic function. Therapy for right-heart failure in reactive SSc patients should be directed, if possible, at the decrease in pulmonary resistance

Fibrin structure in organized thrombotic material removed during pulmonary artery endarterectormy : the effect of vessel calibre

Pulmonary endarterectomy (PEA) is a curative therapeutic approach in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The location-dependent structural differences of thrombotic material found in pulmonary arteries in CTEPH are poorly investigated. We present the case of a 47-year-old woman with antiphospholipid syndrome, diabetes mellitus and abnormal fibrin phenotype, who underwent PEA for CTEPH. Intravascular material removed bilaterally during PEA (from lobar, segmental and sub-segmental arteries) has been studied using light and scanning electron microscopy (SEM). Light microscopy showed tighter fibrous network in the portions of intraluminal thrombotic material facing the vessel wall, which contained collagen and fibrin fibers, and abundant cells. Cells, evaluated by immunostaining, were present in the whole removed material. Tissue factor expression was also observed with the highest values in the portions of intravascular material facing the vessel wall. In the main pulmonary arteries, SEM images revealed thick fibers of fibrous proteins loosly meshed and few erythrocytes and platelets between them (both dysmorphic “wedged” and fresh cells were present). In the fibrotic layers, containing mainly collagen and fibrin, removed from the lobar/segmental pulmonary arteries we found a stepwise increase in fiber density with decreasing vessel calibre, followed by denser fibrous networks composed of thinner fibers. Elastic fibers in the lobar and segmental arteries were aligned along the blood flow vector. These findings demonstrate differences in the structure of endarterectomized PEA material dependent on the vessel calibre and might contribute to understanding of CTEPH pathophysiology

Relationship between mitral leaflets angles, left ventricular geometry and mitral deformation indices in patients with ischemic mitral regurgitation: imaging by echocardiography and cardiac magnetic resonance

Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after myocardial infarction (MI).The study aimed to evaluate the relationship between anterior and posterior mitral leaflet angle (MLA) values, left ventricle remodeling and severity of ischaemic mitral regurgitation (IMR). Methods: Forty-two patients (age 63.5 ± 9.7 years, 36 men) with chronic IMR (regurgitant volume, RV > 20 ml; >6 months after MI) underwent transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging. Anterior and posterior MLA, determined by echocardiography, were correlated with indices of LV remodeling, mitral apparatus deformation and IMR severity by CMR. The anterior and posterior MLA was 25.41 ± 4.28 and 38.37 ± 8.89° (mean ± SD). In 5 patients (11.9%) the posterior MLA was ≥45°. There was a significant correlation between anterior MLA and RV (r = 0.74, P = 0.01). For patients with RV > 30 ml this correlation was stronger (r = 0.97, P = 0.005) and, in addition, there was a correlation between the RV and posterior MLA (r = 0.90, P = 0.037), between tenting area and posterior MLA (r = 0.90, P = 0.04), and between tenting area and anterior MLA (r = 0.82, P = 0.08). With regard to LV remodeling parameters, there was weaker but significant correlation between posterior MLA and LV end-diastolic volume index (r = 0.35, P = 0.031), LV end-systolic volume index (r = 0.37, P = 0.021), stroke volume (r = 0.35, P = 0.03), sphericity index (r = 0.33, P = 0.041). Anterior MLA correlated with wall motion score index (r = 0.41, P = 0.019). Besides, there was a correlation between posterior MLA and left atrial volume (r = 0.41, P = 0.012). Measurement of anterior and posterior MLA may play an important role in evaluating patients with IMR

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome