A randomized controlled trial to prevent glycemic relapse in longitudinal diabetes care: Study protocol (NCT00362193)

BACKGROUND: Diabetes is a common disease with self-management a key aspect of care. Large prospective trials have shown that maintaining glycated hemoglobin less than 7% greatly reduces complications but translating this level of control into everyday clinical practice can be difficult. Intensive improvement programs are successful in attaining control in patients with type 2 diabetes, however, many patients experience glycemic relapse once returned to routine care. This early relapse is, in part, due to decreased adherence in self-management behaviors. OBJECTIVE: This paper describes the design of the Glycemic Relapse Prevention study. The purpose of this study is to determine the optimal frequency of maintenance intervention needed to prevent glycemic relapse. The primary endpoint is glycemic relapse, which is defined as glycated hemoglobin greater than 8% and an increase of 1% from baseline. METHODS: The intervention consists of telephonic contact by a nurse practitioner with a referral to a dietitian if indicated. This intervention was designed to provide early identification of self-care problems, understanding the rationale behind the self-care lapse and problem solve to find a negotiated solution. A total of 164 patients were randomized to routine care (least intensive), routine care with phone contact every three months (moderate intensity) or routine care with phone contact every month (most intensive). CONCLUSION: The baseline patient characteristics are similar across the treatment arms. Intervention fidelity analysis showed excellent reproducibility. This study will provide insight into the important but poorly understood area of glycemic relapse prevention

Glioma stem cell lines expanded in adherent culture have tumor-specific phenotypes and are suitable for chemical and genetic screens

SummaryHuman brain tumors appear to have a hierarchical cellular organization suggestive of a stem cell foundation. In vitro expansion of the putative cancer stem cells as stable cell lines would provide a powerful model system to study their biology. Here, we demonstrate routine and efficient derivation of adherent cell lines from malignant glioma that display stem cell properties and initiate high-grade gliomas following xenotransplantation. Significantly, glioma neural stem (GNS) cell lines from different tumors exhibit divergent gene expression signatures and differentiation behavior that correlate with specific neural progenitor subtypes. The diversity of gliomas may, therefore, reflect distinct cancer stem cell phenotypes. The purity and stability of adherent GNS cell lines offer significant advantages compared to “sphere” cultures, enabling refined studies of cancer stem cell behavior. A proof-of-principle live cell imaging-based chemical screen (450 FDA-approved drugs) identifies both differential sensitivities of GNS cells and a common susceptibility to perturbation of serotonin signaling

Components of the costs of controlling quality: A transaction cost economics approach.

This dissertation sought to identify health care organizations' costs to control quality. A central tenet of my argument is that quality is, at its core, the result of a series of transactions among members of a diverse network. A corollary to this argument is that key functions of management in a health care organization (or, for that matter, in any organization) are to oversee the aforementioned transactions, to ensure that they are completed efficiently and effectively, and in so doing, to assure a minimum standard of quality in all aspects of the organization's operations. Thus, if one can identify the resources expended on the managerial control function, one has made significant progress toward determining the organization's cost to control quality. Unfortunately, the ubiquity of managerial activities is such that identifying and assigning costs to all control-oriented activities would be prohibitively expensive. To counter this problem, I employ transaction cost economics (TCE) to narrow the scope of managerial control activities that must be analyzed. Simultaneously, I use an emerging accounting methodology, activity-based costing (ABC), to operationalize the transaction costs. ABC differs from conventional accounting practices because it establishes a causal relationship between organizational activities and the products or services produced; thus, combining ABC and TCE not only allows accurate measurement of organizations' quality control costs, but also links those control costs to specific outputs (e.g., cardiac catheterization, laboratory services, appendectomies). The information generated by the ABC-TCE methodology helps management to differentiate between the activities that add value to goods and services and those that do not. Taken together, the insights afforded by pairing the analytic power of ABC with the theoretical implications of transaction cost economics suggest exciting possibilities for health services research, policy, and practice.Ph.D.AccountingEconomic theoryHealth and Environmental SciencesHealth care managementSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130370/2/9722099.pd

Defining Underinsurance: A Conceptual Framework for Policy and Empirical Analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68972/2/10.1177_002570879305000204.pd

Risk and protective factors for fires, burns, and carbon monoxide poisoning in U.S. households

BACKGROUND: More needs to be known about the prevalence of risk and protective factors for fires, burns, and carbon monoxide poisoning in U.S. households. METHODS: A random-digit-dial survey was conducted about home safety with 1003 respondents representing households in the continental United States. Descriptive statistics assess the prevalence of risk and protective factors for fires, burns, and carbon monoxide overall, and by demographic characteristics, household structure, region, and residential tenure. The data were weighted to adjust for nonresponse and to reflect the U.S. population. RESULTS: Although most respondents reported having a smoke alarm (97%), and 80% reported having one on each level of their home, <20% reported checking the alarm at least every 3 months. Seventy-one percent reported having a fire extinguisher, 29% had a carbon monoxide detector, and 51% of those living with at least one other person had a fire escape plan. Few could report the temperature of their hot water at the tap (9%), or the setting on the hot water heater (25%). Only 6% had an antiscald device. CONCLUSIONS: Results suggest that there is much room for improvement regarding adoption of measures to prevent fires, burns, and carbon monoxide poisoning. Further investigations of the efficacy of carbon monoxide detectors, fire extinguishers, and escape plans, as well as effectiveness studies of fire and burn-prevention efforts are needed