Implementing the information prescription protocol in a family medicine practice: a case study.

QUESTION: Can an information prescription protocol be successfully integrated into a family medicine practice seeking to enhance patient education and self-management? SETTING: Milton Family Practice, an outpatient clinic and resident teaching site of the University of Vermont and Fletcher Allen Health Care, is located in a semirural area fifteen miles from main campus. OBJECTIVES: The objectives were to increase physicians\u27 knowledge and use of information prescriptions, sustain integration of information prescription use, and increase physicians\u27 ability to provide patient education information. METHODS: Methods used were promotion of the National Library of Medicine\u27s Information Rx, physician instruction, installation of patient and provider workstations, and a collaborative approach to practice integration. MAIN RESULTS: A post-intervention survey showed increased physician knowledge and use of the Information Rx protocol. Support procedures were integrated at the practice. CONCLUSIONS: Sustainable integration of Information Rx in a primary care clinic requires not only promotion and education, but also attention to clinic organization and procedures

Sustainable Results in Urban Middle Schools: How Principals Use Systems Thinking to Lead Effective Change

This study presents the stories of four urban middle school principals engaged in reform that is grounded on the core principle that every early adolescent has the capacity for high-level intellectual development. Data collected over two years through formal interviews and informal conversations with principals and teachers, school and district surveys and reports, student test data, and personal observations were analyzed from a systems thinking theoretical framework to assess each principal\u27s ability to implement reform that produced sustainable results. A systems thinking framework articulates the importance of a leader\u27s ability to: 1) conceptualize the whole and recognize patterns; 2) aspire a purpose for why the organization exists and describe the beliefs about how members of the organizations will interact; 3) reflect so as to surface assumptions and patterns of behavior that facilitate or block the organizations ability to achieve what they want most. The analysis makes visible that all four principals have the ability to conceptualize, aspire, and reflect. The data also suggest that the principal\u27s clarity of purpose has a significant impact on the their ability to stay focused on moving the school in a coherent direction

Information Rx as Patient-Physician Communication Tool and Community Health Information Program

Patient education, communication and empowerment are critical aspects of management of chronic conditions. Patient involvement and education is encouraged as part of patient safety goals, but, physicians have little time for discussion and a handout collection for all conditions is hard to maintain. On the other hand, Americans of all ages, genders, and groups are seeking and finding health information on the Internet. Though effective for many, problems include ineffective searching, unreliable sources, and prevalence of commercial interests. The Information Prescription Program (Information Rx) developed by the National Library of Medicine (NLM) and the American College of Physicians (ACP) Foundation promotes a way for the physician to recommend quality information about health and empower patients to seek and use information on their own.The study describes a collaborative project to integrate the Information Rxprogram as developed by NLM and the ACP Foundation into a community- based medical practice, and develop the capacity of the nearby public library to provide health information services and specifically to follow up on information prescriptions

Putting Public Safety First: 13 Strategies for Successful Supervision and Reentry

Outlines organizational- and case management-level strategies to reduce recidivism through risk reduction and behavior change, such as by aligning resources with risk factors. Describes each practice's benefits, evidence base, and examples from the field

Army Energy and Water Reporting System Assessment

There are many areas of desired improvement for the Army Energy and Water Reporting System. The purpose of system is to serve as a data repository for collecting information from energy managers, which is then compiled into an annual energy report. This document summarizes reported shortcomings of the system and provides several alternative approaches for improving application usability and adding functionality. The U.S. Army has been using Army Energy and Water Reporting System (AEWRS) for many years to collect and compile energy data from installations for facilitating compliance with Federal and Department of Defense energy management program reporting requirements. In this analysis, staff from Pacific Northwest National Laboratory found that substantial opportunities exist to expand AEWRS functions to better assist the Army to effectively manage energy programs. Army leadership must decide if it wants to invest in expanding AEWRS capabilities as a web-based, enterprise-wide tool for improving the Army Energy and Water Management Program or simply maintaining a bottom-up reporting tool. This report looks at both improving system functionality from an operational perspective and increasing user-friendliness, but also as a tool for potential improvements to increase program effectiveness. The authors of this report recommend focusing on making the system easier for energy managers to input accurate data as the top priority for improving AEWRS. The next major focus of improvement would be improved reporting. The AEWRS user interface is dated and not user friendly, and a new system is recommended. While there are relatively minor improvements that could be made to the existing system to make it easier to use, significant improvements will be achieved with a user-friendly interface, new architecture, and a design that permits scalability and reliability. An expanded data set would naturally have need of additional requirements gathering and a focus on integrating with other existing data sources, thus minimizing manually entered data

The Grizzly, February 19, 1982

Union Victim of Apparent Vandalism • Bomberger to be Closed After Hours if Vandalism Continues • Foreign Language Career Day: Getting an Edge in Business • Arnold to Join Administration • Reagan: Friend of the Forces • Richter Urges Campus Involvement • Parents Notified of Possible Changes in Aid • Fraternities and Presidents • Meistersingers Begin Spring Concert Tour • English Department Considers Changes • News Briefs: Astronomer to Speak at Ursinus College; Winning Photographer to Conduct Courses at Ursinus College • Joan Jett at the Tower: I Don\u27t Care About a Bad Reputation • Winterfest 1982 • Pi Nu Epsilon: New Members Honored • UC Represents Bahrain in Model UN • USGA Notes • Aggies Buried by UC Women • Women Lose Thriller • Women\u27s Badminton • Sports Briefs: Aquabears Drop One to F&M; Men\u27s Intramural B-ball; Gymnasts Vault to Best Scores • Men\u27s Hoops Takes Two Out of Three • Grapplers Record Best in UC Historyhttps://digitalcommons.ursinus.edu/grizzlynews/1073/thumbnail.jp

Actionable, Pathogenic Incidental Findings in 1,000 Participants’ Exomes

The incorporation of genomics into medicine is stimulating interest on the return of incidental findings (IFs) from exome and genome sequencing. However, no large-scale study has yet estimated the number of expected actionable findings per individual; therefore, we classified actionable pathogenic single-nucleotide variants in 500 European- and 500 African-descent participants randomly selected from the National Heart, Lung, and Blood Institute Exome Sequencing Project. The 1,000 individuals were screened for variants in 114 genes selected by an expert panel for their association with medically actionable genetic conditions possibly undiagnosed in adults. Among the 1,000 participants, 585 instances of 239 unique variants were identified as disease causing in the Human Gene Mutation Database (HGMD). The primary literature supporting the variants’ pathogenicity was reviewed. Of the identified IFs, only 16 unique autosomal-dominant variants in 17 individuals were assessed to be pathogenic or likely pathogenic, and one participant had two pathogenic variants for an autosomal-recessive disease. Furthermore, one pathogenic and four likely pathogenic variants not listed as disease causing in HGMD were identified. These data can provide an estimate of the frequency (∼3.4% for European descent and ∼1.2% for African descent) of the high-penetrance actionable pathogenic or likely pathogenic variants in adults. The 23 participants with pathogenic or likely pathogenic variants were disproportionately of European (17) versus African (6) descent. The process of classifying these variants underscores the need for a more comprehensive and diverse centralized resource to provide curated information on pathogenicity for clinical use to minimize health disparities in genomic medicine

Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine

Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder