Request For Abstracts: The Practice Of Medicine – Health Affairs (blog)

Health Affairs

February 17, 2017

Health Affairs seeks submissions for a series of articles focusing on the practice of medicine that we will begin publishing in early 2017. The series will explore the broad practice environment and how features of that environment affect physicians, other clinicians, and the practice of medicine on a number of dimensions. The practice environment includes forces that physicians and other clinicians respond to (both on a daily basis and in a strategic sense), such as regulatory requirements, payment policy, quality measurement, economic and market influences, the organization of care, technology, professional standards, etc. We are interested in papers that reflect on and explore how such factors affect care delivery, including consideration of broader implications for health care spending, access to care, and health outcomes.

We will consider new empirical research, essays, reviews, and analysis/commentaries that address these topics.

We invite submissions from anyone with an interest in this topic. Health Affairs reaches a wide audience that includes policymakers; academics and researchers from many disciplines; health and public health professionals and officials; health industry executives; lawyers; consultants; students; and members of the media. Authors should be mindful of this breadth and aim to write for readers who have an interest in health policy issues, but should not assume expertise among readers on any particular topic.

We welcome essays and commentaries, but submissions should have a strong basis in evidence and reflect a thorough understanding of the state of knowledge of the subjects explored as well as the policy issues and questions that surround those subjects.

Please consult our online guidelines for additional formatting instructions and answers tofrequently asked questions.If you have questions about the suitability of a particular paper, please e-mail us at POM_queries@projecthope.org.

We thank you for your time and consideration. Please feel free to pass this invitation along to colleagues who might be interested, as well.

We are grateful to the Physicians Foundation for providing support for this series.

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Request For Abstracts: The Practice Of Medicine – Health Affairs (blog)

Slow Medicine: Good Reads – MedPage Today (blog)

A study published in the New England Journal of Medicine found that high levels of fish oil supplementation during the third trimester of pregnancy in Denmark led to a significant decrease in asthma and wheezing among offspring. Despite these promising results, we agree with the authors and editorialist that fish oil supplementation still should not be recommended during pregnancy. As explained by Maria Makrides in the accompanying Clinical Decision, there are several prior studies that suggest that fish oil does not prevent asthma, the long-term effects on infants are not well-understood, and fish oil supplementation can extend the length of pregnancy.

What month should we start offering the influenza vaccine? Is August or September too early? Does vaccine efficacy wane over a few months as some evidence suggests? A recent STAT report offers a well-balanced discussion of the controversy and a recent study on the topic from CDC investigators.

The USPSTF has concluded there’s no role for screening asymptomatic patients for genital herpes infection using currently available HSV serologic tests. We agree given the poor testing characteristics and unclear benefits, and we see few, if any, indications for HSV serologic testing in routine clinical care.

The USPSTF has, for the most part, been a beacon of Slow Medicine principles. But directly linking insurance coverage decisions to USPSTF guidance could undermine the Task Force’s objectivity, as the authors of this NEJM Perspective argue.

Are we overprescribing oxygen in our patients with COPD? An important new study has found that “in patients with stable COPD and resting or exercise-induced moderate desaturation, the prescription of long-term supplemental oxygen did not result in a longer time to death or first hospitalization than no long-term supplemental oxygen, nor did it provide sustained benefit with regard to any of the other measured outcomes.” According to the editorialist, these findings reconfirm that “long-term oxygen therapy should be prescribed to prolong survival among patients with COPD who have chronic (>3 weeks) severe resting hypoxemia (PaO2 of 55 mm Hg or SpO2 of

Sometimes, more is better. This appears to be the case for treating acute otitis media in children 6 to 23 months of age: 10 days of amoxicillin-clavulanate is better than a 5-day course. Still, as the NEJM editorialist emphasizes, antibiotics should be used only in those children with a definitive diagnosis of acute otitis media, and these findings do not apply to older children.

Were you under the impression that the FRAX tool for fracture prediction was approved by the World Health Organization? If so, a recent editorial from the WHO and a blog from our colleagues at Health News Review are essential reading to understand who’s actually behind the FRAX calculator. It’s not who you think.

In JAMA Internal Medicine, a secondary analysis of one of our favorite studies, ALLHAT, finds that chlorthalidone is slightly more effective in preventing osteoporotic fractures than amlodipine or lisinopril. This further supports the decision to use chlorthalidone as preferred first-line therapy in treating hypertension.

We are big advocates of tailoring our care based on our patients’ goals, which is why we believe it is critical to systematically track patient-reported outcomes. But as with all new initiatives, we need to think carefully about how to implement these systems effectively, as Ethan Basch explains in the NEJM.

Are extra blood tubes obtained at your institution “just in case” they might be needed for additional tests? A recent JAMA Internal Medicine research letter explains that these extra tubes are usually not necessary and should only be drawn in selected cases.

This exchange of letters in the NEJM underscores an important clinical challenge: when to pursue diagnostic testing for pertussis in adults. It is clear from the letters that more data are needed to guide clinicians. We test for pertussis among patients with a mild upper respiratory tract infection followed by a significant persistent cough, especially when other contacts at home are coughing too.

This JAMA Internal Medicine review summarizes the evidence evaluating outpatient palliative care programs. A limited number of heterogeneous studies point towards potential improvement in quality-of-life measures, especially for cancer patients; however, this article is most useful in highlighting the need for more research into which palliative care programs are effective for which patients, and why.

This NEJM perspective highlights the extraordinary burden placed on family caregivers to tend to older and sicker relatives, and begins to articulate an agenda for better recognizing and supporting this work.

Ever wonder what it is like to be a standardized patient? If so, listen to actor Alex Kramer describe his experience as an undercover patient.

We all need a bit of humor these days and the new song “Treat You Better” might not be viral yet but is just the tune that might make Slow Medicine practitioners smile.

2017-02-17T14:30:00-0500

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Slow Medicine: Good Reads – MedPage Today (blog)

Was Andy Cohen the Shadiest Person at the Married to Medicine Reunion? 5 Fierce Moments You Need to Check Out – Bravo (blog)

It was time for the Married to Medicine ladies to face the heat this week after a contentious Season 4. Allegations, shade, and sass abounded when the crew sat down with Andy Cohenfor the epic post-season chat and Andy didn’t hold back with his own witty barbs while rehashing everything that went down this past season. We’re breaking down some of the buzziest moments from last night in The Daily Dish Morning After.

Listen, even thissquad can’t handle all the shade that Andy brings to the stage. That guy can mess around with the best of them, as you can see above.

With all the debate about the ladies’ marriages and husbands, the fellas will get to weigh in on all the drama during Part 2 of the reunion, airing Friday at 8/7c.

…and better than ever, if you ask us. The Charleston gang returns to the airwaves on Monday, April 3 at 9/8c. In the meantime, preview all the feisty ups and downs above.

While most parents pray their adult kids will move out, The Real Housewives of Beverly Hills mom and self-confessed buritto lover is all about her police officer son, Tommy, residing with her. “I actually love having my son there. He’s free security, OK?” she joked.

In fact he oozes so much pride for his daughters, that they sometimes even make him cry. All together now, “Awww!”

Check back every morning as we’ll be recapping the 5 must-see moments from the night before. And don’t forget to tune in toThe Daily Dishpodcastto get the latest on what’s happening in the Bravo galaxy, currently available oniTunes,Soundcloud,Google Play, and Amazon’s Alexa.

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Was Andy Cohen the Shadiest Person at the Married to Medicine Reunion? 5 Fierce Moments You Need to Check Out – Bravo (blog)

Family Medicine Faculty More Diverse Than Most, but Still Wanting – AAFP News

Departments of family medicine employ a higher percentage of female and underrepresented minority faculty members than do those of other specialties as a group, but there is still a way to go before medical schools catch up with the nation’s changing demographics, according to a recent study.

Researchers at the Association of American Medical Colleges (AAMC) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care analyzed the number of women and racial and ethnic minorities in family medicine departments and compared that figure with averages among all other medical faculty.

The study, “Increasing Family Medicine Faculty Diversity Still Lags Population Trends,”(www.jabfm.org) was published in the January/February issue of the Journal of the American Board of Family Medicine.

From 1980 to 2015, the number of full-time family medicine faculty increased nearly fourfold, from 1,396 to 5,507 positions. The proportion of female and minority faculty in family medicine departments more than doubled during that period.

“The fact that FM departments are becoming more diverse is encouraging, given that primary care faculty are charged with training the source of first-contact, continuous, coordinated and comprehensive care for underserved minority patients,” the researchers wrote.

Still, women and minorities hold a higher percentage of the lower-ranking faculty positions.

Women occupy 51 percent of family medicine assistant professorships and ethnic minorities hold 12.6 percent, a higher average percentage of both groups than is found among other medical faculty departments. But when it comes to full professor positions in family medicine, women occupy just 30 percent, and minorities occupy only 7 percent, according to data from the AAMC Faculty Roster.

Progress can be seen, but diversity among faculty still does not reflect that among the U.S. population as a whole, where ethnic minorities grew from 18 percent of the population in 1980 to 31 percent in 2015.

More rapid gains are being made in gender equality than in racial and ethnic diversity. More undergraduate students entering universities are female, and researchers noted that the majority of black physicians are female.

Imam Xierali, Ph.D., a senior researcher at the AAMC, told AAFP News that incoming minority faculty members could benefit from a mentorship program that offers assistance with writing grants and conducting research, two essential factors that determine eligibility for promotion.

Although the medical profession has pushed to expand the number of physicians, and several new medical schools have opened since 2003, overall diversity ratios have remained flat during that period.

A diverse faculty is important because incoming medical students say that diversity is a consideration when they select a school. It’s particularly problematic that the proportion of minority faculty is lower than that of minority students who are entering medical school.

“We need to double down on our efforts regarding the value of diversity,” Xierali said. “The population base is changing, and we need to acknowledge that.”

Admittedly, achieving diversity will take longer among medical faculty than among the student population because of slow turnover, but that should not discourage family medicine departments and all other medical faculty from rededicating their efforts.

“Medical schools and academic FM departments may need to review their current practices and policies with an eye toward enabling more faculty diversity through institutional transformation and moving diversity from the periphery to the core of institutional excellence,” the researchers wrote.

Related AAFP News Coverage High Court Affirms Value of Diversity in Meeting Educational Mission Carefully Tailored Nod to Race in Med School Admissions Benefits Patients, Say AAFP Experts (7/6/2016)

AAFP Joins Brief Supporting Diversity in Med School Admissions Supreme Court to Hear Oral Arguments Dec. 9 (11/20/2015)

More From AAFP Policy on Workforce Reform

Policy on Diversity in the Workforce

Policy on Medical Schools, Minority and Women Representation In Medicine

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Family Medicine Faculty More Diverse Than Most, but Still Wanting – AAFP News

Medicine Hat unveils proposal to assist residents dealing with poverty – The Globe and Mail

The race to eradicate poverty has moved to the forefront of issues confronting Albertas cities, large and small. The provincial capital has End Poverty Edmonton, a 10-year plan to address the more than 100,000 people living in poverty. In Calgary, Enough For All: The Calgary Poverty Reduction Initiative is working to help the more than 114,000 people who live below the poverty line.

Now, Medicine Hat has joined the fight. On Wednesday, its Poverty Reduction Leadership Group unveiled Thrive, its own proposal to assist the one in 10 residents dealing with poverty defined as someone who earns less than what they need to meet the necessities of life.

But what makes Medicine Hat so uniquely qualified to end poverty is its reputation as a place where things get done.

Two years ago, it became the first Canadian city to solve homelessness. It succeeded by taking 1,072 people, including 312 children, off the streets and providing them with a place to live, be it a house, an apartment, basement suite, trailer, townhouse or condo. The rent was set at 30 per cent of a persons income, and pride of ownership has helped keep homelessness from making a significant comeback.

Medicine Hat has been so vigilant at monitoring homelessness, it has attracted the interest of city officials from Victoria, B.C. to St. Johns, Nfld., to Texas, Washington State and the United Kingdom. The program was so successful it became the springboard for ridding an even bigger problem.

When we announced a functional end to homelessness, the next step was logically poverty reduction, said Medicine Hat Councillor Celina Symmonds, who was involved in the homelessness project as a member of the Community Housing Society. It is a very co-ordinated effort [taking on poverty], but this community does pull together. I like to call it the little community that can.

Emanuel Akech, 44, can attest to that. He arrived alone in Medicine Hat in 2008, after leaving his war-torn homeland of Sudan and spending 14 years in Cuba, before eventually becoming a Canadian citizen. When he reached Medicine Hat, he had only a backpack with him.

Community Housing put him in a place for the night, got him into the Canadian Mental Health Associations Housing First program, which ultimately placed him in a fourplex. He pays his rent from the income support he receives from the federal government. He is aware of how fortunate he is.

I see some suffering the same way. Ive been there, he said of his early days in Alberta. To not suffer like that, I like that way.

Medicine Hats approach is to streamline a one-stop system where all services and social needs can be met. Assistance will come from a myriad of sources including the city, Medicine Hat College, the school board and the food bank, all of them committed to making things work and work well.

Theyre all on the inside and theyre pushing the agenda through their different networks, said Jaime Rogers, manager of the Homeless and Housing Development Department. Thats why this is working, because you have all these background players who have connections and legitimacy in the community.

Measuring poverty in Canada is not an exact exercise. The federal government has defined the low-income measuring point as having half the median income of an equivalent household. In Statistics Canadas most recent survey, nearly five million Canadians were considered impoverished.

End Poverty Edmonton was unveiled in September of 2015 as united task force involving the city, the provinces Poverty Reduction Strategy and the United Ways Capital Region. Its members are business people, academia and health-care and social-service workers. Their research told them one in eight Edmontonians earn less than $16,968 per year.

In Calgary, the Poverty Reduction Initiative first surveyed the public to understand what poverty meant and how it impacted people. Enough For All is a collaborative effort between the city and the United Way of Calgary designed to assist the one in 10 Calgarians living below the poverty line. The goal is to be poverty free in a generation.

I think its a worthy initiative, said John Kolkman, research and policy analysis co-ordinator for the Edmonton Social Planning Council. Is it overly ambitious? Some have argued that theres so much attention on the overarching developments that we miss what it really is a series of small steps.

Mr. Kolkman pointed to Medicine Hat as proof that social ills can be cured.

Medicine Hat has largely eliminated chronic homelessness thats when people cant hold a place to stay no matter what is done. Medicine Hat has the gold standard for eliminating that, he said. Ive been to Medicine Hat and Ive been impressed with how cohesive it is there between the city, the non-profit organizations, businesses, the labour unions. Its helped by having the population it has [being the right size to see positive results].

Medicine Hats approach to poverty has 17 milestones to gauge how its performing. Yearly suicide rates will be monitored. So will the waiting lists for social housing. It will be, its administrators believe, very much a made-in-Medicine-Hat success story.

I think communities now are starting to take a look at themselves and saying, What can we do to be part of the solution? Ms. Symmonds said. Yes, provincial and federal governments are going to have to be a part of this. There has to be changes in systems across the board. That said, we have a lot to offer here.

A House of Commons committee on human resources, skills and social development will be in Medicine Hat Thursday for a public hearing. The committee is gathering information on how to reduce poverty.

Editor’s Note: An earlier version of this story incorrectly said Medicine Hat homeless persons were granted new purpose-built housing. In fact, they were granted housing in existing homes, apartments and townhouses.

Follow Allan Maki on Twitter: @AllanMaki

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Medicine Hat unveils proposal to assist residents dealing with poverty – The Globe and Mail

Married to Medicine’s Quad Webb-Lunceford Aims to Prove She’s … – E! Online

Alex Martinez/Bravo

Prepare yourselves for a double dose of doctors and drama.

After a successful fourth season, the cast of Married to Medicine is coming together for a two-part reunion special. As you likely could have predicted, all of these ladies are not on the same page.

Before part one airs tonight on Bravo, E! News chattedwith Quad who expressed her delight at being seated next to Dr. Simone, Dr. Heavenly and Toya.

“I was right where I needed to be. I was prime-time television and right where I needed to be,” she told E! News exclusively. “To be honest, I’m really good with almost everyone from the show excluding the person who drove my name through the mud the entire season and her little minion.”

If you haven’t already guessed, Quad is talking about Mariah and Lisa Nicole.

Throughout the season, these three haven’t seen eye-to-eye and based on previews, it’s only going to continue at the reunion.

“I have purged those people from my life and when you get bit by a snake, you got to get all of the poison out and you don’t let that snake come around again and I’m okay with where I am with Lisa and Mariah and I,” Quad explained. “If the question was would we ever be friends again, I can tell you absolutely not.I can tell you I do not trust Mariah or Lisa Nicole. That ship has sunk to the bottom of the ocean.”

She added, “My advice to Lisa is never be a pawn in someone else’s game and she was a pawn in Mariah’s chess game.”

During the two-part reunion, fans will also see the husbands join the conversation and discuss some hot-button issues of the season. Toya will open up about her financial situation while Dr. Jackie will share new details about her marriage.

As for Mariah calling her co-star “Quad the Fraud,” you better believe there will be some heated discussion about that as well.

“Sometimes people are doing a lot of projecting,” Quad teased to E! News. “I didn’t appreciate the Quad the Fraud’ thing but then again, it didn’t really affect me because I know that’s not who I am.”

Married to Medicine airs Friday night at 8 p.m. only on Bravo.

(E! and Bravo are part of the NBCUniversal family)

E! Online – Your source for entertainment news, celebrities, celeb news, and celebrity gossip. Check out the hottest fashion, photos, movies and TV shows!

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Married to Medicine’s Quad Webb-Lunceford Aims to Prove She’s … – E! Online

Mercy Health joins forces with Michigan Medicine – Grand Haven Tribune

This new relationship brings together two of the states leading health care providers to offer opportunities for patients to access joint clinical consultations in cardiac surgery; allow immediate access to some of the worlds leading protocols in cardiovascular surgery; provide physicians options for ongoing case discussions and best practices; and enhance patient care, including access to innovative clinical care models, for one of Michigans leading Catholic hospitals.

The professional services agreement includes the appointments of two West Michigan-based physicians, Dr. Richard S. Downey and Dr. Nabeel G. El-amir, to the Michigan Medicine cardiac surgery faculty. This gives them the ability to collaborate with Michigan Medicines heart team on complex cases and non-complex consultations. The two will continue to perform open heart surgery services in Muskegon.

As members of the U-M medical faculty, Downey and El-amir can participate in U-M medical education opportunities and U-M supported clinical trials. They retain their clinical relationships with physicians in West Michigan.

This collaboration is part of our continued commitment to enter affiliations with key health care providers, such as Michigan Medicine, to bring the best care and access to West Michigan, Mercy Health President/CEO Roger Spoelman said. Together, we will continue to strengthen the level of health care in this region. Both organizations share a commitment to excellence and to continue offering care in a complex health care environment.

Dr. Richard Prager, director of the University of MichigansFrankel Cardiovascular Center, said the collaboration will allow Michigan Medicine to provide Mercy Health patients a team of doctors and researchers who make significant advances in cardiovascular surgery.

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Mercy Health joins forces with Michigan Medicine – Grand Haven Tribune

Maine’s HealthInfoNet taps Orion Health for precision medicine platform – Healthcare IT News

Maine’s Health Information Exchange, HealthInfoNet, announced that it will deploy Orion Healths precision medicine platform.

Orion’s Amadeus platform leverages an open and scalable database to capture, store and align patient information from multiple providers and payers.

The HealthInfoNet deal with Orion is pending final review by the HealthInfoNet Board of Directors, and the financial terms were not released.

HealthInfoNet also plans to incorporate Orion Health’s integrated population health applications Coordinate and Amadeus Analytics. The goal is to ensure the timely delivery of insightful patient information to healthcare professionals, HealthInfoNet COO Shaun Alfreds said.

HealthInfoNet’s HIE contains 98 percent of all Maine residents’ clinical information and is connected to all Maine hospitals and more than 500 ambulatory care sites.

Alfreds said HealthInfoNet chose Orion Health for the precision medicine platform because of its single suite of open source, scalable products that offer in-depth analysis and interoperability at both a population and an individual patient level.

“The precision medicine tools will allow us to bring to fruition a new data exchange that expands beyond the delivery system to incorporate social services, genomics, and other unstructured data that will in turn empower Maine residents to be active participants in their health in a new ‘data-informed’ ecosystem, Alfreds said in a statement.

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Hospitals, Hospital Medicine, And Health For All – Health Affairs (blog)

In September 2015, world leaders convened at the United Nations Summit to adopt the Sustainable Development Goals. Goal three, to ensure healthy lives and promote well-being for all at all ages, is ambitious, and many in the field are asking how nations can contribute to achieving this target. The world has made great health gains, but in order to ensure health for all, the current and highly successful strategies of investing in primary health care (PHC), outreach, and implementing vertical, disease-oriented programs must be integrated with a safety net of high quality hospitals. We believe that the field of hospital medicinea clinical specialty that combines knowledge in acute care and inpatient medicine with expertise in hospital care deliverycan steward the valuable resource of hospital care toward high performance.

Since the Alma Ata Declaration in 1978the landmark declaration that affirmed the importance of primary carethe health care system strengthening strategy has emphasized PHC. With its successes in equitably delivering cost-effective health care services, the PHC movement has become a priority for achieving universal health coverage. Meanwhile, hospitals have either primarily served the well-to-do or catastrophically impoverished the poor, and have been seen as cost sinks for ministry of health budgets; hospital expenditures account for a quarter to half of total health expenditures in Organization for Economic Co-operation and Development (OECD) countries, and can be higher in low- and middle-income countries (LMIC). Although both non-health care interventions (for example, road safety policy) and PHC can prevent the lions share of the global burden of disease, which is shifting toward predominantly non-communicable and chronic diseases, prevention and early intervention do not obviate the need for hospital care. There is mounting evidence of the important role hospitals will need to play in health care systems.

An integrated continuum of care allows patients to move seamlessly from the community to the clinic to the hospital, and then back home as illness episodes come and go. Yet access to high quality hospital care remains inadequate, particularly in LMICs. Of the 42.7 million adverse events and consequent 23 million disability adjusted life years lost in hospitals worldwide, two-thirds occurred in LMIC. Furthermore, as many as one in 50 hospital admissions in a group of eight LMICs led to death from preventable adverse events, or errors. Simply put, hospitals around the world are underperforming.

The recognition that hospital care requires a specialized skill set, and the organization of a discipline to supply that skill set, is relatively new. Unlike other medical specialties that focus on an organ system (e.g. cardiology), group of diseases (e.g. infectious disease), or diagnostic or treatment modalities (e.g. surgery), the field of hospital medicine has emerged to develop expertise in a platform of care delivery: acute hospital care. Two forces of the 1990s catalyzed this change. First, hospitals in high-income countries were (and still are) put under increasing financial pressures to reduce hospital costs. Second, increasing attention to quality and safety of care put a spotlight on the systems and processes of hospital care. One response to these forces was at the point of service delivery: a hospital medicine discipline emerged to equip generalist health care professionals with a specialized knowledge of the nuances of hospital care. The field came to be known as hospital medicine in the United States, and while that name has gained international traction, the discipline draws from a legacy of hospital care worldwide and has a distinctly international value proposition. Today, hospital medicine has three core offerings that support delivery of high-value hospital care.

First, the combination of clinical generalism and site-based, system specialization can promote hospital effectiveness. Akin to its primary care counterpart, hospital medicine is a generalist clinical specialty, poised to deliver holistic and patient-centered care to patients presenting with any combination of undifferentiated disease, systemic disease, or multiple pre-existing comorbidities. However, the nature of acute and hospital care is complex some problems, like nosocomial infections (i.e. hospital acquired infections) or venous thromboembolism (a group of blood clotting disorders), require a nuanced skill set that generalist training alone might not provide. Hospital medicine develops a specialized understanding of the implications of hospitalization to make hospital care more effective, and data are increasingly justifying the fields value. An emphasis on the systems and processes of hospital service delivery can bring hospital care to its full potential. Tasks that are technically nonclinical, like coordinating care among specialists and outpatient providers, managing care transitions across the care continuum, or conducting quality improvement projects or safety inquiries, can make hospital care more effective, and have thus become a major focus of hospital medicine.

Second, the field of hospital medicine can promote hospital efficiency. Staffing hospitals with generalists trained in hospital medicine can better allocate human resources, improving cost allocation and cost-effectiveness. In such an environment, patients receive specialist care only when a generalists training is insufficient to address the patients needs (as might be the case when a patient with congestive heart failure needs the care of a cardiologist, for example), freeing specialists to see more patients better matched to their skill sets. Moreover, dedicated inpatient staffing can improve outpatient access to primary care by freeing primary care physicians of hospital duties. Hospital medicine encourages rational utilization of health care resources in areas such as length of hospital stay, readmission rates, or cost awareness and cost-effective interventions. Because of its value in improving hospital efficiency, hospital medicine expertise is becoming increasingly valued on hospital management teams and in system leadership positions.

Third, new understandings in the field of hospital medicine have bolstered the case for using and improving team-based care. The complexity of acute care means doctors and nurses are no longer the only ones participating in a hospitalized patients care. Physical and occupational therapists, case managers, social workers, medical interpreters, and volunteer health workers are among the many roles on a modern inpatient care team. Because of increasing pressures on performance and patient flow, these interdisciplinary teams need leadership that keeps the patient at the center, yet draws upon a strong system understanding hospital medicine naturally supplies such leadership.

The hospital medicine value proposition is rooted in both a whole-of-patient and a whole-of-system perspective. Driven by its value proposition, the number of practitioners of hospital medicine has grown exponentially. Today, most of the supporting evidence of value comes from the United States this, and that the term hospital medicine is widely considered American, limits the conceptual generalizability of the field. However, many countries have experience with staffing models that include hospital-based health care professionals, or with staffing of hospital medicine-trained personnel. This evidence base may provide some guide to how the field can affect hospitals worldwide.

There are myriad international examples of hospital staffing models whereby providers spend most or all of their time caring for hospitalized patients. In many cases, the connection between those models and the growing movement of hospital medicine has not yet been made, and they are distinct in two ways. First, much of international hospital-based care is provided by early-career physicians who face common district-level challenges like lower pay or prestige, specialists, or nurses and auxiliary staff. Specialists are more costly and likely better suited in a consultative role since patients rarely present with problems that fall discretely into one scope of practice, while challenges of respect and remuneration traditionally experienced by early-career or non-physician health workers may limit their access to hospital-specific training and development. Second, hospital medicine treats the hospital as part of a patients pathology. This clinical and systemic expertise widens the range of intervention possibilities, from traditional case management to quality improvement initiatives to medical informatics solutions, among other possibilities.

The scope of hospital medicine practice is expanding worldwide. We searched the literature, sought country information from the International Section of the Society of Hospital Medicine, and explored our own network to identify hospital medicine practices in 37 countries (Figure 1).Of these, we identified only 12 middle-income countries and no low-income countries practicing hospital medicine. Although the practice is not widespread outside North America, these numbers likely underrepresent its global impact. Furthermore, we are aware of four national or international professional organizations related to the practice of hospital medicine outside of the US-based Society of Hospital Medicine, and more are planned. Hospital medicine groups around the world have replicated results seen in the United States, showing that hospital medicine can improve select hospital outcomes, quality, utilization, cost, research, or education indicators.

Hospital medicine can catalyze needed integration of high quality hospital care into health care systems globally. As countries transition from low to middle income status over the next generation, there is potential for a surge in domestic health care investment, including in hospital care. As access to hospital care is achieved, health care systems must be ready to ensure those hospitals are providing high value care. Though a global expansion of hospital medicine is far from a panacea, it should account for a smallbut importantshare of the human resources for health strategy worldwide.

To date, the expansion of hospital medicine has mostly been from the bottom-up, emerging at the local level in response to local needs. However, there is much that can and should be done from ministry and leadership levels to facilitate appropriate hospital medicine uptake worldwide.

First, while health care system stewardship needs to be country-led, global institutions can advocate for creation (and universal coverage) of a complete continuum of care, and supply both capital and technical assistance to meet this end. Leading global institutions should engage with national ministries of health, professional societies, and donor organizations to advocate for integration of hospitals with PHC, and for careful stewardship. Refocusing a share of existing hospital investments on hospital medicine training could help hospitals operate at greater value and would not divert needed funds from PHC. Ultimately, however, many LMIC health care systems will need to simultaneously strengthen all platforms of care delivery. An either/or world of hospitals or PHC is both dogmatic and unrealistic, and has potential to constrain health care system effectiveness.

Second, there is a knowledge gap on how to make hospital care more cost-effective, and research will be needed to understand how the principles of hospital medicine add value to existing hospitals, financing structures, and health care system cultures across a variety of international settings and then to make the case that this is a global public good that donors should fund. This need is particularly glaring in low-income countries, where resources are limited, hospital performance is poor, and the burden of disease is shifting such that hospital care will be increasingly pressing.

Finally, the expansion of hospital medicine has demonstrated a valuable opportunity to transform health care education. The experience of hospital medicine has shown that over a generation there can be a remarkable shift in the culture of care delivery. The near simultaneous emergence of the field of hospital medicine with the quality and safety movements was both coincidental and synergistic the latter because hospital medicine rapidly became the leader in performance improvement efforts. If there is any ultimate lesson to carry forward, it is that the experience of hospital medicine should not be unique. All health care providers practicing in all settings would benefit from specialized training on their respective practice models. We now know that knowledge of disease is only one part of achieving high health care performance. How we deliver the care, and how we improve upon it, is the other.

Health care systems display emergent properties: if hospitals remain neglected, inefficient, or mismanaged, all aspects of the system suffer. The field of hospital medicine can be a powerful force in strengthening the value of hospital care, thereby balancing the health care system and potentiating its net effect. Unsurprisingly, the field is spreading worldwide. To maximize its effect, the global community should manage and cultivate it across health care contexts. If the Sustainable Development Goals are asking for health for all, hospitalsand their core discipline, hospital medicinehave an important role to play in integrated health care systems.

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Hospitals, Hospital Medicine, And Health For All – Health Affairs (blog)

Medicine Rocks State Park – Atlas Obscura

Its not hard to see why Native American tribesconsidered the ancient sandstone pillars of the Medicine Rocks in southeastern Montana sacred.The remote landscapeis both peaceful and beautiful, coveredwith strangegeological rock formations. In the 1800s,Sioux and Northern Cheyenne camped near these unique perforated rocks, which are filled with holes and tunnelscrafted by rainfall and wind over 61 million years.

The Medicine Rocks site is populated with chained and isolated arches, and caves and spires reaching 80 feet high and 200 feet across.Tribes came here searching for medicinal plants to use in theirvision quests, as well as lookout pointsfor hunting bison and resting spots whiletraveling from the Yellowstone River Valley to the Black Hills. Later, in 1883, future President Theodore Roosevelt visited the land and wrote, As fantastically beautiful a place as I have ever seen.

The 320 acres of Medicine Rocksstill offers physical reminders of the past. Youcan find thousands oftribal petroglyphs that predate European settlement, signatures of cowpunchers, a sheepherders famous profile of a woman with a flower beside a bird, and recent inscriptions of elk, cattle brands, and military mentions.

Carving into the rocks isprohibited and park officials ask you be careful not to vandalize the site or disturb earlier markings. Instead,they recommend climbing the swiss cheese rocks and taking in the sights ofthe golden eagles flying in the skies above, and the mule deer and sharp-tailed grouse moving on the prairiebelow.

Medicine Rocks is setabout 11 miles north of Ekalaka and 30 miles west of both the North Dakota and South Dakota borders. The sitewas privately owned until Carter County, Montana seized the property inthe 1930s. Thestate of Montana took over ownership in 1957 and in 1993 it hadthe site declared a primitive park. Today, the parkis managed by the stateDepartment of Fish, Wildlife and Parks.

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Medicine Rocks State Park – Atlas Obscura

What a dying patient taught me about the limits of medicine – Crain’s Chicago Business


Crain’s Chicago Business
What a dying patient taught me about the limits of medicine
Crain’s Chicago Business
(STAT)Propelled in part by the unalloyed hopes I cultivated in medical school, I got through my internal medicine residency training largely free of questions about medicine's limitations. Ailing strangers entered my life in the hospital, and I

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Five-day fasting diet could fight disease, slow aging – Science Magazine

Going hungry for 5 days a month may improve your health.

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By Mitch LeslieFeb. 15, 2017 , 2:00 PM

Fasting is all the rage. Self-help books promise it will incinerate excess fat, spruce up your DNA, and prolong your life. A new scientific study has backed up some health claims about eating less. The clinical trial reveals that cutting back on food for just 5 days a month could help prevent or treat age-related illnesses like diabetes and cardiovascular disease.

Its not trivial to do this kind of study, says circadian biologist Satchidananda Panda of the Salk Institute for Biological Studies in San Diego, California, who wasnt connected to the research. What they have done is commendable.

Previous studies in rodents and humans have suggested that periodic fasting can reduce body fat, cut insulin levels, and provide other benefits. But there are many ways to fast. One of the best known programs, the 5:2 diet, allows you to eat normally for 5 days a week. On each of the other 2 days, you restrict yourself to 500 to 600 calories, about one-fourth of what the average American consumes.

An alternative is the so-called fasting-mimicking diet, devised by biochemist Valter Longo of the University of Southern California in Los Angeles and colleagues. For most of the month, participants eat as much of whatever they want. Then for five consecutive days they stick to a menu that includes chips, energy bars, and soups, consuming about 700 to 1100 calories a day.

The food, produced by a company that Longo helped found (but from which he receives no financial benefit), is high in unsaturated fats but low in carbohydrates and proteins, a combination that may spur the body to restore itself and burn stored fat. Two years ago, Longos team reported that mice on the rodent version of the diet lived longer and exhibited other positive effects, such as lowered blood sugar and fewer tumors. They also presented preliminary data suggesting health benefits in humans.

Now, the researchers have completed a randomized clinical trial in which 71 people followed the fasting-mimicking diet for 3 months, while volunteers in the control group didnt change their eating habits. Overall, the dieters lost an average of 2.6 kilograms (5.7 pounds), whereas the control group remained at the same weight, the scientists report online today in Science Translational Medicine. The calorie cutters also saw reductions in blood pressure, body fat, and waist size.

A 3-month trial cant determine whether the diet increases longevity in people like it did in mice, which rarely survive beyond a couple years. But Longo notes that levels of insulin-like growth factor 1, a hormone that promotes aging in rodents and other lab animals, plunged in the low-cal group. And subjects who were at the highest risk for age-related illnesses also saw other indicators of malfunctioning metabolism go down, such as blood glucose levels and total cholesterol.

Longo says that this diet treats aging, the most important risk factor for killers like diabetes and cardiovascular disease. It looks like you can go at the underlying problem rather than just putting a Band-Aid on it, he says. In a follow-up trial, the team hopes to determine whether the diet helps people who already have an age-related diseaseprobably diabetesor are susceptible to one.

Dieting is often hard, but 75% of the low-cal participants managed to complete thetrial, notes gerontologist Rafael de Cabo of the U.S. National Institute on Aging in Baltimore, Maryland, who wasnt involved with the work. The next step, saysphysiologist Eric Ravussin of the Pennington Biomedical Research Center in Baton Rouge, is todetermine whether the dietalsoworks in people who are not as healthy as they used in this study.

Research dietitian Michelle Harvie of the University Hospital of South Manchester in the United Kingdom adds that she wants to see longer studies confirm that the benefits persist and that people remain on the regimen. We need to help a lot of people, but what if only 2% of them are willing to do this?

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Five-day fasting diet could fight disease, slow aging – Science Magazine

Medicine: Discovery through doing – Nature.com

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How an orchestra uses space in a time-critical context can hold lessons for surgical teams.

Analytical chemist Matthew Lewis had a problem: when he tried to bisect kidney stones for analysis by mass spectrometry, they crumbled. Glass artist Katharine Coleman suggested a solution, using lens-grinding equipment mounted on a portable lathe. With this, the kidney stone could be gently abraded to produce a clean equatorial section. As Lewis (who works in the Division of Computational and Systems Medicine at Imperial College London) put it: An epiphany for me was that the tools Katharine works with are more suited to our application than our own.

Nearby, at the Imperial-run St Mary’s Hospital, embroiderer Fleur Oakes has identified techniques from her repertoire that could improve surgeons’ control over fine sutures when they join arteries together. Oakes lacemaker in residence at the vascular-surgery unit is working with the clinical team to devise an educational programme aimed at overcoming problems with thread tangling during surgery.

These cross-cutting collaborations are part of the engagement and performance science programme that I direct at Imperial. Under its aegis, bioscientists and clinicians in the divisions of computational medicine and surgery are working with expert practitioners and academics from the Art Workers’ Guild, the Royal College of Music and the Victoria and Albert Museum Research Institute to explore common ground in haptic learning how we discover through doing in science and craft (J. Kiverstein and M. Miller Front. Hum. Neurosci. 9, 237; 2015). Science and medicine are no more purely cognitive than the arts. All depend on performance, technical skill, observation, dexterity and the ability to work under pressure.

Over more than ten years in this arena, I have learned that the conditions for serendipitous encounters must be deliberately curated. The Imperial programme is not a conceptual scienceart collaboration, whose benefits for scientists are often considered marginal. It hinges instead on physical communication at the level of doing and making the craft of science. We have found that the collaborations have led to changes in approach, such as heightening surgeons’ awareness when handling suture thread, as well as inspiring experimentation with new stitching techniques. Engaging with different experts can send a cold blast through our assumptions, scouring them out and leading to new insights.

Rachel Warr is revealing the value of puppetry to surgery, for instance. A leading freelance puppetry director and artistic director of London’s Dotted Line Theatre, she has shown how puppeteers start rehearsals with a sequence of hand and finger exercises to prepare them for the intricately dexterous work of manipulating rods or marionette strings. Similar routines could be applied to surgery to enhance finger control and precision. Pre-performance group warm-ups could improve surgical teamwork.

The BBC Symphony Orchestra’s principal percussionist, David Hockings, has shown how he interacts with fellow musicians and their instruments on a narrow platform, collaboratively negotiating space in a time-critical performance. Using complex contemporary music Lera Auerbach’s The Infant Minstrel and His Peculiar Menagerie he has also revealed how individual experts create new ensembles to perform challenging tasks under pressure. That highlights parallels with ‘transient teams’ in surgery, where surgeons, anaesthetists and nurses must forge collaborations quickly for high-stakes operations.

Close-up magician Richard McDougall (a Gold Star Member of Britain’s Inner Magic Circle) is working with a neurosurgical team at St Mary’s led by neurotrauma specialist Mark Wilson. Learning even simple tricks demands much practice: the performer must perfect the choreography of fine motor skills and engage with the audience. McDougall and Wilson will be teaching magic techniques to people in rehabilitation after sudden head injuries, as a motivational adjunct to more conventional therapies.

These collaborations are already showing their value. In time, some may have demonstrable impact on scientific and medical practice. They are experiments, of course, so uncertainty is built in. But intention to collaborate and think differently lies at their heart.

Science and medicine can develop a seductive self-sufficiency, a belief that everything that must be learned can be found in their specialized worlds. Engaging directly with the practice of craftspeople and performers reveals another way.

Knowledge in the arts, crafts and trades has been devalued by successive governments. School curricula have been hollowed out in the belief that doing and making are subordinate to thinking. Collaborative university programmes are being cut or curtailed, and generous-minded exploration between disciplines is under threat. Yet doing and thinking are two sides of the same coin. It is in all our interests to cherish and protect what can all too easily become lost in description the enduring craft of science and medicine.

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Medicine: Discovery through doing – Nature.com

Brookhaven Police offer medicine disposal collection unit – Atlanta Journal Constitution

The Brookhaven Police Department announced Wednesday it was awarded a grant for a drug collection unit as part of CVS Healths Medication Disposal for Safer Communities Program. The new unit will be located in the lobby of the Police Department headquarters at 2665 Buford Highway and will provide residents with a safe and environmentally responsible way to dispose of unused or expired controlled substances. The collection unit is open to the public 24 hours a day, seven days a week, and drugs can be dropped off with no questions asked, reducing prescription drug abuse and contamination of local landfills and water supplies from unused medication.

Safely disposing of unused medication is critical to preventing prescription drug abuse and keeping pharmaceuticals out of our waterways, said Brookhaven Police Chief Gary Yandura. The Brookhaven Police Department is proud to partner with CVS Health and we thank them for their commitment to helping residents reduce the amount of unneeded medicine in our community.

Information: http://www.brookhavenga.gov; 1-866-559-8830.

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Brookhaven Police offer medicine disposal collection unit – Atlanta Journal Constitution

A Canadian City Thrives on Gas, Like a ‘Wealthy Little Country’ – New York Times


New York Times
A Canadian City Thrives on Gas, Like a 'Wealthy Little Country'
New York Times
Now, Medicine Hat is setting up the equivalent of Norway's famous sovereign wealth fund, a pool of money that should make more money for generations to come. We could separate from the world, and we'd be totally self-sufficient, said Ted Clugston

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A Canadian City Thrives on Gas, Like a ‘Wealthy Little Country’ – New York Times

Paul Ryan: Democrats Want To Go Down ‘Socialized Medicine Path’ – TPM

rF/=;vIr,%5_2jMW;U{?|)R|IkfH}Yz/_xhMY_LXT$k2?7/DX/”M,NqficE@On4kiX`q2r,:ZVf%28″TV5q”u’ 7ro”%`MB?l z#~Gag4 nht/WZL,=cf_&0`5Or 2X””D9~/t9]#0kQg[}A4~L$=Dp3 ?V UArWR-0=8[?sXO5 (gbO=Chz F@8!:FYIv|>}U.1x”@kF,YDLr%raU)OQB3=V?)hlznuz|0X |o;x~85fuxy@’ h+9if;mLlib;-gz ;sR8D1Hqpe}~>$f==ZoFoGW$-8GQ ‘/.Kg(,NTprowZ}Agp?x==zXC+kc$d hrV aofa7JJLm6!.isABGA7JF.kEJ{#Ca>hY{HNlQ0ucb$Yx-9;U.Qp yvDzmK1kmYLf~–J]Yjn>]4n?tzH w D04W=QoaWu~&w?6}E`@f zyy’I>YVd>A[w’zY”I(v2 any6GL7S729,c9EKu7^:?C{vPpa6[tDt!p7^EVudk~>N YAn;AIGakxckA, U] w2KeBHFbw”b6a”V[gNG95IKUo y?eiH7;=X#17″‘r X2ANZ^)qt}Hj3k~kn4F7p}#da;+RE~’LC$=Y9!QU$F.vh$@Al@KG$?Os0Zf/u^~u| * “rHa( MT>VhJ w 3N9″%gF)W:1!Gh&i`1w^=WQ&y} J op9wRZ,:,-1′ W!t=EVJ8 XFs 9u_=?LBeOWp`6==jDpoe’hAVit2]i6 m:WuP>ip0ii.^t%=q-&8c+z-so,R7 |G&?8y,V:q&g& Yu]$8 ,7I4[&’mVPNgozd!aGM&_)P xJpdZ4’~{k!w KL&Imsn5)j v”*mH4dB;hv” PD8Zg^ #}/’):H5Q|Q;LuA9K, 0g(T {yRf>he7DYwNskf”?m 4:f”u?#Lab=p5x$,I!#ivK1i~Fi1oiLNexkWOQIur7=;IJ/??on>0HE$A2x.Zw #5nMBdDxD N}NKh^0oWgQ}.)v5su.dW@0G$Ml$oKT1>*F#G[YQygb2t}wYA q$ rNn4tC{&4A Ig?pkWT/T6nw8~n5XQ6jaeNS|6Ny:OVHq{“%yhMgS4V$1Nc0i{CFNpOqGz]]Xbsy(@7+ nB3$ ‘p!4pK}2Pm”Ou@[;4i

Why Fortress Investment Group, Editas Medicine, and Hertz Global Holdings Jumped Today – Motley Fool

The stock market continued to climb sharply on Wednesday, sending major market benchmarks to record highs yet again and propelling the Dow Jones Industrials up more than 100 points. Economic data continued to support the notion that the U.S. economy remains strong, and rising inflation levels led many to conclude that the Federal Reserve is more likely than ever to follow through on its promise to keep lifting short-term interest rates in 2017. Rising bond yields reflected investors’ reluctance to hold onto fixed-income investments in anticipation of higher rates, prompting some to shift assets into the stock market. Several companies also reported, andFortress Investment Group (NYSE:FIG), Editas Medicine (NASDAQ:EDIT), and Hertz Global Holdings (NYSE:HTZ) were among the top performers on the day. Below, we’ll look more closely at these stocks to tell you why they did so well.

Shares of Fortress Investment Group soared almost 30% after the investment specialist received a takeover bid from Japan’s SoftBank. The terms of the $3.3 billion buyout involve Fortress Class A shareholders receiving cash of $8.08 per share, and in addition, shareholders will be entitled to receive dividend payments for the fourth quarter of 2016 and the first quarter of 2017 if the transaction doesn’t close before the latter payment is due. As part of the deal, key leaders at Fortress have agreed to stay on, and the company’s principals have agreed to invest at least half of their after-tax proceeds from the sale into Fortress-managed fund offerings. SoftBank CEO Masayoshi Sun said that his company “looks forward to benefiting from [Fortress’] leadership, broad-based expertise, and world-class investment platform,” and the Japanese company expects Fortress to contribute toward its overall growth objectives.

Image source: Getty Images.

Editas Medicine stock climbed 29% in the wake of its announcement of a favorable intellectual property decision. The genome-editing company said that the U.S. Patent and Trademark Office issued a favorable decision in a case involving patents that Editas licenses from the Broad Institute. A dispute between MIT and Berkeley regarding the patents had threatened to put a stop to some of the work that Editas was doing, given that Berkeley scientists had developed technology that Broad Institute used to evaluate gene editing in certain specific cases. In the ruling, the U.S. PTO ruled in favor of Broad Institute’s request for no interference in fact, a legal term of art that allows Editas to keep using CRISPR-Cas9 patents as part of its fundamental genome-editing work. By ensuring that Editas will be able to continue its work, the ruling gave investors hope for future breakthroughs unhampered by the need for further licensing.

Finally, shares of Hertz Global Holdings rose 7%. The rental car giant got good news in the form of an increased ownership stake from well-known activist investor Carl Icahn. Icahn reported in his quarterly disclosure of investment holdings that he had raised his investment in Hertz to 29.3 million shares, more than doubling his previously reported position. That gives the activist investor about a one-third stake in Hertz, and it will be interesting to see to what extent Icahn pushes Hertz harder to take steps toward getting its shares back on track. The rental car specialist’s shares are down 60% just since September, and many expect more aggressive action from Icahn in the near future.

Dan Caplinger has no position in any stocks mentioned. The Motley Fool owns shares of Hertz Global Holdings. The Motley Fool has a disclosure policy.

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Why Fortress Investment Group, Editas Medicine, and Hertz Global Holdings Jumped Today – Motley Fool

Capitalism, race and medicine are topics this spring at Crispus Attucks Community Academy – LancasterOnline

Registration has opened for the spring term of Crispus Attucks Community Academy. Faculty from local colleges will lead five classes ranging from capitalism to race and medicine.

The classes meet weekly for six weeks at Crispus Attucks Community Center at S. Duke Street and Howard Avenue.

The fee is $25 per course. No exams are given.

For information on registering, call 717-394-6604, ext. 120, between 1 and 5 p.m. weekdays.

Capitalism: What it is, how it works taught by Antonio Callari of Franklin & Marshall College 7 to 8:20 p.m. Tuesdays March 21 to April 25. Topics include markets, wages, poverty and inequality.

The Black Woman taught by Rita Smith-Wade-El of Millersville University 6 to 7:20 p.m. Wednesdays, March 22 to April 26. The course looks at issues confronting black women in non-Islamic Africa and the United States.

Africa Before Colonialism taught by Onek Adyanga of Millersville University 7:30 to 8:50 p.m. Wednesdays, March 22 to April 26. Topics include theories of African societies, migrations, civilizations and cross-cultural contacts.

Race, Medicine and Social Justice taught by Ashley Rondini of Franklin & Marshall College 2 to 3:30 p.m. Thursdays, March 23 to April 27. Topics include health consequences of racialized public policies and racial and ethnic health disparities.

Colonialism: Culture, Economics and Power taught by Eimam Zein-Elabdin of Franklin & Marshall College 7 to 8:20 p.m. Thursdays, March 23 to April 27. Topics include colonialism as a system of control, with a primary focus on Africa, and the continuing effects of colonialism.

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Capitalism, race and medicine are topics this spring at Crispus Attucks Community Academy – LancasterOnline

The Daily Pennsylvanian | Penn Medicine has developed a vaccine … – The Daily Pennsylvanian

Professor of medicine Drew Weissman said that vaccines that require multiple doses are hard to implement in areas with poor infrastructure because it can be hard to ensure people get their follow-up vaccinations.

The Zika virus may be mostly out of the news after its summertime peak, but Penn Medicine is still actively working to combat the spread of the disease.

A new vaccine developed at Penn Medicine could provide long-term protection against the Zika virus with just a single, relatively low dose. The virus continues to affect 76 countries in Central and South America and the Caribbean, with isolated local transmission cases in Florida.

Unlike other vaccines currently being developed, this new immunization does not use live viruses, which tend to cause adverse side effects and are not effective for those who have already been affected by the virus.

The new vaccines uses tiny strands of RNA that hold the genetic codes for making viral proteins that block Zika infection.

Drew Weissman, professor of medicine at the Perelman School of Medicine and senior author of the report on the new vaccine, said vaccines that require multiple doses are difficult to implement in areas with poor infrastructure.

The population that you would immunize right now is across South America, and much of that is very poor regions without much infrastructure for medical care, so if you had to give a vaccine twice or more, you would have to set up clinics and ways of following people to make sure everybody got immunized with two doses, Weissman said.

With a single dose, you go in, you find everybody, you immunize them once and youre done, he continued.

Up to this point, the vaccine has been tested on lab mice and monkeys. Human clinical trials are expected to start within 12 to 18 months.

The most important finding of this paper is that the vaccine is safe, Norbert Pardi, research associate and co-author of the report, said. We didnt see any side effects after vaccination in mice and monkeys.

Pardi also noted that the vaccine is protective after a single immunization with a relatively small dose.

This is very important [that] there is long-term protection, Pardi said. Many times, the problem with vaccines is that we get some protection for a while but after months or years, you have to be vaccinated again.

Weissman said this type of vaccine could be applied to other diseases, including influenza, HIV and malaria.

The research involves collaboration with lab researchers at Duke University and the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Theres a lot of potential to move [the vaccine] into a lot of different directions, he said.

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The Daily Pennsylvanian | Penn Medicine has developed a vaccine … – The Daily Pennsylvanian

Mt. Sinai Merger Shuts New York’s Integrative Medicine "Crown Jewel" – Huffington Post

The Continuum Center for Health and Healing on First Avenue in New York City was a pearl among the large integrative medicine centers that were sponsored by medical delivery organizations in the first years of the integrative era. First conceived in 1998, an estimated $10-million in philanthropic funds directly backed the construction and supported clinical services. The clinic’s leaders included Woodson Merrell, MD, Barbara Glickstein, RN, MPH and Ben Kligler, MD, MPH.

The work at the Continuum Center was leading edge. The team fostered a high level of interprofessionalism and team care. They generated an important body of research. They experimented with business models and experienced times of profitability. Yet amidst a larger economic drama of what was called a merger between Continuum Health Partners and the now dominant Mt. Sinai Medical Center, the formerly 32-clinician integrative center, with its 6,000 visits per month, was put on the corporate chopping block last fall.

To gain an understanding of what took place, I contacted Merrell, pictured above, who left his position prior to the decision, and Kligler, who had already accepted a new position with the Veteran’s Administration’s integrative health initiative prior to Mt. Sinai’s closure decision. Glickstein left early on.

In a short interview, Merrell spoke to how significantly new leadership or corporate culture can shift an integrative center’s stature: “A vice president of the (former) Beth Israel leadership described us as a ‘crown jewel’ of the system. We were drawing a high percentage of new patients to the system. We got great reviews from patients for our care. Now Mt. Sinai is taking a more limited view of how to assess value, focusing on RVUs [relative value units]. They clearly didn’t see the value in the center.”

Kligler and I spoke at length about the turns of events leading to the decision. At the core of our exchange was the vulnerability of these stand-alone clinics amidst leadership changes and system mergers. I shared that I had recently interviewed his frequent colleague, University of Arizona Center for Integrative Medicine’s executive director Victoria Maizes, MD about the shutdown of ACIM’s Phoenix-based integrative health clinic. Maizes had referenced what she viewed as a parallel with the Continuum story. In both cases, the clinics seemed to be collateral damage to a larger merger with a dominant player who didn’t have much interest in the field. (That interview is here.)

Kliger began by sharing a perspective from the Continuum partner, Beth Israel, with which the clinic was most directly associated: “From Beth Israel there was a long-time commitment to the idea of integrative health and of integrative health having value to the system. There was always pressure about the business model but there was never a question that integrative health had more value to Beth Israel than just the stand-alone clinic.”

Kligler was vice chair and Merrell chair, for instance, for an associated Department of Integrative Medicine, formed in 2007. The Center’s robust activities hit on all three of the research-education-clinical care sweet spots. They had not only an Academic Fellowship in Integrative Medicine but also an inpatient acupuncture fellowship. Kligler secured a series of major federal research grants.

This was a remarkable track record of local and national engagement. Yet, Kligler added, “we never got a message from Mt. Sinai that integrative health as a clinical service was important to them.”

Kligler quickly clarified that he “totally understands how it looks from [Mt. Sinai’s] point of view. We just looked like another practice in a hospital that was losing money.” He shared that the termination of operations is part of the territory. Mt. Sinai is also ending Beth Israel’s service as a general hospital. “Some systems have integrative health in their core clinical mission,” Kligler says, adding, with finality: “Others don’t.”

Kligler views the loss of the Center as “just bad luck.” Why? “[Mt. Sinai] came in when we were the most vulnerable.” Had the merger come through a couple of years earlier, it would have been when the center “was booming.”

Kligler explains. In 2012, demand exceeded the ability to fulfill on meeting patient interest. The Center was operating profitably and expanded to a third floor. New investment coupled with new practices not yet overflowing added up to a temporal moment of significant red ink. Had the merger come later, in Kligler’s view, the new configuration would have had time to fill out and flourish. Mt. Sinai caught the snapshot of that moment’s performance rather than considering a promising revenue trajectory. Kligler summed up his view: “Honestly, we can’t hold Sinai responsible. It was terrible timing.”

Mt. Sinai’s integrative clinical services will not be fully terminated. A core of 4 physicians will re-locate to a clinic across Manhattan in the West Village. Some are pushing the system to keep some of the non-MD practitioners associated. Research grants and education initiatives have been moved to the Sinai Department of Family Medicine, reflecting the fact that Sinai remains supportive of research and education in integrative medicine, reports Kligler.

Meantime, the Department of Integrative Medicine has not been terminated. Kligler, who applied in August 2015 for his current new position as the National Director of the Integrative Health Coordinating Center at the Veteran’s Health Administration, maintains a role in research as principal investigator on three projects. How well these will survive the departure of Kligler’s driving energy is yet to be seen, especially as the curret research grants come to an end.

Kligler noted that “health systems tolerate losses in many areas, for all kinds of reasons – primary care for instance.” While typically losing money, primary care serves as a funnel for more lucrative tertiary care operations.

I asked Kligler his views of what Mt. Sinai lost in their decision to shut the Center. He spoke first of the group of patients “for whom integrative health is important.” He then considered the loss to students and residents to experience integrative practices on such a large scale through their rotations through the interprofessional and multidisciplinary Continuum Center. Mt. Sinai lost, he concluded “the opportunity to envision a healthcare system that brings a wider range of tools and practitioners to the treatment of patients.”

This article is one in a series on significant ups and downs with major centers. We see significant expansion at Jefferson in Philadelphia, a new 17,000 square foot space for the Center for Functional Medicine at the Cleveland Clinic, and system-wide integrative health at Meridian Health. The build-up of integrative health and research in the Veterans Administration with which Kligler is now involved is another bright light.

Meantime, on the deficit side: the shutdown of the Banner/Center for Integrative Health in Phoenix which was intended as a proving ground for integrative care; the Allina/Penny George Institute shut its research department and limited its inpatient program; and while not a clinical site, the Samueli Institute, an engine of integrative health research, also announced that it is ending operations.

I am still digesting the meaning of all these changes. One reasonable conjecture is that the lack of discussion in the Trump administration of the need to move to from “volume to value” that is promoted in some ways through the Affordable Care Act will make the medical industry even less hospitable to integrative services.

What is certain, however, is that as Continuum’s robust research output winds down, the real world, institutional research base for integrative health – with the losses here, at Penny George, Samueli Institute and in Arizona – is on the ropes. Who and what will step up?

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Mt. Sinai Merger Shuts New York’s Integrative Medicine "Crown Jewel" – Huffington Post