New York City’s health department developed a program to support vaccine outreach and counseling through an innovative collaboration with a diverse mix of health plans to identify unvaccinated ...patients and provide reimbursement for clinicians.
The New York City (NYC) Department of Health and Mental Hygiene, as a local health department, partnered with health plans to pay for provider-initiated outreach for Covid-19 vaccine counseling for unvaccinated people through a program called the Vaccine Outreach and Counseling Program (VOCP). The collective effort and use of emergency contracting — with a budget of $35 million in funding from the government of NYC — allowed for an idea-to-execution period of 6 weeks. Seven insurance companies covering more than 90% of the NYC Medicaid market and a significant portion of the NYC Medicare Advantage market (insurance products that have a disproportionately large representation of people of color in NYC) administered the program as an in-kind contribution to the effort. Providers implementing the VOCP reported that they felt counseling efforts were valuable in increasing vaccination uptake, but also described operational challenges. Shortly after launching the VOCP, the federal government reached out to the health department to learn more about the program. Two months later, the U.S. Centers for Medicare & Medicaid Services authorized state Medicaid programs to cover such counseling. New York State’s Medicaid program subsequently adopted a reimbursement policy with similar guidance for counseling while addressing some of the operational challenges of the VOCP model.
Servitization of the manufacturing firm Baines, Tim; Lightfoot, Howard W
International journal of operations & production management,
01/2014, Volume:
34, Issue:
1
Journal Article
Peer reviewed
Open access
Purpose - This paper aims to explore practices and technologies successfully servitised manufacturers employ in the delivery of advanced services. Design/methodology/approach - A case study ...methodology is applied across four manufacturing organisations successful in servitization. Through interviews with personnel across host manufacturers, their partners, and key customers, extensive data are collected about service delivery systems. Analyses identify convergence in their practices and technologies. Findings - Six distinct technologies and practices are revealed: facilities and their location, micro-vertical integration and supplier relationships, information and communication technologies (ICTs), performance measurement and value demonstration, people deployment and their skills, and business processes and customer relationships. These are then combined in an integrative framework that illustrates how operations are configured to successfully deliver advanced services. Research limitations/implications - The analyses are reductive and rationalising. Future studies could identify other technologies and practices. Case study as a method is inherently limited in the extent to which findings can be generalised. Practical implications - Awareness and interest in servitization is growing, yet adoption of a servitization strategy requires particular organisational capabilities on the part of the manufacturer. This study identifies technologies and practices that underpin these capabilities. Originality/value - This paper contributes to the understanding of the servitization process and, in particular, the implications to broader operations of the firm.
Abstract
Response assessment after immunotherapy remains a major challenge in glioblastoma due to an expected increased incidence of pseudoprogression. Gadolinium-enhanced magnetic resonance imaging ...(MRI) is the standard for monitoring therapeutic response, however, is markedly limited in characterizing pseudoprogression. Given that hypoxia is an important defining feature of glioblastoma regrowth, we hypothesized that 18F-fluoromisonidazole (FMISO) positron emission tomography (PET) could provide an additional physiological measure for the diagnosis of immunotherapeutic failure. Six patients with newly diagnosed glioblastoma who had previously received maximal safe resection followed by Stupp protocol CRT concurrent with pembrolizumab immunotherapy were recruited for FMISO PET and Gd-MRI at the time of presumed progression. The hypoxic fraction was defined as the ratio of hypoxic volume to T1-weighted gadolinium-enhancing volume. Four patients diagnosed with pseudoprogression demonstrated a mean hypoxic fraction of 9.8 ± 10%. Two with recurrent tumor demonstrated a mean hypoxic fraction of 131 ± 66%. Our results, supported by histopathology, suggest that the noninvasive assessment of hypoxic fraction by FMISO PET/MRI is clinically feasible and may serve as a biologically specific metric of therapeutic failure.
The development of calcium salt deposits in the skin can occur in the presence or absence of membranous ossification and are categorized into osteoma cutis (i.e., cutaneous osteoma) and calcinosis ...cutis. For the former, distinction into primary or secondary osteoma cutis is mainly based on clinical and histopathological parameters, as primary osteoma cutis originates without any underlying intradermal inflammatory or neoplastic process, as opposed to a far greater number of secondary osteoma cutis that occur on the grounds of inflammation or tumors. Genetic disorders might predispose a person to the formation of these overall rare tumors. However, some patients develop primary osteoma cutis in the absence of any genetic background. In pre-menopausal women with fair skin, the condition of multiple miliary osteoma cutis is a relevant differential diagnosis for solid subcutaneous facial nodules. While pathogenesis remains unclear, most affected individuals have suffered from acne vulgaris at some point. Excision might be a viable option for disturbing lesions, as are ablative lasers. Here, we discuss and review relevant causes of calcium salt deposits in the skin based on a notable case of multiple primary osteoma cutis of the face in an otherwise healthy woman.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Hemophagocytic lymphohistiocytosis is a rare and potentially fatal disorder caused by immune dysregulation. It can occur as a primary genetic disease or secondarily due to various causes including ...infections, malignancies or autoimmune diseases. In this case report, we present two cases of Hemophagocytic lymphohistiocytosis which were secondary to typhoid and dengue fever. While primary disease occurs predominantly in infants, secondary hemophagocytic lymphohistiocytosis can occur in any age group. Both primary and secondary hemophagocytic lymphohistiocytosis are characterised by fever, hepatosplenomegaly, pancytopenia and multiorgan dysfunction. But unusual persistence of fever and other organ involvement should need further workup for hemophagocytic lymphohistiocytosis. Secondary hemophagocytic lymphohistiocytosis may resolve on treating the underlying disorder. But severe cases need treatment with immunosuppressive/immunomodulation therapy to prevent morbidity. Early clinical suspicion, prompt diagnosis and treatment of hemophagocytic lymphohistiocytosis are essential to prevent deleterious effects to health.
In the case presented here the reported result for total creatine phosphokinase led to the physician calling for report confirmation. The repeated test result was in keeping with the clinical picture ...and thus the previous erroneous result was amended. The incorrect result from auto analyzer was identified as failure to run the sample in dilution after instrumental flagging of possible substrate exhaustion evidenced by erroneous progress curve. A frequent reason for nonlinear progress curves is the presence of excess enzyme which can be easily misinterpreted as lower enzyme activity in a provided sample. Careful inspection of progress curve and predilution of sample in anticipated cases could avoid erroneous result.
This is a flexible, interrupted video case that uses phantom limb pain as a platform to investigate brain anatomy with a focus on somatosensory cortical mapping and the homunculus. The case begins ...with a video of neurologist Dr. V.S. Ramachandran interviewing two amputees who experience phantom limb pain (part one). Through Dr. Ramachandran’s dialog with amputees, students learn about the paradoxical condition of feeling pain in a limb that does not exist (e.g., phantom limb pain). Students witness Dr. Ramachandran analyzing fMRI data from an amputee, and subsequently learn the somatosensory cortical mapping of the amputee has remarkably changed. Dr. Ramachandran also introduces and demonstrates one form of treatment for phantom limb pain, the mirror box. The video case is supplemented with optional opportunities for further exploration about the mirror box (part two) and somatosensory cortical mapping, via the two-point discrimination test (parts three and four). In part two, students use the primary literature to investigate the effectiveness of the mirror box, and practice skills of interpreting figures. In parts three and four, students conduct a two-point discrimination test (part three) on each other or a person in their residence and analyze class data (part four). Students are led to discover conceptual connections between all four parts of this module. As one example, students are challenged to predict how two-point discrimination data from amputees (interviewed in the video, part one) would compare to students’ two-point discrimination data (parts three and four). While the four parts of this learning module are highly interconnected, instructors can choose to selectively implement one or more parts. In addition, each part can be executed in the face-to-face classroom, as out-of-classroom assignment, in a synchronous or non-synchronous video meeting platform, or as a hybrid of these options, providing flexibility for the instructor. This case has been used in a 100-level face-to-face, non-science major course and it has been modified as an online module for a 300 level
General Physiology
course.
Houston Methodist’s policies designed to avoid the spread of severe acute respiratory syndrome coronavirus 2 during hospital-based surgeries or procedures led to a postintervention nosocomial ...Covid-19 infection rate of 0.1% during the first 19 months of the pandemic. Preoperative polymerase chain reaction testing was found to be particularly effective.
During the initial onset of the Covid-19 pandemic, there was little information regarding how to deliver surgical care safely. Houston Methodist, an eight-hospital system with a flagship academic medical center (Texas Medical Center), adopted and implemented policies that were driven by science and expert opinion, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction preoperative testing to decrease patient risk of Covid-19 diagnosis postintervention. In examining outcomes of the policies during the first 19 months of the pandemic, the authors discovered from a retrospective cohort study of 141,439 patients that the policies — especially SARS-CoV-2 preoperative testing — were effective in reducing postintervention Covid-19 disease, with an overall rate of 0.6%. Analysis of patients who had Covid-19 after intervention found that most had contracted the disease from community sources, which led to a nosocomial Covid-19 rate of 0.1%. Effective policy implementation was associated with successful delivery of safe surgical care during the pandemic.
Delirium is an acute confusional state due to physical illness and is a frequent cause of hospital admission. In this article, we describe the development and outcomes for a community delirium ...toolkit pilot across Greater Manchester during the COVID-19 pandemic. We conclude that delirium can be safely managed in the community by using a toolkit that incorporates structured assessment and management. Carers and patients benefited from the use of a co-designed information leaflet.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and is significantly underdiagnosed in the community. Respiratory impairment is a key risk factor for ...perioperative morbidity and mortality. The National Institute for Health and Care Excellence (NICE) does not recommend routine spirometry before major surgery. However, in this article, we present the potential benefits of targeted spirometry in high-risk patient groups. Of 183 patients who underwent targeted preoperative spirometry, 25/70 (35.7%) of those with airflow obstruction had no previously known respiratory diagnosis. Of patients with known COPD, 20/46 (43.5%) were not prescribed optimum inhaled therapies for their degree of lung function deficit. Knowledge of lung function in respiratory disease helps to optimise patients perioperatively and facilitate shared decision making regarding the benefits and risk of surgeries. We propose that targeted spirometry should be used as part of the perioperative multidisciplinary team assessment of selected patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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