A simple strategy to reduce disparities in Covid-19 vaccination is to consistently offer the vaccine during primary care visits, a process that can be measured using standardized documentation ...practices.
The Covid-19 pandemic has exposed stark disparities in health outcomes among communities of color. Black patients are at higher risk of being infected with and dying from Covid-19 but are less likely to be vaccinated relative to the overall population. At the San Francisco Health Network in March 2021, the vaccination rate for primary care patients aged 65 and older was 69.8% overall versus just 61.5% for Black patients. In this article, the authors share data that Black patients had lower documented offer rates for the Covid-19 vaccine in their primary care network. The network iterated a series of interventions to address the disparity in vaccine offer rate documentation and used process measure data and stakeholder engagement to understand this disparity. They observed a 7–percentage-point gap in March 2021, which briefly narrowed to a 4-point difference but increased to 5 to 6 points for most of 2021. By March 2022, the disparity had decreased to 2 points, and the offer rates for all patients reached 95% and for Black patients, 93%. This improvement journey generated conversations about implicit bias and burnout and ultimately led to reduced disparities in both the documented offer rate and the vaccination rate for Black patients in the network. In navigating conversations about implicit bias, the network found it most effective to focus on actionable system-level changes rather than on blaming individual behaviors.
In spite of increasing interest in open innovation, discussion about the concept and its potential application to the SME sector has been excluded from mainstream literature. However, given that the ...argument about the effect of firm size on the effectiveness of innovation is still ongoing, it is worth addressing the issue from an SME perspective. That is the focus of this article, which seeks, firstly, to place the concept of open innovation in the context of SMEs; secondly to suggest the input of an intermediary in facilitating innovation; and finally to report accounts of Korean SMEs’ success in working with an intermediary. The research results support the potential of open innovation for SMEs, and indicate networking as one effective way to facilitate open innovation among SMEs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Monoclonal antibody (MAb) treatments have been safe and effective in averting severe Covid-19 infections when given early, but supplies have been scarce. Intermountain Healthcare used its supply to ...maximum effect across its broad geographic footprint by identifying patients at highest risk and delivering them MAb therapy at the optimal time, saving lives and easing strain on hospitals.
Providing access to anti–severe acute respiratory syndrome coronavirus 2–neutralizing monoclonal antibody (MAb) infusions to ambulatory patients with early-onset Covid-19 poses numerous operational challenges to health care systems. Among these include optimizing efficacy through early identification of high-risk patients, ensuring equitable access to disadvantaged populations and across wide geographic regions, preserving access to infusion services for other populations, maintaining adequate infection control, and managing resource constraints. Intermountain Healthcare shares its experience designing and implementing a novel care delivery pathway for MAb therapy to address these challenges within a large integrated health care system. By describing adaptable and scalable solutions, the authors hope to illustrate the real-world feasibility of implementing these promising therapies in health care systems, large and small, to improve patient outcomes and preserve hospital capacity.
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
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.
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.
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.
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