Implementation of a Portable Medical Summary for Adolescents and Young Adults With Medical Complexity in Transition to Adult Health Care.

BACKGROUND: Adolescents and young adults (AYA) with special health care needs are living into adulthood, as improvements in care increase the likelihood of survival. Fewer than half have the resources needed to transition to adult care (McPheeters et al., 2014). A portable medical summary is a concise document summarizing current medical information about a patient that can be used across healthcare systems as AYA transition to adult care. Though a consensus statement recommending the use of such a summary has existed for over a decade (American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians-American Society of Internal Medicine (ACP-ASIM), 2002), little progress had been made in the development of a portable medical summary. METHODS: The Institute for Healthcare Improvement (IHI) Model was used to implement a process to provide a portable medical summary to AYAs with medically complex conditions (Institute for Healthcare Improvement, 2017). INTERVENTIONS: The tool was developed using the electronic health record and shared with families. Feedback from care providers and families led to modifications to improve its usefulness and feasibility. Implementation of the process was tested for four months. RESULTS: The number of AYA, ages 16-24, who were being seen for well care or chronic care management visits, and had a portable medical summary initiated, had increased from 0% to 100%. CONCLUSIONS: The use of a PMS that summarizes medical care received in the pediatric system, is one tool that may be used to bridge the gap between pediatric and adult care.

Enhancing shared governance for interdisciplinary practice.

Cincinnati Children's Hospital Medical Center has a strong history of embracing staff empowerment and shared decision making. Shared governance for nursing was implemented in 1989; a separate allied health structure was created in 1999. The two operated in parallel with few occasions for interface, and with little collaboration. With the beginning of the medical center's efforts to pursue perfect patient care in 2002, there was a marked increase in the frequency of interprofessional initiatives and collaborations in the organization. By 2005, this increase in collaborative practice precipitated discussions questioning the purpose and efficiency of two separate structures. Over the next two years, planning ensued to merge these structures to better reflect the current interprofessional reality. The enhanced shared governance structure at Cincinnati Children's was launched in 2008. Each discipline now governs its own practice, but as patient care issues overlap, there is a structure in place to resolve patient issues that cross disciplines. The new Patient Care Governance Council includes physician and family representatives.

A streamlined clinical advancement program improves RN participation and retention.

Retaining expert nurses in direct care is essential to quality patient outcomes. The goal of the clinical advancement program at Cincinnati Children's Hospital Medical Center has always been to recruit, retain, recognize, and reward nurses in direct care. A program revision in 2002 markedly increased nursing promotions and a higher retention rate for program participants versus their peers' retention rate of 88%. Nearly 40% of the hospital's nurses now participate in the program.

A PP1-binding motif present in BRCA1 plays a role in its DNA repair function.

Protein phosphatase 1alpha (PP1alpha) regulates phosphorylation of BRCA1, which contains a PP1-binding motif (898)KVTF(901). Mutation of this motif greatly reduces the interaction between BRCA1 and PP1alpha. Here we show that mutation of the PP1-binding motif abolishes the ability of BRCA1 to enhance survival of Brca1-deficient mouse mammary tumor cells after DNA damage. The Rad51 focus formation and comet assays revealed that the DNA repair function of BRCA1 was impaired when the PP1-binding motif was mutated. Analysis of subnuclear localization of GFP-tagged BRCA1 demonstrated that mutation of the PP1-binding motif affected BRCA1 redistribution in response to DNA damage. BRCA1 is required for the formation of Rad51 subnuclear foci after DNA damage. Mutation of the PP1-binding motif in BRCA1 also affected recruitment of Rad51 to sites of DNA damage. Consistent with these findings, knockdown of PP1alpha in BRCA1-proficient cells by small interfering RNA also significantly reduced Rad51 focus formation induced by DNA damage. Further analysis indicated that mutation of the PP1-binding motif compromised BRCA1 activities in homologous recombination. Altogether, our data implicate that interaction with PP1alpha is important for BRCA1 function in DNA repair.