Improving Efficiency of Primary Care Provider Communication for Uncomplicated Admissions.

BACKGROUND: Communication between inpatient pediatric hospital medicine (HM) and primary care providers (PCPs) is important for quality care. As provider workload increases, it is important to focus on a means to improve communication efficiency. Our goal was to increase the percentage of HM admissions using 1-way communication from 0% to 35% over a 16-month period. METHODS: HM providers and PCPs collaborated to identify 12 admission diagnoses for which 1-way communication could be used. Using quality improvement methods, we studied the implementation of "Leave a Message" (LAM) calls for 1-way communication and providing PCPs with the option to place a return call. Control charts were used to track LAM call use and balancing measures of PCP return phone calls, additional PCP communications, and 7-day readmissions over time. RESULTS: A total of 778 LAM calls were placed by HM providers over 16 months. The percentage of LAM calls out of all PCP calls placed ranged from 0% to 35% during this time, increasing significantly during winter months and before the coronavirus disease 2019 pandemic. Only 0.4% (n = 3) of LAM calls were returned by PCPs. Estimated PCP return phone calls were reduced by 11.1 calls per week. CONCLUSIONS: We created a system for 1-way telephone communication between HM providers and PCPs for common, simple admissions and reduced the need for PCP return phone calls. The low percentage of LAM calls returned by PCPs may suggest that 1-way communication is adequate for most simple admissions.

Voltammetric detection of trifluralin in tap water, fruit juice, and vegetable extracts in the presence of surfactants.

This study describes a novel electrochemical method to determine the herbicide trifluralin in samples of water, fruit juice, and vegetable extracts in the presence of surfactants, using a glassy carbon electrode (GCE). In acidic media, trifluralin was irreversible on the glassy carbon electrode surface at -0.5 V vs. Ag/AgCl. Surfactant presence on the electrode-solution interface modified current intensities and shifted the reduction peak potential of trifluralin. Different types of surfactant and their concentrations were investigated. The anionic surfactant significantly enhanced the peak current intensity of trifluralin. Under optimal analytical conditions, an analytical curve was obtained in the concentration range of 0.48-32.20 µM. The limits of detection and quantification were estimated at 0.031 and 0.104 µM, respectively. The method was successfully applied to quantify trifluralin in samples of water, orange and tomato juice, and green pepper, carrot, and onion extracts, with recovery rates of 97.9-102.1%. The results were in good agreement with those obtained using high-performance liquid chromatography, indicating that the proposed electrochemical method can be employed to quantify trifluralin in various types foods, with sensitivity, specificity, selectivity and reproducibility.

Using theory and technology to design a practical and generalizable smoking reduction intervention.

The aim of this article is to describe the process of using theory to form strategies for a generalizable smoking reduction intervention delivered through multiple intervention modalities. This report describes the process of integrating theory, data from diverse sources, staff from three different organizations, and different intervention modalities into an efficient, large-scale smoking reduction program featuring automated data from electronic medical records, computer-assisted telephone interviews, and tailored newsletters. The authors successfully developed a program that was consistently implemented as planned for 320 smokers in a managed care organization. The mapping of theory to intervention, data transfer and security procedures, and processes and strategies used to overcome challenges to intervention implementation should provide lessons learned for similar health promotion projects. Few intervention studies discuss details of how they translate theory into practice or how they integrate different modalities and collaborating institutions, but such integration is critical for project success.

Long-term results of a smoking reduction program.

INTRODUCTION: There have been few comprehensive evaluations of smoking reduction, especially in health care delivery systems, and little is known about its cost, maintenance of reduced smoking, or robustness across patient subgroups. METHODS: A generally representative sample of 320 adult smokers from an HMO scheduled for outpatient surgery or a diagnostic procedure was randomized to enhanced usual care or a theory-based smoking reduction intervention that combined telephone counseling and tailored newsletters. Outcomes included cigarettes smoked, carbon monoxide levels, and costs. RESULTS: Both intervention and control conditions continued to improve from 3- to 12-month assessments. Between-condition differences using intent-to-treat analyses on both self-report and carbon monoxide measures were nonsignificant by the 12-month follow-up (25% vs. 19% achieved 50% or greater reductions in cigarettes smoked). The intervention was implemented consistently despite logistical constraints and was generally robust across patient characteristics (eg, education, ethnicity, health literacy, dependence). CONCLUSIONS: In the absence of nicotine replacement therapy, the long-term effects of this smoking reduction intervention seem modest and nonsignificant. Future research is indicated to enhance intervention effects and conduct more comprehensive economic analyses of program variations.

Association of specific haplotypes of D2 dopamine receptor gene with vulnerability to heroin dependence in 2 distinct populations.

CONTEXT: Dopamine receptor-mediated pathways play critical roles in the mechanism of addiction. However, associations of the D(2) dopamine receptor gene (DRD2) with substance abuse are controversial. OBJECTIVE: To determine whether susceptibility sites resided at DRD2. DESIGN: Haplotype-based case-control analysis of 2 distinct populations using 10 single nucleotide polymorphisms (SNPs) with heroin dependence. SETTING: Universities of Mainz and Bonn, Germany, and 3 local hospitals in southwestern China. Patients Cases and control subjects recruited from China (486 cases, 313 controls) and Germany (471 cases, 192 controls). INTERVENTIONS: Genotyping for 10 SNPs by 5'-exonuclease fluorescence assays. The D' value of linkage disequilibrium and haplotypes were generated by the expectation-maximization algorithm. MAIN OUTCOME MEASURES: Genotype, allele, and haplotype frequencies were compared between cases and controls by chi(2) tests constructed for each population. An additional 32 SNPs randomly distributed in the genome were genotyped for detecting population admixture in the 2 populations. RESULTS: A haplotype block of 25.8 kilobases (kb) was defined by 8 SNPs extending from SNP3 (TaqIB) at the 5' end to SNP10 site (TaqIA) located 10 kb distal to the 3' end of the gene. Within this block, specific haplotype cluster A (carrying TaqIB1 allele) was associated with a high risk of heroin dependence in Chinese patients (P = 1.425 x 10(-22); odds ratio, 52.80; 95% confidence interval, 7.290-382.5 for 8-SNP analysis). A putative recombination "hot spot" was found near SNP6 (intron 6 ins/del G), creating 2 new daughter haplotypes that were associated with a lower risk of heroin dependence in Germans (P = 1.94 x 10(-11) for 8-SNP analysis). There was no evidence of population stratification in either population. CONCLUSIONS: These results strongly support a role of DRD2 as a susceptibility gene with heroin dependence in Chinese patients and was associated with low risk of heroin dependence in Germans.

Association of the G1947A COMT (Val(108/158)Met) gene polymorphism with prefrontal P300 during information processing.

BACKGROUND: A common functional polymorphism, G1947A, of the catechol-O-methyltransferase (COMT) enzyme has gained interest in schizophrenia research because of its critical involvement in cortical dopamine catabolism and frontal lobe function. An assumed mechanism of dopamine is the reduction of noise in prefrontal neural networks during information processing. Therefore, the hypothesis was tested whether a variation of the COMT genotype is associated with prefrontal noise, which is in part reflected by the frontal P300 amplitude. It was predicted that homozygous Met allele carriers have a lower frontal P300 amplitude. METHODS: The P300 component (auditory oddball) was recorded in 49 schizophrenic patients and 170 healthy control subjects. Three single nucleotide polymorphisms (SNPs) of the COMT gene (G1947A, C1883G, and G1243A) were investigated. RESULTS: We observed a significant effect of G1947A COMT genotype on frontal P300 amplitude, with evidence for a genotype x diagnosis interaction. Lower frontal P300 amplitudes occurred in homozygous carriers of the Met allele, particularly in schizophrenic patients. CONCLUSIONS: The association of the frontal P300 amplitude with the G1947A COMT genotype further emphasizes the functional role of this SNP. As the finding was mainly observed in schizophrenic patients, this may indicate that additional factors are required to interact with COMT genotype to affect prefrontal function. The smaller frontal P300 amplitude in Met carriers suggests that the amount of noise in prefrontal neural networks during information processing might be in part under genetic control, which is mediated by dopamine.

Genetic origins of anxiety in women: a role for a functional catechol-O-methyltransferase polymorphism.

OBJECTIVE: Women are more prone to anxiety than men. The catechol- -methyltransferase functional polymorphism, Val158Met, is likely to be implicated in anxiety vulnerability. We hypothesized that, particularly in women, the low-activity Met158 allele would be associated with higher anxiety scores and a biological trait, low-voltage alpha resting electroencephalogram (EEG), previously associated with alcoholism and anxiety disorders. METHODS: DNA was obtained from two independent groups of participants ascertained as community samples: 149 predominantly Caucasian individuals (92 women, 57 men), and 252 Plains American Indians (149 women, 103 men). Dimensional measures of anxiety (Tridimensional Personality Questionnaire harm avoidance subscales HA1 and HA2) were obtained and DSM-III-R lifetime psychiatric diagnoses were determined. EEGs were recorded and EEG phenotypes assigned. RESULT: In both populations, women showed significant associations between catechol- -methyltransferase genotype and elevated harm avoidance scores, and the Met158/Met158 genotype was most strongly associated: predominantly Caucasian participants: HA1, P=0.03, HA2, P =0.03; and Plains American Indians: HA2, P=0.01. This was also the case with low-voltage alpha resting EEG: predominantly Caucasian participants: P=0.01, odds ratio=5.0 (95% confidence interval, 1.3-18.7); Plains American Indians: P=0.03, odds ratio=3.7 (95% confidence interval, 1.1-12.7). CONCLUSIONS: The results of the present study suggest that an inherited difference in catecholamine metabolism is important in the pathogenesis of anxiety in women.