Collaborative health systems ECHO: The use of a tele-education platform to facilitate communication and collaboration with recipients of state targeted response funds in Pennsylvania.

Background: The opioid epidemic continues to erode communities across Pennsylvania (PA). Federal and PA state programs developed grants to establish Hub and Spoke programs for the expansion of medications for opioid use disorders (MOUD). Employing the telementoring platform Project ECHO (Extension for Community Health Outcomes), Penn State Health engaged the other seven grant awardees in a Collaborative Health Systems (CHS) ECHO. We conducted key informant interviews to better understand impact of the CHS ECHO on health systems collaboration and opioid crisis efforts. Methods: For eight one-hour sessions, each awardee presented their unique strategies, challenges, and opportunities. Using REDCap, program characteristics, such as number of waivered prescribers and number of patients served were collected at baseline. After completion of the sessions, key informant interviews were conducted to assess the impact of CHS ECHO on awardee's programs. Results: Analysis of key informant interviews revealed important themes to address opioid crisis efforts, including the need for strategic and proactive program reevaluation and the convenience of collaborative peer learning networks. Participants expressed benefits of the CHS ECHO including allowing space for discussion of challenges and best practices and facilitating conversation on collaborative targeted advocacy and systems-level improvements. Participants further reported bolstered motivation and confidence. Conclusions: Utilizing Project ECHO provided a bidirectional platform of learning and support that created important connections between institutions working to combat the opioid epidemic. CHS ECHO was a unique opportunity for productive and convenient peer learning across external partners. Open dialogue developed during CHS ECHO can continue to direct systems-levels improvements that benefit individual and population outcomes.

The effect of the American Heart Association step one diet on hyperlipidemia following renal transplantation.

Cardiovascular disease is a frequent cause of morbidity and mortality following renal transplantation. The percentage of deaths due to ischemic cardiovascular disease and cerebrovascular accidents nearly equals that caused by infection among patients receiving their first transplant, according to data from the European Dialysis and Transplant Association Registry. Hypercholesterolemia is a risk factor for cardiovascular disease frequently identified following renal transplantation, and diets low in fat and cholesterol have been suggested as treatment. Previous studies have not reported the response of LDL cholesterol to dietary treatment, and it is this form of cholesterol that is most closely related to cardiovascular disease. The American Heart Association has provided nutritionists with guidelines for the treatment of hyperlipidemic patients which include the Step One Diet. Previous dietary studies of renal transplant recipients have allowed a slightly higher intake of fat than that currently recommended by the AHA. We wondered if an easily reproducible diet well known to nutritionists such as the AHA Step One Diet would be effective in lowering cholesterol levels in hyperlipidemic renal transplant recipients. The purpose of our study was not to define the mechanisms of posttransplant hyperlipidemia, but rather to assess the effectiveness of dietary intervention on hyperlipidemia following renal transplantation.

Self-ratings of personality: a naturalistic comparison of normative, ipsative, and idiothetic standards.

The purpose of this research is to examine some of the implicit standards that individuals may use when they rate themselves on personality dimensions. Specifically, we compared ratings based on instructions that specified normative, ipsative, or idiothetic criteria with ratings obtained when subjects used their own (implicit) standards. In a series of three studies, we found that each of the explicit ratings was highly similar to the implicit-standard ratings and that there were substantial individual differences in the relative similarity of each of the explicit ratings to the implicit ratings. However, because the normative instructions elicited less extreme responses than any of the other instructions, there was a small but consistent tendency for them to be less similar to the ratings based on implicit standards than the ipsative or idiothetic ratings. The implications of this research for personality assessment and self-evaluation are discussed.

Identifying health care stakeholders: a key to strategic implementation.

As the number and complexity of stakeholders for health care organizations has increased, health care managers have become more aware of the ability of these groups to thwart or facilitate the implementation of strategic plans. Most stakeholder models have focused on identification of groups within the usual, global definition of affecting or being affected by an organization's actions. The authors argue that stakeholders management is critical to the implementation of strategic plans. They provide a narrower, more operationally useful stakeholder definition and present a framework for assessing the relative importance of each stakeholder for a given situation. The situational evaluation of stakeholders is critical to successful implementation of strategy.

Comparison of acute hemodynamic effects of nitroglycerin versus diltiazem and combined acute effects of both drugs in angina pectoris.

Fifteen patients with exertional angina underwent hemodynamic monitoring and measurement of cardiac output during a control treadmill exercise test. They were then randomized to receive sustained-release nitroglycerin, 13 mg (group I) or placebo (group II). Repeat exercise testing revealed that in group I, both maximal oxygen consumption and cardiac output increased significantly. In group II neither maximal oxygen consumption nor cardiac output increased significantly. All patients then received diltiazem, 60 mg, and repeat testing was carried out 1 hour later. In group I maximal oxygen consumption and cardiac output were higher than control, but were no higher than after nitroglycerin. In group II, maximal oxygen consumption increased significantly, but the increase in cardiac output was not significant. Thus, sustained-release nitroglycerin, 13 mg, or diltiazem, 60 mg, both improve exercise performance, but the combination does not improve exercise performance to an extent greater than either drug alone.