Food insecurity in Detroit: exploring the relationship between patient-reported food insecurity and proximity to healthful grocery stores.

OBJECTIVE: The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence. DESIGN: A secondary data analysis that uses baseline data from a pilot intervention/feasibility study. SETTING: Detroit, Michigan, USA. PARTICIPANTS: Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study (i.e. Henry's Groceries for Health), conducted through a collaboration with Gleaners Community Foodbank of Southeastern Michigan. Only patients residing in Detroit city limits (including Highland Park and Hamtramck) were included in the secondary analysis. Of the 1,100 patients included in the analysis, 336 (31 %) were food insecure. RESULTS: After accounting for socio-demographic factors associated with food insecurity, we did not find evidence that food insecure patients lived further away from healthier grocery stores, nor was this modified by ecological measures of vehicle access. However, some neighbourhoods were identified as having a significantly higher risk of food insecurity. CONCLUSIONS: Food insecure patients in Detroit are perhaps limited by social and political determinants and not their immediate neighbourhood geography or physical access to healthy grocery stores. Future research should explore the complexity in linkages between household socio-economic factors, socio-cultural dynamics and the neighbourhood food environment.

Trans-ancestry meta-analyses identify rare and common variants associated with blood pressure and hypertension.

High blood pressure is a major risk factor for cardiovascular disease and premature death. However, there is limited knowledge on specific causal genes and pathways. To better understand the genetics of blood pressure, we genotyped 242,296 rare, low-frequency and common genetic variants in up to 192,763 individuals and used ∼155,063 samples for independent replication. We identified 30 new blood pressure- or hypertension-associated genetic regions in the general population, including 3 rare missense variants in RBM47, COL21A1 and RRAS with larger effects (>1.5 mm Hg/allele) than common variants. Multiple rare nonsense and missense variant associations were found in A2ML1, and a low-frequency nonsense variant in ENPEP was identified. Our data extend the spectrum of allelic variation underlying blood pressure traits and hypertension, provide new insights into the pathophysiology of hypertension and indicate new targets for clinical intervention.

Developing communities of interprofessional practice: using a communities of practice framework for interprofessional education.

Development of interprofessional education programs that meet new Interprofessional Education Collaborative competencies is a challenge for faculty and administrators. This article describes a curricular design that places students in learning communities over a 2-year period with a plan for 5 learning sessions. Communities of practice is the theoretical framework of the curricular design, creating interprofessional clinicians capable of effective collaborative practice.

Holistic admissions process: an initiative to support diversity in medical education.

In accordance with the call from multiple academic medicine bodies and professional medical societies, the physician assistant studies program at a small northeastern university implemented a holistic admissions process in 2008 with the intent of increasing diversity in the classroom. This manuscript outlines the processes that occurred and the results that ensued after adoption of a holistic admissions process.

2011 John M. Eisenberg Patient Safety and Quality Awards. The Henry Ford Health System No Harm Campaign: a comprehensive model to reduce harm and save lives. innovation in patient safety and quality at the local level.

BACKGROUND: In 2008 Henry Ford Health System launched its "No Harm Campaign," designed to integrate harm-reduction interventions into a systemwide initiative and, ultimately, to eliminate harm from the health care experience. METHODS: The No Harm Campaign aims to decrease harm events through enhancing the system's culture of safety by reporting and studying harm events, researching causality, identifying priorities, and redesigning care to eliminate harm. The campaign uses a comprehensive set of 27 measures for harm reduction, covering infection-, medication-, and procedure-related harm, as well as other types of harm, all of which are combined to comprise a unique global harm score. The campaign's objective is to reduce all-cause harm events systemwide by 50% by 2013. A wide range of communication processes, from systemwide leadership retreats to daily e-mail news sent to all employees and physicians, is used to promote the campaign. In addition, the campaign is on the intranet "Knowledge Wall," where monthly dashboards, meeting minutes, and best practices and the work of our teams and collaboratives are documented and shared. RESULTS: From 2008 through 2011, a 31% reduction in harm events and an 18% reduction in inpatient mortality occurred systemwide. DISCUSSION: Building infrastructure, creating a culture of safety, providing employee training and education, and improving work process design are critical to systemwide implementation of harm-reduction efforts. Key actions for ongoing success focus on leadership, disseminating performance, putting everyone to work, and stealing ideas through national and local collaborations. A financial model was created to assess cost-savings of reducing harm events; early results total nearly $10 million in four years.

Attitudes toward interprofessional education: comparing physician assistant and other health care professions students.

PURPOSE: Since the release of the 1988 World Health Organization report on the need for interprofessional education (IPE) programs, various forms of IPE curricula have been implemented within institutions of higher education. The purpose of this paper is to describe results of a study using the Readiness for Interprofessional Learning Scale (RIPLS) to compare physician assistant (PA) students with other health professions students. METHODS: The RIPLS survey was completed by 158 health professions graduate students, including 71 PA students, at a small northeastern university in the fall of 2010. Students were enrolled in either counseling psychology, occupational therapy, physical therapy, or PA studies. Students completed the RIPLS survey, demographic questions, and a question regarding experience with the health care environment. RESULTS: PA students scored significantly lower on three of the four subscales of the RIPLS survey, as well as lower in total score. Females of all health professions scored significantly higher on the RIPLS total score and on the Teamwork and Collaboration subscale than did males. Students with prior exposure to the health care system as a patient or as an immediate family member of a patient scored significantly higher on the Negative Professional Identity subscale than did students without such exposure. CONCLUSIONS: Results indicate that PA students may value interprofessional collaboration less than other health professions students. Also, there may be gender and experiential differences in readiness for interprofessional learning. These findings may affect the design of IPE experiences and support integration of interprofessional experiences into PA education.

A PACU crisis: a case study on the development and management of methemoglobinemia.

The development of methemoglobinemia requires rapid recognition, confirmation, and treatment. This case study describes the development, diagnosis, and management of a 63-year-old male scheduled for a laparoscopic cholecystectomy with an intraoperative cholangiogram who developed methemoglobinemia after benzocaine was given for intubation.