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Hypertension awareness, treatment, and control are lower among uninsured than insured adults. Time trends in differences and underlying modifiable factors are important for informing strategies to improve health equity. National Health and Nutrition Examination Surveys 1988 to 1994, 1999 to 2004, and 2005 to 2010 data in adults aged 18 to 64 years were analyzed to explore this opportunity. The proportion of adults with hypertension who were uninsured increased from 12.3% in 1988 to 1994 to 17.4% in 2005 to 2010. In 1988 to 1994, hypertension awareness, treatment, and control to <140/<90 mm Hg (30.1% versus 26.5%; P=0.27) were similar in insured and uninsured adults. By 2005 to 2010, the absolute gap in hypertension control between uninsured and insured adults of 21.9% (52.5% versus 30.6%; P<0.001) was explained approximately equally by lower awareness (65.2% versus 80.7%), fewer aware adults treated (75.2% versus 88.5%), and fewer treated adults controlled (63.1% versus 73.5%; all P<0.001). Publicly insured and uninsured adults had similar income. Yet, hypertension control was similar across time periods in publicly and privately insured adults, despite lower income and education in the former. In multivariable analysis, hypertension control in 2005 to 2010 was associated with visit frequency (odds ratio, 3.4 [95% confidence interval, 2.4-4.8]), statin therapy (1.8 [1.4-2.3]), and healthcare insurance (1.6 [1.2-2.2]) but not poverty index (1.04 [0.96-1.12]). Public or private insurance linked to more frequent healthcare, greater awareness and effective treatment of hypertension, and appropriate statin use could reverse a long-term trend of growing inequity in hypertension control between insured and uninsured adults. [ABSTRACT FROM AUTHOR]

Reducing medication errors is a fundamental patient safety goal; however, few improvement interventions have been evaluated in primary care settings. The Medication Safety in Primary Care Practice project was designed to test the impact of a multimethod quality improvement intervention on 5 categories of preventable prescribing and monitoring errors in 20 Practice Partner Research Network (PPRNet) practices. PPRNet is a primary care practice–based research network among users of a common electronic health record (EHR). The intervention was associated with significant improvements in avoidance of potentially inappropriate therapy, potential drug-disease interactions, and monitoring of potential adverse events over 2 years. Avoidance of potentially inappropriate dosages and drug-drug interactions did not change over time. Practices implemented a variety of medication safety strategies that may be relevant to other primary care audiences, including use of EHR-based audit and feedback reports, medication reconciliation, decision-support tools, and refill protocols. [ABSTRACT FROM PUBLISHER]

The article presents a study which investigated bleeding complications linked to cardiac rhythm device implantation. PubMed and Cochrane Database searches searched for studies based on design, outcomes, and available data. Device recipients were categorized as no therapy, aspirin only, anticoagulant (AC) held, AC continued, dual antiplatelet, and heparin-bridging strategy. The result was defined as a bleeding complication which include hematoma, transfusion, or extended hospitalization.

The article presents a study on the achievable benchmarks of care (ABCs) for primary care quality indicators. The highest abcs include measures of routine vital signs and suggested laboratory tests for patients with chronic illness. Avoiding antibiotics prescriptions for upper respiratory infection, use of antidepressant for depression, and avoiding inappropriate medications in the elderly are considered. Also cited are recommended medication arrangement, glucose screening, mammogram and pap smear screenings, and routine immunization.

This research describes implementation strategies used by primary care practices using electronic medical records in a national quality improvement demonstration project, Accelerating Translation of Research into Practice, conducted within the Practice Partner Research Network. Qualitative methods enabled identification of strategies to improve 36 quality indicators. Quantitative survey results provide mean scores reflecting the integration of these strategies by practices. Nursing staff plays important roles to facilitate quality improvement within collaborative primary care practices. [ABSTRACT FROM AUTHOR]

The article presents the results of a study on the impact of multicomponent medical quality improvement (QI) intervention on adherence with 13 measures of diabetes care. The findings of the study suggests that independent primary care practices participating in a QI project involving performance reports, occasional practice site visits and annual network meetings can improve the extent to which their patients with diabetes receive recommended monitoring and treatments.

Advances in technology can have direct and indirect benefits to clinical practice. The challenge that clinicians face is to properly match resources and outcomes, along with patient preferences. This articles explores the use of an innovative interactive voice response system to increase patient compliance with antidepressant medication prescribed in primary care settings. The development of the interactive voice response system, its implementation, and clinical outcomes are described. The findings underscore the need to carefully match intervention strategies with the needs of specific patient populations, and the importance of human dialog in the context of healing. [ABSTRACT FROM AUTHOR]

This article presents a case study from a primary care practice that achieves blood pressure control (ie,less than 130/85 mm Hg) in a majority of patients with diabetes. Fifty-three percent of the last blood pressure measured in 2001 were controlled and 38% of patients achieved blood pressure control without medications or with a single agent. Blood pressure control is achieved in a majority of patients in this practice secondary to their focus on guidelines, involvement of nursing staff in case management, and medication use consistent with recommendations. [ABSTRACT FROM AUTHOR]

Conclusions. In this predominantly rural area, decreased utilization of health services was evident among older, poor, black, rural cancer patients. Further investigation involving prospective data collection from cancer patients is warranted. [ABSTRACT FROM AUTHOR]

Presents information on a study which explored the relationship between system supports for chronic care and clinical outcomes for diabetes and cardiovascular disease. Methodology of the study; Results and discussion of the study.

ABSTRACT: The impact of reducing smoking initiation, increasing smoking cessation, and combination approaches on life expectancy, deaths averted, and life-years gained in a birth cohort of 50,000 persons and in the state population (3.6 million) were analyzed. A 60% reduction in initiation of smoking in adolescents would increase life expectancy by 0.42 years. Over the next 100 years, there would be an additional 18,000 years of life for a birth cohort and an additional 675,000 years of life for the state's population. The reduction in mortality, however, would not begin before 35 years, and only 25% of the benefit would occur in the next 70 years. An increase in smoking cessation would have a smaller impact that would occur sooner. Maximum reduction in mortality could be achieved by reducing initiation and increasing cessation at all ages, but a reduction in mortality would not occur for several decades. [ABSTRACT FROM AUTHOR]

Abstract: The locally invasive soft-tissue sarcoma, dermatofibrosarcoma protuberans (DFSPs), shares certain histologic features of the much more common and benign dermatofibroma (DF). While immunohistochemical stains, specifically cluster of differentiation 34 and Factor XIIIa, can be used to distinguish the 2 entities using microscopy, these markers are not entirely sensitive nor specific. Three-dimensionally, DFSP nuclei resemble a "puck" or "coin"-like shape. As hematoxylin/eosin-stained slides are prepared, these "puck" nuclei are fixed in an infinite number of orientations depending on their current position in rotation about their axes within the tumor cells. Under histological examination, this random nuclear positioning produces the appearance of 2 predominate morphologies: an ovoid "disk" shape (en face) and a narrow spindled shape (side view), which distribute in a roughly 50:50 ratio throughout the tumor sample slide. Nuclear morphology was analyzed in 324 DFSP and DF samples at high magnification (×400) to determine the presence or absence of a predominant morphology in which nuclei appear to alternate between an ovoid (en face) and spindled (side view) throughout most of the tumor sample. An alternating ovoid-spindled nuclear morphology was the predominant cytology in 98% of DFSP and was not predominant in 100% of DF samples (P < 0.001). This morphology was found to be highly specific (Sp = 1) and sensitive (Sn = 0.98) for DFSP. This unique nuclear morphology may be a more sensitive and specific diagnostic tool in identifying DFSP from DF in comparison with costly immunohistochemical stains., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This study aimed to determine the relationship between main pulmonary artery diameter (MPAD) and pulmonary hypertension (PH) in scleroderma patients with and without interstitial lung disease., Methods: We retrospectively reviewed 48 subjects with scleroderma who underwent a chest computed tomography (CT) and right heart catheterization with 6 months of each other. Patients were divided into 2 groups based on the absence or presence of interstitial lung disease on chest CT. Subset analysis was performed based on available pulmonary function tests and divided into groups by forced vital capacity (FVC). Computed tomographic scans were scored for extent of fibrosis and ground glass opacity. Pulmonary artery and ascending aorta measurements were obtained by 2 independent observers. Univariate and multivariate models were used to evaluate the correlation between MPAD and mean pulmonary artery pressure (mPAP) measured by right heart catheterization. Receiver operating characteristic analysis was performed for diagnostic accuracy of the MPAD measurement in predicting PH., Results: Strong correlations between mPAP and MPAD were found in this study regardless of the presence or absence of mild to moderate interstitial fibrosis on chest CT. When dividing patients based on FVC, the correlation between mPAP and MPAD was substantially attenuated. An MPAD value of 30.8 mm yielded the highest sensitivity and specificity at 81.3% and 87.5%, respectively., Conclusions: In scleroderma patients, an enlarged main pulmonary artery (>30 mm) predicts PH even in the presence of mild to moderate fibrosis although the relationship may be attenuated in the presence of a low % FVC.

Purpose: Tibial osteotomy is used to treat a variety of orthopedic conditions, including reduction in pain and improvement of deformity and function. In templating for surgery, accurate radiographic measurement aids in planning for correction. The purpose of our study was to examine the effect of internal rotation and external rotation on measurement of tibial sawbone models with 5 closing wedge varus deformities at 10-degree increments between 10 and 50 degrees. One sawbone without deformity served as the control., Study Design: A total of 66 radiographs were measured by 5 individuals. Measurement deviations from the control in each of the 10 positions of rotation were assessed., Results: In the analysis of variance models, increased rotation and varus angulation were associated with increased deviation compared with the control. In external rotation for every 10 degrees of varus angulation, the degree deviation increased 0.69 degrees. In IR for every 10 degrees of angulation, the degree deviation increased by 0.84 degrees. Internal rotation had the greatest impact. Mean differences between different rater's measurements were small (1.1+/-1.2 degrees) and correlations suggested high interrater reliability., Conclusions: As the degree of rotation from neutral increased and varus angulation increased, deviation from neutral increased., Clinical Relevance: Clinically, the results of this study support the importance of proper alignment of the tibia during radiography to more precisely template surgery.

Objectives: The study seeks to evaluate whether continuity in medical care provides a mechanism that contributes to increased parental awareness of the importance of dental services, nutrition, and child development and whether health insurance encourages such continuity., Methods: Data pertaining to medical utilization and dental, child nutrition, and child development counseling were extracted from the National Maternal and Infant Health Survey, 1988 and the 1991 Longitudinal Follow-up. These data permit the investigation of whether having continuity in medical care for a child increases the likelihood that the child's parent receives advice about dental health, nutrition, and child development. Restricting the analyses to Caucasian and African American women and excluding respondents with missing information on the child's health care utilization yielded 7056 participants. We created a set of binomial logit models, with correction for clustering (due to sample design). These models jointly estimate the likelihood that a child was classified as having continuity of care and the likelihood that the child's mother received advice about the 3 areas of interest., Results: Private fee-for-service health insurance was found to increase the likelihood that a child receives continuity of care. When primary care was provided with high continuity of care, the probability that physicians provide mothers with dental, nutritional, and developmental advice was increased., Conclusions: These results suggest that continuity of care may have important spillover effects beyond direct medical care by improving maternal information about child dental care, nutrition, and developmental issues.