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Doroshenk M.,National Colorectal Cancer RoundtableWashingtonDC | Hotz J.,Cancer Coalition of South GeorgiaAlbany | Brooks D.,Colorectal and Prostate CancersAmerican Cancer Society AtlantaGA | Hayashi S.,Bureau of Primary Health Care | And 4 more authors.
CA Cancer Journal for Clinicians | Year: 2013

Community health centers are uniquely positioned to address disparities in colorectal cancer (CRC) screening as they have addressed other disparities. In 2012, the federal Health Resources and Services Administration, which is the funding agency for the health center program, added a requirement that health centers report CRC screening rates as a standard performance measure. These annually reported, publically available data are a major strategic opportunity to improve screening rates for CRC. The Patient Protection and Affordable Care Act enacted provisions to expand the capacity of the federal health center program. The recent report of the Institute of Medicine on integrating public health and primary care included an entire section devoted to CRC screening as a target for joint work. These developments make this the ideal time to integrate lifesaving CRC screening into the preventive care already offered by health centers. This article offers 5 strategies that address the challenges health centers face in increasing CRC screening rates. The first 2 strategies focus on improving the processes of primary care. The third emphasizes working productively with other medical providers and institutions. The fourth strategy is about aligning leadership. The final strategy is focused on using tools that have been derived from models that work. © 2013 American Cancer Society, Inc.

Mitchell M.,Community Medical Centers | Dizon D.,University of California at San Francisco | Libke R.,University of California at San Francisco | Peterson M.,University of California at San Francisco | And 2 more authors.
Journal of Clinical Microbiology | Year: 2015

Rapid real-time PCR (RT-PCR) can be performed in a community hospital setting to identify Coccidioides species using the new Becton Dickinson molecular instrument BD Max. Following sample preparation, DNA extraction and PCR were performed on the BD Max using the BD Max extraction kit ExK-DNA-1 test strip and a master mix prepared by BioGX (Birmingham, AL). Sample preparation took 2 h, and testing on the BD Max took an additional 2 h. Method sensitivity and specificity were evaluated along with the limits of detection to confirm that this convenient method would provide medically useful information. Using serial dilutions, the lower limit of detection was determined to be 1 CFU/μl. Testing with this method was validated using samples from various body sites, including bronchial alveolar lavage (BAL) fluid; sputum and lung tissue samples; and pleural and spinal fluids. Safety protocols were established, and specimen preparation processes were developed for the various types of specimens. The range for the cycle threshold (CT) indicating adequate fluorescent signal to signify a positive result was established along with the acceptable range for the internal standard. Positive controls run with each batch were prepared by spiking a pooled BAL fluid specimen with a known dilution of Coccidioides immitis organism. Our experience with testing >330 patient samples shows that clinically relevant information can be available within 4 h using an RT-PCR method on the BD Max to identify Coccidioides spp., with sensitivity equivalent to culture. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Kataoka S.,University of California at Los Angeles | Novins D.K.,Community Medical Centers | DeCarlo Santiago C.,University of California at Los Angeles
Child and Adolescent Psychiatric Clinics of North America | Year: 2010

Ethnic minority children continue to have substantial unmet mental health needs, and evidence-based treatments (EBTs) have proved challenging to disseminate widely among ethnic minority communities. Indeed, policy makers have made an important distinction between EBTs, interventions that have proven efficacy in clinical trials, and evidence-based practice, which involves " the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences." The present research evidence suggests that several interventions have been found to be effective in ethnic minority populations without a need for major adaptations of the original interventions. However, this article highlights the need to deliver evidence-based practice, which is defined as the implementation of EBTs delivered with fidelity and with the integration of important cultural systems and community factors. © 2010 Elsevier Inc.

Kolla B.P.,Center for Sleep Medicine | Lovely J.K.,Hospital Pharmacy Services | Mansukhani M.P.,Community Medical Centers | Morgenthaler T.I.,Center for Sleep Medicine
Journal of Hospital Medicine | Year: 2013

Background: Inpatient falls are associated with significant morbidity and increased healthcare costs. Zolpidem has been reported to decrease balance and is associated with falls. Yet, it is a commonly used hypnotic agent in the inpatient setting. Zolpidem use in hospitalized patients may be a significant and potentially modifiable risk factor for falling. Objective: To determine whether inpatients administered zolpidem are at greater risk of falling. Design: Retrospective cohort study. Setting: Adult non-intensive care unit (non-ICU) inpatients at a tertiary care center. Methods: Adult inpatients who were prescribed zolpidem were identified. Electronic medical records were reviewed to capture demographics and other risk factors for falls. The fall rate was compared in those administered zolpidem versus those only prescribed zolpidem. Multivariate analyses were performed to determine whether zolpidem was independently associated with falls. Results: The fall rate among patients who were prescribed and received zolpidem (n = 4962) was significantly greater than among patients who were prescribed but did not receive zolpidem (n = 11,358) (3.04% vs 0.71%; P < 0.001). Zolpidem use continued to remain significantly associated with increased fall risk after accounting for age, gender, insomnia, delirium status, dose of zolpidem, Charlson comorbidity index, Hendrich's fall risk score, length of hospital stay, presence of visual impairment, gait abnormalities, and dementia/cognitive impairment (adjusted odds ratio [OR] 4.37, 95% confidence interval [CI] = 3.34-5.76; P < 0.001). Additionally, patients taking zolpidem who experienced a fall did not differ from other hospitalized adult patients who fell in terms of age, opioids, antidepressants, sedative-antidepressants, antipsychotics, benzodiazepine, or antihistamine use. CONCLUSION: Zolpidem use was a strong, independent, and potentially modifiable risk factor for inpatient falls. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine.

News Article | October 28, 2016

Central Valley residents are invited to participate in the American Heart Association’s 2016 Central Valley Heart & Stroke Walk and Lawyers Have Heart Run. The 24th annual “Heart Walk” includes a 5K Run and 2 Mile Walk plus Kid’s Fun Run. The event is set for Saturday, October 22 at Tesoro Viejo, an upcoming master-planned community located at Highway 41 and Road 204, just 10 minutes north of River Park Shopping Center. Presented this year by Tesoro Viejo, the annual Heart & Stroke Walk is the largest local event for the association and is expected to draw over 2,500 walkers and runners and has raised roughly $180,000 so far. All proceeds will go toward the American Heart Association’s overall goal of funding research to find better ways to treat and prevent cardiovascular diseases and stroke while providing educational health resources to the local region. “We are thrilled to host the Heart Walk at Tesoro Viejo, where participants can take in the scenery of vineyards, orchards and gorges along with the beautiful backdrop of Little Table Mountain,” said Karen McCaffrey, vice president of The McCaffrey Group and chair of this year’s Heart & Stroke Walk. “Tesoro Viejo was designed with healthy, sustainable living in mind, so The Heart Walk is a natural fit for our community. It’s a great opportunity to promote physical activity and heart-healthy living, in an atmosphere that is fun for the entire family. We’re very proud to be the local presenter.” Everyone is invited to participate in the non-competitive 2 mile Heart & Stroke Walk that starts at 9:30 am. Walkers will follow a course that will wind past natural gorges, orchards and vineyards. Over 75 local businesses have already signed up and will be represented with teams of employees bringing along friends and family members of all ages. Those not on a company team are invited to form community teams to help raise funds and encourage friends and family to participate. Heart disease and stroke survivors will receive special survivor caps to distinguish them from the rest of the pack. Participants can walk or run and there is no registration fee for the walk. Walkers who raise $100 or more will receive the official 2016 Heart Walk t-shirt. The Lawyers Have Heart Run kicks off at 8:00 am and is a timed 5K event on a moderate trail. The $40 registration fee benefits the American Heart Association and American Stroke Association. All runners will receive an official Heart Run t-shirt. Participants will have their run timed, and the top male and female runners will be awarded prizes. Participants are invited to stick around and peruse the health expo where they will find booths on wellness, healthy snack samples, a kid’s zone with fun activities for kids and other fun booths and activities. According to the American Heart Association, walking is the simplest positive change individuals can make to effectively improve their heart health because it’s free, easy and has the lowest dropout rate of any exercise. Research has shown walking is the single most effective form of exercise to achieve heart health. The benefits of walking and moderate physical activity for as little as 30 minutes each day can help reduce the risk of heart disease and stroke - the number one and number 5 killers of Americans, respectively. For information on participating or to make a donation, visit or call (559) 650-4010. About the American Heart Association The American Heart Association is devoted to saving people from heart disease and stroke – America’s No. 1 and No. 5 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit or call any of our offices around the country. The Heart & Stroke Walk is sponsored nationally by Subway and locally presented by Tesoro Viejo. The local Heart & Stroke Walk top sponsors include Community Medical Centers, Vulcan Materials, Camarena Health, Kaiser Permanente, and E-Z Haul. The media sponsors are CBS 47, Telemundo 51, The Fresno Bee, Y101 and Mega 97.9. For a complete list of sponsors, visit About Tesoro Viejo Situated at the foot of Little Table Mountain, Tesoro Viejo, is an upcoming 1,600 acre master-planned community located off Highway 41 in Madera. A model of innovative design and sustainable living, the community will be a vibrant hub for southeast Madera County where residents can live, work, and play with housing and business opportunities, a walkable town center, green living, thriving industry, and neighborhood parks and schools.

Samus Q.M.,Johns Hopkins University | Amjad H.,Johns Hopkins University | Johnston D.,Johns Hopkins University | Black B.S.,Johns Hopkins University | And 2 more authors.
American Journal of Geriatric Psychiatry | Year: 2015

Objective: To provide a critical review of a multipronged recruitment approach used to identify, recruit, and enroll a diverse community-based sample of persons with memory disorders into an 18-month randomized, controlled dementia care coordination trial. Methods: Descriptive analysis of a recruitment approach comprised five strategies: community liaison ("gatekeepers") method, letters sent from trusted community organizations, display and distribution of study materials in the community, research registries, and general community outreach and engagement activities. Participants were 55 community organizations and 63 staff of community organizations in Baltimore, Maryland. Participant referral sources, eligibility, enrollment status, demographics, and loss to follow-up were tracked in a relational access database. Results: In total, 1,275 referrals were received and 303 socioeconomically, cognitively, and racially diverse community-dwelling persons with cognitive disorders were enrolled. Most referrals came from letters sent from community organizations directly to clients on the study's behalf (39%) and referrals from community liaison organizations (29%). African American/black enrollees were most likely to come from community liaison organizations. Conclusion: A multipronged, adaptive approach led to the successful recruitment of diverse community-residing elders with memory impairment for an intervention trial. Key factors for success included using a range of evidence-supported outreach strategies, forming key strategic community partnerships, seeking regular stakeholder input through all research phases, and obtaining "buy-in" from community stakeholders by aligning study objectives with perceived unmet community needs. © 2015 American Association for Geriatric Psychiatry.

Krasna M.J.,Community Medical Centers
Personalized Medicine | Year: 2010

Transforming healthcare through collaborative relationships is the key to making successful advances in personalized medicine. The strategies for building a framework to bring together expertise and resources in order to realize all the possibilities of personalized medicine are discussed in this article. The key to this endeavor is the ability to identify potential collaboration with academic medical centers, research laboratories, biotechnology companies and community cancer centers. Translation of research from bench to bedside is only paradigm changing if it can then be translated to community care. The value of clinical prospective biospecimen collection with high quality clinical annotation will be explored. Recognizing the opportunities for performing clinical trials, beta-testing of new technology especially in community clinical practice will be emphasized. The goal is to expand the realm of personalized cancer care to allow for integration of molecular marker and individualized therapy to the majority of cancer patients worldwide. © 2010 Future Medicine Ltd.

Mansukhani M.P.,Community Medical Centers | Wang S.,Mayo Medical School | Somers V.K.,Mayo Medical School
American Journal of Physiology - Heart and Circulatory Physiology | Year: 2015

Obstructive and central sleep apnea have been associated with increased risk of adverse cardiovascular events and mortality. Sympathetic dysregulation occurring as a result of the respiratory disturbance is thought to play a role in this increased risk. Sleep apnea increases the risk of arrhythmias, myocardial ischemia/infarction, stroke, and heart failure, all of which may increase mortality risk. A higher incidence of nocturnal arrhythmias, cardiac ischemia, and sudden death has been noted in subjects with sleep-disordered breathing (SDB). In this review, the association between SDB and each of these conditions is discussed, as well as the potential mechanisms underlying these risks and the effects of treatment of SDB. Particular emphasis is placed on the relationship between SDB and nocturnal atrial and ventricular arrhythmias, myocardial ischemia/infarction and sudden death. © 2015 the American Physiological Society.

Garrison G.M.,Mayo Medical School | Mansukhani M.P.,Community Medical Centers | Bohn B.,Mayo Medical School
Journal of the American Board of Family Medicine | Year: 2013

Purpose: Hospital readmissions within 30 days of initial discharge occur frequently. In studies of elderly patients receiving Medicare, readmissions have been associated with poor-quality inpatient care, ineffective hospital-to-home transitions, patient characteristics, disease burden, and socioeconomic status. Among adult family medicine patients spanning a wide age range, we hypothesize that previous hospitalizations, length of stay, number of discharge medications, medical comorbidities, and patient demographics are associated with a greater risk of hospital readmission within 30 days. Methods: A retrospective case-control study of 276 family medicine inpatients was conducted to determine the factors associated with 30-day readmission. Bivariate statistics were computed and a multivariate analysis using logistic regression was performed to determine the independent effects of each factor. Results: Patients readmitted within 30 days had more hospitalizations, more emergency department visits, longer hospital stays, more comorbidities, and more discharge medications and were less likely to be married. Multivariate logistic regression found that hospitalization within the previous 12 months (odds ratio, 2.71) and long hospital stays (odds ratio, 2.16) were associated with 30-day readmission; being married (odds ratio, 0.54) had a protective effect. Conclusions: This study demonstrates that factors previously found to be associated with 30-day readmission among elderly patients receiving Medicare also apply to family medicine patients of all ages. It also demonstrates prior hospitalizations, length of stay, and marital status are useful proxies for many more complicated factors, such as disease burden, medical complexity, and social issues, that influence hospital readmission.

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