Using Electronic Clinical Decision Support in Patient-Centered Medical Homes to Improve Management of Diabetes in Primary Care: The DECIDE Study.

This prospective, randomized, real-world study aimed to examine the impact of electronic health record-based clinical decision support (CDS) tools on the management of diabetes in small- to medium-sized primary care practices participating in Delaware's patient-centered medical home project. Overall, use of CDS systems was associated with greater reductions from baseline in hemoglobin A1c and low-density lipoprotein cholesterol, and more patients achieving treatment goals. Physicians and staff reported that the CDS toolkit empowered them to be more involved in clinical decision-making, thereby helping to improve diabetes care. However, all cited significant barriers to fully implementing team-based CDS, predominantly involving time and reimbursement.

Biomimetic Dextran-Based Hydrogel Layers for Cell Micropatterning over Large Areas Using the FluidFM BOT Technology.

Micropatterning of living single cells and cell clusters over millimeter-centimeter scale areas is of high demand in the development of cell-based biosensors. Micropatterning methodologies require both a suitable biomimetic support and a printing technology. In this work, we present the micropatterning of living mammalian cells on carboxymethyl dextran (CMD) hydrogel layers using the FluidFM BOT technology. In contrast to the ultrathin (few nanometers thick in the dry state) CMD films generally used in label-free biosensor applications, we developed CMD layers with thicknesses of several tens of nanometers in order to provide support for the controlled adhesion of living cells. The fabrication method and detailed characterization of the CMD layers are also described. The antifouling ability of the CMD surfaces is demonstrated by in situ optical waveguide lightmode spectroscopy measurements using serum modeling proteins with different electrostatic properties and molecular weights. Cell micropatterning on the CMD surface was obtained by printing cell adhesion mediating cRGDfK peptide molecules (cyclo(Arg-Gly-Asp-d-Phe-Lys)) directly from aqueous solution using microchanneled cantilevers with subsequent incubation of the printed surfaces in the living cell culture. Uniquely, we present cell patterns with different geometries (spot, line, and grid arrays) covering both micrometer and millimeter-centimeter scale areas. The adhered patterns were analyzed by phase contrast microscopy and the adhesion process on the patterns was real-time monitored by digital holographic microscopy, enabling to quantify the survival and migration of cells on the printed cRGDfK arrays.

In situ viscoelastic properties and chain conformations of heavily hydrated carboxymethyl dextran layers: a comparative study using OWLS and QCM-I chips coated with waveguide material.

Hydration, viscoelastic properties and dominant structure of thin polymer layers on the surface of waveguide material were evaluated using optical waveguide lightmode spectroscopy (OWLS) and quartz crystal microbalance (QCM) methods. The fundamentally different principles of the two applied label-free biosensors enable to examine analyte layers from complementary aspects, e.g. to determine the amount of bound water in hydrated layers. In this study, a new QCM instrument with impedance measurement (QCM-I) is introduced. Its specially designed sensor chips, covered by thin film of waveguide material, supply identical surface as used in OWLS sensors, thus enabling to perform parallel measurements on the same type of surface. Viscoelastic analysis of the measured data was performed by our evaluation code developed in MATLAB environment, using the Voinova's Voigt-based model. In situ deposition experiments on the ultrathin films of poly(L-lysine)-graft-poly(ethylene glycol) (PLL-g-PEG) were conducted for instrumental and code validation. Additionally, a novel OWLS-QCM data evaluation methodology has been developed based on the concept of combining hydration and viscoelastic data with optical anisotropy results from OWLS measurements. This methodology provided insight into the time-dependent chain conformation of heavily hydrated nano-scaled layers, resulting in unprecedented structural, hydration and viscoelastic information on covalently grafted ultrathin carboxymethyl dextran (CMD) films. The measured mass values as well as hydration and viscoelastic properties were compared with the characteristics of PLL-g-PEG layers.

Developing a quality measurement tool and reporting format for long- term care.

BACKGROUND: Quality measurement in long term care (LTC) presents many challenges: the lack of a uniform definition of quality, the existence of multiple domains for measurement, a multitude of potential perspectives, and regulatory influences that emphasize measurement only of poor quality. Research efforts have yet to solve the issues of measurement; however, operators of long term care facilities must use the current state of the art in quality measurement as the basis for their quality improvement efforts. A project was commissioned by management of a large integrated delivery system with a robust network of LTC facilities who wished to implement a continuous quality improvement process on the basis of a measurement tool that provides a comprehensive resident-centered assessment of quality. The objectives of this project, therefore, were to identify domains of quality, to select and adapt validated instruments for measurement within each domain, to pilot test a data collection process, and to develop an operational quality profiling report format for LTC facilities. DESIGN AND METHODS: Using an expert panel and the LTC research literature, an operational measurement tool was developed, consisting of four domains of quality: organizational, clinical, environmental, and social. DISCUSSION: A pilot study conducted in two nursing facilities demonstrated that the data collection process could be operationalized within tight resource and budgetary constraints. The development of an operational quality assessment tool enables management to take a consistent view of diverse institutions, focusing in detail on quality of care as it is perceived by residents. The tool allows evaluation of trends over time and comparison to external norms.