Improving Primary Care Behavioral Health Integration in an Academic Internal Medicine Practice: 2-Year Follow-Up.

This report details ongoing efforts to improve integration in the 2 years following implementation of the Primary Care Behavioral Health model at a general internal medicine clinic of an urban academic medical center. Efforts were informed by a modified version of the validated Level of Integration Measure, sent to all faculty and staff annually. At baseline, results indicated that the domains of systems integration, training, and integrated clinical practices had the greatest need for improvement. Over the 2 years, the authors increased availability of behavioral medicine appointments, improved depression screening processes, offered behavioral health training for providers, disseminated clinical decision support tools, and provided updates about integration progress during clinic meetings. Follow-up survey results demonstrated that physicians and staff perceived improvements in integration overall and in targeted domains. However, the main ongoing barrier to integration was insufficient behavioral health staff to meet patient demand for behavioral health services.

Best Reporting Practices for Multipart CT Scans: A Pilot Evaluation and Construction of the Optimal Analysis Methodology.

PURPOSE: Communication failure between radiologists and referring physicians contributes to a substantial portion of medical errors. With a rising number of complex imaging orders and subspecialization among radiologists, the best method of reporting those results has yet to be evaluated. The aim of this study was to create, validate, and pilot a survey to reveal best practices for communication of radiologic findings, specifically addressing multipart CT scans of the chest, abdomen, and pelvis. METHODS: A survey consisting of Likert-type and narrative response items was created, tested, and validated. It was then administered to physicians of five specialties (including radiology) at an urban quaternary care academic center and an affiliated community hospital. RESULTS: The pilot survey results revealed that there was a small preference among both radiologists and referring physicians to have a single radiologist read in a single report for a multipart CT scan, rather than multiple subspecialist radiologists and reports. The findings were supported by narrative response explanations as well and demonstrate the importance of a rapid, clear, and cohesive image interpretation, despite the growing trend of radiology subspecialization. The results of the survey also confirmed its validity through an assessment with Messick's five sources of validity evidence. CONCLUSIONS: The survey's validity indicates its generalizability to a future national survey to physicians of multiple specialties to further identify the preference of physicians on reporting of complex radiologic studies, in the setting of increased radiologic subspecialization.

Integrins of the starlet sea anemone Nematostella vectensis.

Integrins are extracellular matrix receptors composed of α and ß subunits. Here we describe two α subunits and four ß subunits from the starlet sea anemone Nematostella vectensis. Phylogenetic analysis suggests that the α subunits are most closely related to RGD- and LDV-dependent α subunits of chordates. The ß subunits cluster with the previously described ß integrins of the hard coral Acropora millepora. The expression of one of the α subunits and three of the ß subunits was confirmed by reverse transcription PCR and in situ hybridization. The α subunit is primarily expressed in cells near muscles, by a subset of gastrodermal cells, and in the gonad. The three ß subunits each have distinctive patterns of expression: one is concentrated in the gonad and mesenteric filament, another is found in a subset of cells in the epidermis of the oral region and in a subset of gastrodermal cells in the mesenteries, and a third is expressed widely. Changes in expression were also studied 48 h after horizontal transection by quantitative reverse transcription PCR and in situ hybridization. One of the ß subunits is expressed 8-fold higher during regeneration, and its expression is observed in cells within both the epidermis and the gastrodermis at the site of regeneration. Our observations confirm that complex patterns of integrin expression were already present in basal metazoans. The integrins expressed in the gonads may play roles in mediating sperm-egg interactions in N. vectensis, while others may play a role in regulating proliferation during regeneration.