Institute of Medicine and Humanities

IHI – Visionary Leadership for Enhanced Care

megantwohig — Thu, 02 Jun 2011 22:36:38 +0000

In a recent article published on the Institute for Healthcare Improvement (IHI) website, Karen Boudreau discusses visionary leadership to enhance care for populations and communities. To further leadership capacity, Karen Boudreau “would encourage organizations to develop a deep and comprehensive understanding of both the population served (bifocal) and the way the larger community reflects, understands and serves that population (trifocal).”

The Institute for Healthcare Improvement believes that everyone deserves safe and effective health care, and has been working with health care providers and leaders throughout the world to fulfill that promise. An independent not-for profit-organization based in Cambridge, Massachusetts, IHI focuses on motivating and building the will for change; identifying and testing new models of care in partnership with both patients and health care professionals; and ensuring the broadest possible adoption of best practices and effective innovations.

To learn more about the Institute for Healthcare Improvement and how you can work to increase the quality of care at your organization, visit the IHI website.

Missoula County Response to H1N1 Influenza

megantwohig — Fri, 25 Sep 2009 18:30:07 +0000

In this seven minute video local infectious disease specialist Dr. George Risi explains the response to H1N1 in Missoula County.

Liz Fowler at the IMH Healthcare Reform Panel

megantwohig — Wed, 15 Jul 2009 21:22:54 +0000

Liz Fowler, the Senior Council to Senator Max Baucus, Chairman of the Senate Finance Committee spoke via CD at the IMH sponsored Healthcare Reform Panel in Missoula on April 16, 2009. Click the link to hear her speech. Photo from Google Images. Liz Fowler at the IMH Healthcare Reform Panel, 4/16/2009

Ridge in the News

megantwohig — Wed, 15 Jul 2009 20:27:58 +0000

Follow this link to watch Wade See, a 2009 Ridge Research Award recipient on KPAX Healthbreak!

http://www.kpax.com/Global/category.asp?C=131911&nav=menu562_11

watch the video blog:

imh4msla — Sat, 28 Feb 2009 05:15:29 +0000

In this 20 minute video, IMH director Peggy Schlesinger,MD interviews IMH board member Randale Sechrest, MD about IMH activities. Listen to ideas about the new Area Health Education Center in Western Montana, the Center for Health Information at St Patrick Hospital and the IMH Scholars Program. We welcome comments.

health education necessary for good appendectomy outcomes:

imh4msla — Thu, 29 Jan 2009 22:13:00 +0000

In a recent article about appendectomies in the province of Manitoba, Canada, the authors looked at the percentage of inflamed appendices that were ruptured at the time of operation. This somewhat obscure data produced somewhat surprising results:

“Total rupture rates were inversely correlated with socioeconomic status; the highest rupture rates occurred in the lowest socioeconomic status groups among both rural and urban residents.”

What surprised me was that in the midst of looking at complications of the most common abdominal surgical procedure done on children, out popped health care inequality due to socioeconomic status as a risk factor for rupture of the appendix.

The authors conclude as follows:
“The study also demonstrates that universal access to healthcare for pediatric patients, which many of us want, will not eliminate healthcare disparities. If we aim to decrease healthcare disparities, we must educate patients and family members about how and when to access the healthcare system.”

Sobering. There’s clearly more to effective health care reform than universal access. The role of education in improving our health care system and reducing health disparities cannot be over sold. Let’s hope that this part of health care reform continues to pop up on agendas all over Washington DC in the coming months.

The IMH will sponsor the Friday Medical Conference talk on healthcare inequalities at St. Patrick Hospital on 4/17/09 during April is Ethics Month, with Dr. John Stone. John Stone, MD,PhD is a faculty member of the Center for Health Policy and Ethics at Creighton University School of Medicine, and one of the original founders of the Institute of Medicine and Humanities in Missoula.

Hope to see you there – 4/17/09 7:30am @SPH conference center.

Bratu I et al. Pediatric appendicitis rupture rate: Disparities despite universal health care. J Pediatr Surg 2008 Nov; 43:1964.

Microchimerism as Metaphor

imh4msla — Mon, 19 Jan 2009 02:01:00 +0000

One love. One heart. Let’s get together and we’ll feel all right – the crowd on the Mall in Washington, DC sings Bob Marley today as we celebrate our president elect and his message of unity. He speaks of America coming together with one voice, despite our different races, ideologies, economic blessings, and religions. Obama paints the picture of our country as a stronger whole, greater than the sum of its’ parts; strengthened by the difference within. Somehow, in this very moving moment, my mind thinks of microchimerism as metaphor.
Our symbiotic relationship with microorganisms is generally advantageous, evolving as it did over the past millennia. There is new information about the gut flora “tending”, even nurturing our immune system through its proximity to immunocompetent cells in the intestine. We have normal flora – bacteria present on our skin and in our mouths, all performing vital tasks unbeknownst to us. Even some of our organelles – specialized areas of a cell that perform necessary cellular functions – come from bacterial origin, as does some of our DNA. It is thought that mitochondria – the engine of energy production inside a cell – were once free-living entities that teamed up with other parts of a cell to make our current version a composite whole. Mitochondria are maternally derived – passed along from mother to offspring. Is this the cellular origin of Jewish guilt? If so – it likely passes on other endearing qualities as well!
So our selves are really a mosaic of other microbes and particles that work in concert, and together we seem to feel all right…most of the time.
Yet sometimes it doesn’t work out so well.
Researchers have been studying microchimerism for many years to unravel the mysteries of autoimmunity and the physiology of parturition. Microchimerism defines the presence of cells from another human being that reside (usually happily and un-noticed) within a different human being. Cells from our mothers are admixed in with our blood, and cells from our children are similarly retained in the mother’s system. Some of us have cells from a twin that died in utero that we never knew. This admixing of cells has been studied as a possible mechanism for development of some autoimmune disorders, most recently rheumatoid arthritis. But most of the time this mixing of cells from different beings occurs happily and stays under the radar of the researcher’s microscope.
This invasion, this admixture, this mosaic makes us one – in the composite sense.
We can be redefined as a host for myriad life forms, and cellular remnants of other humans we have known intimately. White mothers with black babies can have black people’s cells within them, genetically speaking. And the same goes for Serbs and Croatians, who have intermarried, and Hutus and Tutsis, and Sunni and Shi’a. This puts the ideologies that divide us in a different light. Is the right hand fighting the left hand? We have so much biology in common with each other. And our interdependence and interrelationships with other organisms suggests that, indeed: we ARE one! A biological marvel of a living, breathing laughing interrelated being.
A microchimerism miracle.

Standing up for Change

imh4msla — Sun, 18 Jan 2009 05:04:00 +0000

Change is the buzzword these days – in government and current events around the globe. Change is surely occurring in our health care system but it proceeds with apparent geologic celerity. Meanwhile, talented, experienced, knowledgeable physicians and health care providers are becoming ever more frustrated, cynical and sarcastic, as a result of trying to work within a broken system. Some retreat into just doing the best they can while remaining dispassionate, and disengaged from administrative opportunities for becoming involved in the institutions where they work.
We are taught to develop our own personal quality agenda – always do your best and offer the patient the best possible care at all times. But what happens when the system we work in doesn’t resonate with this viewpoint? When the business of running a hospital or clinic and the quality patient care agenda collide? The challenge of our time is to engage physicians at all stages of their careers in the quality agenda, and to foster a shared concern for institutional quality with their own internal quality control. This shift – physicians engaged in a quality agenda – will definitely produce cultural change within our hospitals and clinics and is long overdue.

The tales of hospitals that have made very impressive changes with a patient-centered focus on quality care are recounted in Charles Kenney’s book The Best Practice: How the Quality Movement is Transforming Medicine. Each chapter details how a different institution adopted the ideal of quality process/outcome improvement and what the process of change looked like along the way. For some of us in practice, it is gratifying to read about physicians who effectively push the quality agenda firmly into the lead and how all good things follow this approach. Sometimes I wonder if it is too late to engage the cynical and burned out among us to participate in this quiet revolution. Yet each chapter identifies an unlikely hero who steadfastly believed in the possibilities of change in their hospital, and worked at staying on target with initiatives designed to reach the goal of providing quality care. Tempered radicals they are, with a hefty dose of moral courage. And hopefully their story will encourage and ignite the next group of physicians to pick up the torch and continue the effort.

Ridge Scholarship Recipients

imh4msla — Sun, 18 Jan 2009 04:48:00 +0000

The Ridge Scholarships are given annually to students for research that utilizes the Ridge Library Collection at St Patrick Hospital. The Ridge Collection includes >1800 books and monographs, plus video materials as well. The collection focuses on ethics, history, medical anthropology, literature, biography and pathography that relates to the human experience of health and illness. The Ridge Scholars utilize the resources of this remarkable collection to put their research together. Prior scholarship winners and the title of their research include the following:

2006 Winners
Emily Bulger – Western Wishes: The Globalization of Feminine Beauty Ideals.
Apryle Pickering -Changing Fertility and Population Growth: The Case of Montana Hutterites

2007 Winner
Hayley Blackburn -Sociocultural Medicine: An Integrated Approach to Infectious Disease Prevention in Africa.

2008 Winners
Wade See – Influence of Medical Journalism on Healthcare: Will News Coverage of Tim Russert’s Death Encourage or Discourage Treadmill Stress Tests?
Henry Erickson Bundy – Illness Narratives in the 21st Century: The Proliferation of Autobiographical Pathographies of the Web 2.0.

The 2008 winners will present their findings at the Third Annual Ridge Symposium, Thursday evening April 23,2009. Scholarship applications will be available for 2009
at the end of March. Please contact Megan Twohig at mtwohig@saintpatrick.org for more information and application details.

The Tibetan Way

imh4msla — Sun, 18 Jan 2009 04:36:00 +0000

The IMH has sponsored several excellent Global Health Lectures this year in our series, but Dr. Kelsang Wangyal deserves special mention. He is a Tibetan physician, trained by the physician to the Dalai Lama, who was visiting Montana and agreed to speak thanks to Dr. Georgia Milan’s efforts. Dr. Kelsang spoke to a room full of 75 people through an interpreter, “Karma.” He described the Tibetan view of physiology with different types of energy focused in different anatomic locations. He described a few of the herbs used as medicinals, and how they are imbued with extra effectiveness via prayer. But the most extraordinary thing about him was his humility. He felt blessed to be able to connect with every living thing – plant and animal – as he humbly described his work. His manner, his comments, and his style all conveyed serenity that was palpable.
As one person in the audience remarked, “…it was an honor just to share the space with him.” Could it be that the Tibetan was of healing the spirit and the physical – can produce such centering? He made it look so appealing!