IHI – Visionary Leadership for Enhanced Care

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.

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Missoula County Response to H1N1 Influenza

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

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Liz Fowler at the IMH Healthcare Reform Panel

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


Liz Fowler, Senior Council to Senator Max Baucus, Chairman, Senate Finance Committee

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Ridge in the News

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


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watch the video blog:

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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.

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health education necessary for good appendectomy outcomes:

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.

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Microchimerism as Metaphor

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.

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