Summer 2007 - Volume 11 Number 3

Original Articles

2007 James A Vohs Award for Quality Second-Place Selection
Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women
Cosette Taillac, LCSW, BCD; Nancy Goler, MD; Mary Anne Armstrong, MA; Kathleen Haley, MS; Veronica Osejo
Because of prior limited success with substance-abuse problems in pregnant women, a new program was developed, tested, and widely transferred. Key elements are universal screening and embedment of substance-abuse specialists within Obstetrics Departments.

Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care
Esther (Estee) B Neuwirth, PhD; Julie A Schmittdiel, PhD; Karen Tallman, PhD; Jim Bellows, PhD
This report examines the successes and problems of this rapidly spreading form of team assistance to primary care physicians in management of populations of patients. An important component consists of communication, largely by telephone, by highly knowledgeable medical assistants.

Church-Based Heart Health Project: Health Status of Urban African Americans
Lisaann S Gittner, MSc; Salwa E Hassanein, PhD, RN; Pamala J Murphy, MD
In 2004, a community project was implemented to address the cardiovascular health disparity in the African-American population of greater Cleveland, Ohio.

2006 David M Lawrence, MD, Chairman's Patient Safety Award
Promoting Patient Safety: The Rapid Medical Response Team
Dawn Gould, RN, MSN, CNS
With teams of an ICU charge nurse and a respiratory therapist and directed primarily at nonICU medical and surgical patients, this program reduced adverse events, deaths, and unneeded ICU transfers. Readiness to initiate the process and education of the staff were major elements.

Review Articles

Clinical Evidence Review: Best Practices
Diagnosis and Treatment of Major Depression 2007
Patricia deSa, MS; David W Price, MD, FAAFP
In this review of a common and dangerous illness consideration is given to definitions, diagnosis, risk stratification, and acute and longer-term treatment.

Case Studies

Sri Lanka Poison Control: Toxicology Case Studies in Narrative
Rais Vohra, MD
On a rotation to Sri Lanka's only poison control center, a fellow in medical toxicology recorded his experiences with a foreign medical system and cases in common poisonings.

Tachycardia-Induced Heart Failure
Jitenbhai J Patel, MD; Charles T Whittaker, MD
When the heart failure syndrome is induced partially or completely by a tachy-arrhythmia, management of this aspect can result in partial, sometimes complete, reversibility of the heart failure.

Clinical Medicine

Michael S Kaplan, MD
Within the context of a case study, anaphylaxis is defined, its mechanisms and common causes are enumerated, and management in multiple settings is described.

"You Gotta Be Crazy!" Tales of My Practice in Rural Maine
Ronald Blum, MD
A family practice physician, raised and trained in the big city, describes the challenges and rewards of a life of medicine in northern Maine.


Purpose, Partnership, and The Permanente Federation's Tenth Anniversary
Jay Crosson, MD
The Executive Medical Director cites the advice from Sidney Garfield, MD, physician cofounder of Kaiser Permanente, as the principled basis for the creation and first-decade achievements of The Permanente Federation.

New Approaches to Confronting an Imminent Influenza Pandemic
David S Fedson, MD; Peter Dunnill, DSc, FREng
Three affordable alternatives are proposed that could be made available to people worldwide, including the potential role of statins, not yet discussed in the general medical literature.

Why Now Is the Time to Enact Health Care Reform
George Halvorson
Eight recent developments in American health care have combined to give us, for the first time ever, a very real opportunity to systematically improve both care delivery and reduce the costs of care on a large scale, in a relatively short time frame.


Transforming Medicines
Charles Elder, MD, MPH, FACP; Cheryl Ritenbaugh, PhD, MPH
Patients undergoing treatment with certain CAM systems (ayurveda, trandional Chinese medicine, and naturopathy) may experience and value nonspecific, whole-person, or transformational changes as essential components of the healing process.

Quality through Sustainability and Transferability
Tom Janisse, MD
The Original Articles in this issue demonstrate the importance of sustainability and transferability in the process of quality innovation.

Narrative Medicine

The Nature of Narrative Medicine
Lewis Mehl-Madrona, MD, PhD
Interactions with patients with respect to both diagnosis and treatment can be enriched and benefited by storytelling. Why and how we all use stories is illustrated by case examples.

Letters to the Editor

Volunteerism and Homeless Health Care

Book Reviews

How Doctors Think: Clinical Judgment and the Practice of Medicine Doctors' Stories: The Narrative Structure of Medical Knowledge

Parenting: The First Three Years: A Group-Based Positive Parenting Program Play Golf Forever

Soul of the Healer

Original Visual Art 

Lunch Break

Laukahi Street

Women of the Serengeti

Barking Dog Rapids 2

Original Literary Art


On the Cover

Sierra Drive
Douglas Davenport, MD


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