Improving quality in a complex primary care system-An example of refugee care and literature review
by Kaitlin
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Rationale, aims and objectives: Implement quality improvement of traditional industries (QI) methodology for primary care is often inappropriate for primary care and its relationship with Macrosystem health has many features of a complex adaptive system (CAS), which is highly responsive to a bottom-up instead of top management -down approach. We report on a case study demonstration of improvements made in the Family Health Center (FHC) of the JPS Health Network in a patient population of refugees who describe the features of QI in the framework of the CAS as opposed to the traditional approach to QI.
Methods: We report the changes in the health system utilization with new refugees from FHC patients from 2016 to 2017. We reviewed the literature and summarize the relevant theoretical understanding of quality management in a complex adaptive system that applies to this case for example.
Results: Applying the principles of CAS in the FHC, the use of the Emergency Department and Urgent Care Center patients newly arrived refugees before their first clinic visit is reduced by more than half (total visits decreased from 31% -14% of patients IDPs). Our review of the literature shows that the top-down algorithmic QI traditional process that most often succeed in raising even more metrics-single disease, and improve physician fatigue and punish doctors who treat patients who are susceptible.
An increase in the CAS occurs when the front-line physicians identify care gaps and given the flexibility to learn and adjust itself to enable emerging treatment process, which was created from the bottom-up leadership that utilizes the interdependence and interaction that exists with the top level of the organization through intelligent cause and as a result of top-down. We give examples of early adapters who better to apply the principles of CAS change their QI efforts.
Conclusion: Increased Means in primary care are more likely to be achieved when the urge to apply changes to shift from top-down to bottom-up.
Improving quality in a complex primary care system-An example of refugee care and literature review
The international consensus guidelines for Risk Factors in Chronic pancreatitis. Recommendations of the working group for international consensus guidelines for chronic pancreatitis in collaboration with the International Association Pancreatology, the American Pancreatic Association, Japan Pancreas Society, and the European Pancreatic Club.
chronic pancreatitis (CP) is a complex inflammatory disease with severely impaired quality of life and permanent destruction of the pancreas. This article is part of an international consensus guidelines on CP and gift consensus on elevating risk factor for the international working group of 20 experts CP.An CP of the main pancreatic society (IAP, APA, JPS, and EPC) evaluated 14 statements resulting from the evidence on four questions considered most relevant clinically in CP.
The Grading Assessment, Development and Evaluation (GRADE) approach is used to evaluate the level Recommendation evidence provided by the report. To determine the degree of agreement, the working group as at 14 statement to the strength of the agreement, using a nine-point Likert scale for calculating Cronbach alpha reliability coefficient.Strong consensus and agreement obtained for the following statement :, smoke Alcohol and certain genetic changes are risk factors for CP , past history, family history, symptoms, and lifestyle factors, including alcohol intake and smoking history should be determined. Dose-dependent alcohol consumption raised the risk of CP to 4-fold.
Description: A polyclonal antibody for detection of JIP-2 from Human, Mouse, Rat. This JIP-2 antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from the C-terminal region of human JIP-2 at AA rangle: 550-630
Description: A polyclonal antibody for detection of JIP-2 from Human, Mouse, Rat. This JIP-2 antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from the C-terminal region of human JIP-2 at AA rangle: 550-630
Description: A polyclonal antibody for detection of JIP-2 from Human, Mouse, Rat. This JIP-2 antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from the C-terminal region of human JIP-2 at AA rangle: 550-630
Description: A polyclonal antibody for detection of JIP-3 from Human, Mouse. This JIP-3 antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from the Internal region of human JIP-3 at AA range: 590-670
Description: A polyclonal antibody for detection of JIP-3 from Human, Mouse. This JIP-3 antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from the Internal region of human JIP-3 at AA range: 590-670
Description: A polyclonal antibody for detection of JIP-3 from Human, Mouse. This JIP-3 antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from the Internal region of human JIP-3 at AA range: 590-670
Description: A polyclonal antibody for detection of JIP-1 phospho Thr103) from Human, Mouse, Rat. This JIP-1 phospho Thr103) antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from human JIP-1 around the phosphorylation site of T103
Description: A polyclonal antibody for detection of JIP-1 phospho Thr103) from Human, Mouse, Rat. This JIP-1 phospho Thr103) antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from human JIP-1 around the phosphorylation site of T103
Description: A polyclonal antibody for detection of JIP-1 phospho Thr103) from Human, Mouse, Rat. This JIP-1 phospho Thr103) antibody is for WB, IHC-P, IF, ELISA. It is affinity-purified from rabbit antiserum by affinity-chromatography using epitope-specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from human JIP-1 around the phosphorylation site of T103
Description: A Rabbit Polyclonal antibody against JIP-1 (phospho Thr103) from Human/Mouse/Rat. This antibody is tested and validated for WB, ELISA, IHC, IF, WB, ELISA
Description: A Rabbit Polyclonal antibody against JIP-1 (phospho Thr103) from Human/Mouse/Rat. This antibody is tested and validated for WB, ELISA, IHC, IF, WB, ELISA
Description: JIP1 is a regulator of the pancreatic beta-cell function. It is highly similar to JIP-1, a mouse protein known to be a regulator of c-Jun amino-terminal kinase (Mapk8). This protein has been shown to prevent MAPK8 mediated activation of transcription factors, and decrease IL-1 beta and MAP kinase kinase 1 (MEKK1) induced apoptosis in pancreatic beta cells. This protein also functions as a DNA-binding transactivator of the glucose transporter GLUT2.
Description: JIP1 is a regulator of the pancreatic beta-cell function. It is highly similar to JIP-1, a mouse protein known to be a regulator of c-Jun amino-terminal kinase (Mapk8). This protein has been shown to prevent MAPK8 mediated activation of transcription factors, and decrease IL-1 beta and MAP kinase kinase 1 (MEKK1) induced apoptosis in pancreatic beta cells. This protein also functions as a DNA-binding transactivator of the glucose transporter GLUT2.
Description: A polyclonal antibody raised in Rabbit that recognizes and binds to Human JIP3 . This antibody is tested and proven to work in the following applications:
Description: A polyclonal antibody for detection of JIP4 from Human, Mouse. This JIP4 antibody is for WB, ELISA. It is affinity-purified from rabbit serum by affinity-chromatography using the specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from part region of human JIP4 protein at amino acid sequence of 590-670
Description: A polyclonal antibody for detection of JIP4 from Human, Mouse. This JIP4 antibody is for WB, ELISA. It is affinity-purified from rabbit serum by affinity-chromatography using the specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from part region of human JIP4 protein at amino acid sequence of 590-670
Description: A polyclonal antibody for detection of JIP4 from Human, Mouse. This JIP4 antibody is for WB, ELISA. It is affinity-purified from rabbit serum by affinity-chromatography using the specific immunogenand is unconjugated. The antibody is produced in rabbit by using as an immunogen synthesized peptide derived from part region of human JIP4 protein at amino acid sequence of 590-670
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is not conjugated.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 390.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 488.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 565.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 594.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 633.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 655.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 680.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with ATTO 700.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Alkaline Phosphatase.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with APC.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with APC/Cy7.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Biotin.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Dylight 350.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Dylight 405.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Dylight 488.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Dylight 594.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Dylight 633.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with FITC.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with HRP.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with PE/ATTO 594.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with PerCP.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with RPE.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is conjugated with Streptavidin.
Description: A monoclonal antibody from clone S135-37 against Human JIP2/IB2. The host species for the production of this antibody is Mouse. The antigen used for immunization is Mouse Fusion protein amino acids 226-421 of mouse JIP-2/IB-2. Rat: 94% identity (127/135 amino acids identical). Human: 86% identity (173/200 amino acids identical) >50% identity with JIP-1.
. The antibody is tested and validated for WB, IHC, ICC/IF assays with the following recommended dilutions: WB (1:1000), ICC/IF (1:100). This MAb for JIP2/IB2 is not conjugated.
C-Jun-Amino-Terminal Kinase Interacting Protein 1 / JIP1 (MAPK8IP1) Antibody
Description: A polyclonal antibody raised in Goat that recognizes and binds to Human JIP3 / Syd2 / JSAP1 (N-Term). This antibody is tested and proven to work in the following applications:
C-Jun-Amino-Terminal Kinase-Interacting Protein 2 (JIP2) Antibody
Description: T-cell immunoglobulin and mucin domain-containing protein 1 (TIM-1) or Kidney injury molecule 1 (KIM-1), also known as HAVCR1 and HAVCR, is a protein that in humans is encoded by the KIM1 gene. Biochemical, mutational, and cell adhesion analyses confirm that TIM-1 is capable of homophilic interactions. The features identified in murine TIM1 is conserved in human protein. The protein is a receptor for virus through the infection of canine osteogenic sarcoma cells expressing HAVCR1 with HAV. Using a monoclonal antibody to mouse TIM-1, expression was seen after activation of naive T cells and on T cells differentiated in Th2-polarizing conditions. Ectopic expression during mouse T-cell differentiation leads to production of the Th2-type cytokine IL4, but not the Th1-type cytokine Ifng.
Never smokers, even smoked less than a pack of cigarettes per day, have an increased risk for CP, compared with never smokers.Both genetic and environmental factors can markedly increase the risk of CP. Therefore, health-promoting lifestyle education and in certain cases the genetic counseling should be used to reduce the occurrence of CP.
