Mini-Cog screening by office staff is feasible in primary care practice and has measurable effects on physician behavior. However, new physician action relevant to dementia was likely to occur only when impairment was severe, and additional efforts are needed to help primary care physicians follow up appropriately on information suggesting cognitive impairment in older patients.

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PURPOSE We conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. METHODS Primary care practices across Washington, Oregon, and Idaho were eligible if they had fewer than 10 full-time clinicians. Practices were randomized to practice facilitation only, practice facilitation and shared learning, practice facilitation and educational outreach visits, or practice facilitation and both shared learning and educational outreach visits. All practices received up to 15 months of support. The primary outcome was the CQM for blood pressure control. Secondary outcomes were CQMs for appropriate aspirin therapy and smoking screening and cessation. Analyses followed an intention-to-treat approach. RESULTS Of 259 practices recruited, 209 agreed to be randomized. Only 42% of those offered educational outreach visits and 27% offered shared learning participated in these enhanced supports. CQM performance improved within each study arm for all 3 cardiovascular disease CQMs. After adjusting for differences between study arms, CQM improvements in the 3 enhanced practice support arms of the study did not differ significantly from those seen in practices that received practice facilitation alone (omnibus P = .40 for blood pressure CQM). Practices randomized to receive both educational outreach visits and shared learning, however, were more likely to achieve a blood pressure performance goal in 70% of patients compared with those randomized to practice facilitation alone (relative risk = 2.09; 95% CI, 1.16-3.76). CONCLUSIONS Although we found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation.

Ideas for an optimal workflow to generate a medication list include involving patients and utilising clerical staff to a greater extent in medication information gathering, identifying and flagging patients with missing medication information, and gathering only the medication information needed to make clinical decisions in the emergency department.

Utilizing a wireless, automated messaging system in clinical practice is a feasible, low-cost, interactive way to facilitate diabetes self-management, which is acceptable to patients. While providing a convenient way for patients and providers to communicate, this system can support automated recording and ready retrieval of these real-time interactions.

The purpose of this study was to determine the effects that result when truant and tardy junior high school students with learning disabilities are used as tutors for younger LD pupils After 6 weeks of tutoring, the 16 tutors made significant gains in locus of control. In addition, most of the tutors showed a decrease in truant and tardy behaviors.

The Survey of Reading Attitudes was administered to 613 fourth-, fifth-, and sixthgrade students enrolled in the schools that serve the metropolitan area of a small city in Ontario, Canada. Means, standard deviations, coefficient of alpha reliability estimates, and standard errors of measurement were computed for the eight dimensions of reading attitude included in the Survey, The reliability estimates for the respective dimensions are as follows: Expressed Reading Difficulty, a=.88, Reading as Direct Reinforcement, a=.83, Reading as Enjoyment, a = 3 9 , Alternative Learning Modes, a = . 7 2 SampleThis sample of 613 fourth-, fifth-, and sixth-grade children is a representative sample from the metropolitan area of a small city in Ontario, Canada; it represents approximately 75% of the student body at these grade levels and includes 3 I4 girls and 299 boys. The breakdown by grade level is 195 fourth graders, 226 fifth graders, and 192 sixth graders. The sample's reading achievement is slightly higher than that for the Province of Ontario and is average for this metropolitan area.

Special communication Knowledge Transfer Statement: This special communication presents the Oral Health Delivery Framework, a conceptual model for incorporating preventive oral health care in routine medical care and improving referrals from primary care to dentistry. The framework, along with supporting case examples and stakeholder actions, was