内容摘要：homes and other structures this week. It has overwhelmed shelters, whose leaders have implored people, if they’re able, to find friends or family to foster their pets.

homes and other structures this week. It has overwhelmed shelters, whose leaders have implored people, if they’re able, to find friends or family to foster their pets.

While programs like Healthy Start focus on individual patient needs, other efforts manage the overall quality of medical care.California has the lowest maternal mortality in the nation — 10.5 per 100,000 live births, less than half the national rate. But that wasn’t the case before it created a “maternal quality care collaborative” in 2006.

Founded at Stanford University’s medical school in partnership with the state, it brings together people from every hospital with a maternity unit to share best practices on how to deal with issues that could lead to maternal injury or death, like high blood pressure, cardiovascular disease and sepsis.“When you look at the rate of maternal death in the United States compared to California, they basically ran neck-and-neck until it was established,” said Dr. Amanda Williams, clinical innovation adviser for the collaborative. “At that time they totally separated and California started going down. The rest of the country started going up.”Denise Jones speaks with Dr. Allison Garnett during a prenatal appointment at the Oklahoma State University obstetrics and gynecology clinic. (AP Photo/Mary Conlon)

Denise Jones speaks with Dr. Allison Garnett during a prenatal appointment at the Oklahoma State University obstetrics and gynecology clinic. (AP Photo/Mary Conlon)In the collaborative, hospitals get toolkits full of materials such as care guidelines in multiple formats, articles on best practices and slide sets that spell out what to do in medical emergencies, how to set up medical teams and what supplies to keep on the unit. The collaborative also tackles issues such as improving obstetric care by integrating midwives and doulas – whose services are covered by the state’s Medicaid program.

At first, some doctors resisted the effort, figuring they knew best, Williams said, but there’s much less pushback now that the collaborative has proven its value.

MemorialCare Miller Children’s & Women’s Hospital Long Beach started participating around 2010. The collaborative helps “vet through all the research that’s out there,” said Shari Kelly, executive director of perinatal services. “It’s just so important to really understand how we as health care providers can make a difference.”Lots of extra steps come before and after surgery.

First, what pig to use: Some have up to 10 genetic changes but Montgomery is betting one is enough — removal of a single porcine gene that triggers an immediate immune attack.While the pigs are housed in a germ-free facility, researchers performed extra testing for any hidden infection. Everyone in the operating room must have certain vaccinations and undergo blood tests of their own.

Surgery over, doctors wheeled Miller’s body into the same ICU room where five years earlier Montgomery had recovered from his heart transplant.Next came more intense testing than living patients could tolerate. Every week doctors biopsy the kidney, putting samples under the microscope to spot any hints of rejection. Blood is continually monitored, the spleen got a peek, and nurses keep close watch that the body is being properly maintained on the ventilator.