Aligning mission to digital health strategy in academic medical centers.

The strategies of academic medical centers arise from core values and missions that aim to provide unmatched clinical care, patient experience, research, education, and training. These missions drive nearly all activities. They should also drive digital health activities - and particularly now given the rapid adoption of digital health, marking one of the great transformations of healthcare; increasing pressures on health systems to provide more cost-effective care; the pandemic-accelerated funding and rise of well-funded new entrants and technology giants that provide more convenient forms of care; and a more favorable regulatory and reimbursement landscape to incorporate digital health approaches.

Hydrogen peroxide vapor decontamination of N95 respirators for reuse.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has led to global shortages of N95 respirators. Reprocessing of used N95 respirators may provide a higher filtration crisis alternative, but whether effective sterilization can be achieved for a virus without impairing respirator function remains unknown. We evaluated the viricidal efficacy of Bioquell vaporized hydrogen peroxide (VHP) on contaminated N95 respirators and tested the particulate particle penetration and inhalation and exhalation resistance of respirators after multiple cycles of VHP.

Prevention of Nosocomial Catheter-Associated Urinary Tract Infections Through Computerized Feedback to Physicians and a Nurse-Directed Protocol.

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI.

Pursuit of Value Drives Strategy to Improve Operations and Outcomes.

The future of American healthcare remains cloudy, with the shifting contours of regulatory and fiscal reform still being shaped. Providers are beset by many challenges that vary but often include state and federal healthcare funding decisions that are antithetical to the interests of patients and aging populations. Regional public health crises and rapidly evolving relationships with third-party payers complicate matters even further.

Association of inpatient and outpatient glucose management with inpatient mortality among patients with and without diabetes at a major academic medical center.

Background: Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade.

Objective: To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors.

Design: Serial, cross-sectional observational study.

The safe patient flow initiative: a collaborative quality improvement journey at Yale-New Haven Hospital.

Background: Yale-New Haven Hospital (YNHH) began a successful journey to achieve safe patient flow in fiscal year (FY) 2008 (October 1, 2007-September 30, 2008). The 966-bed (now 1,541-bed) academic medical center faced several challenges, including overcrowding in the Adult Emergency Department (ED); delays in the postanesthesia care unit, which affected the flow of patients through the operating rooms; pinched capacity during the central part of the day; and a lack of interdependent institutionwide coordination of patients.

Methods: The Safe Patient Flow Steering Committee oversaw improvement efforts, most of which were implemented in FY 2009 (October 2008-September 2009), through a cascade of operational meetings.

Evaluating inpatient glycemic management: the Quality Hyperglycemia Score.

Background: Inpatient hyperglycemia has become a major focus at many hospitals. However, although several professional organizations have pushed for improved inpatient glucose management, glycemic control at many institutions remains suboptimal. There is a general consensus that improved quality of care is needed, but objective assessment of care quality remains a challenge.

Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol.

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI.

Utilization and effectiveness of a weight-based heparin nomogram at a large academic medical center.

Objective: To determine the utilization rate of a weight-based heparin nomogram and to assess the performance of the nomogram outside of experimental conditions.

Study Design: Prospective cohort analysis.

Patients And Methods: A total of 747 consecutive patients treated with intravenous heparin therapy for any indication on an internal medicine service were evaluated for the utilization rate of the weight-based nomogram, the time needed to exceed heparin's therapeutic threshold (activated partial thromboplastin time [aPTT] of > 1.

Serotonin syndrome. Presentation of 2 cases and review of the literature.

Serotonin syndrome is an underreported complication of pharmacotherapy that has been relatively ignored in the medical literature. We discuss 2 recent cases seen at our institution and 39 cases described in the English-language literature since 1995. We found that patients with serotonin syndrome most often (74.

A surplus of physicians? The view of internists at a single institution.

Background: The sizable increase in the United States physician workforce over the last 25 years has led to a concern by health policy analysts that we are training too few generalist physicians, too many specialists and too many doctors altogether. Nearly all analysts' studies report that the United States currently has an adequate or more than adequate supply of physicians; however, few reports discuss practicing physicians' view of the issues.

Objective: To determine internists' opinion regarding the current and future physician supply and specialty mix.

A web-based risk management and medical-legal curriculum for graduate medical education.

An educational Web site on the topic of risk management and medical-legal issues was designed. The site incorporates a 25-question multiple-choice quiz where resident responses were stored in a database for quantitative analysis. Residents who browsed the educational module scored significantly higher on the quiz (81%) than those who did not (62%).

The use of a spectrophotometric assay to study the interaction of S-adenosylmethionine synthetase with methionine analogues.

We have developed a continuous spectrophotometric assay for S-adenosylmethionine synthetase and, using this assay, have examined the interaction of five potential inhibitors with the E. coli enzyme. S-Vinylhomocysteine and S-allylhomocysteine were found to be substrates, while S-(methanethio)cysteine and S-(methanethio)homocysteine were found to be competitive inhibitors.