Four synchronous primary tumors in a male patient.

Multiple primary malignancies are defined as two or more primary malignant tumors diagnosed in one individual; they are further classified to synchronous or metachronous based on the period between each cancer diagnosis and the other. The diagnosis of four synchronous cancers is exceedingly rare. We report a case of a 72-year-old man, diagnosed with synchronous quadruple cancers, Hurthle cell carcinoma and papillary carcinoma of the thyroid, as well as squamous cell carcinoma and carcinoid tumor of the lung.

Cancer pain management and the JCAHO's pain standards: an institutional challenge.

Unrelieved pain is a major medical problem. In response to this problem, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched new standards for pain management in 1999. A review was conducted in five hospitals of 117 charts of 80 inpatients and 37 outpatients with cancer who had pain documented in their medical records to determine whether application of these JCAHO standards was documented.

A data-driven approach to improving clinical outcomes in cardiac care.

The performance improvement department at The Queen's Medical Center (QMC) in Honolulu, has been monitoring the outcomes of cardiovascular interventional procedures and cardiothoracic surgical procedures. By using an institution-wide database as well as participating in national cardiac databases, a set of clinical indicators is tracked, and quarterly reports are provided to the cardiovascular medicine (CV) and thoracic and cardiovascular surgery (TCV) services. After reviewing the data, a combined CV/TCV/anesthesia morbidity and mortality committee meets monthly to further evaluate the data, review cases, and formulate action plans based upon the findings.