Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study.

Objectives: To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU.

Design: Qualitative observational cross-sectional study.

Setting: Seven ICUs across three hospitals in an integrated academic health system.

When One's Not Enough: Colony Pool-Seq Outperforms Individual-Based Methods for Assessing Introgression in .

The human management of honey bees () has resulted in the widespread introduction of subspecies outside of their native ranges. One well known example of this is , native to Northern Europe, which has now been significantly introgressed by the introduction of C lineage honey bees. Introgression has consequences for species in terms of future adaptive potential and long-term viability.

Outcomes of Patients Receiving Thrombolysis in a Mobile Stroke Unit: A 4-Year Retrospective, Observational, Single-Center Study.

Background And Purpose: Patients with acute ischemic stroke (AIS) eligible for thrombolysis benefit when thrombolysis is administered quickly, and mobile stroke units (MSU) can facilitate timely thrombolysis. We sought to compare time metrics and clinical outcomes of AIS patients receiving thrombolysis in an MSU compared with patients arriving via local emergency medical services (EMS).

Methods: We performed a retrospective, non-randomized, cohort study comparing MSU-arriving to EMS-arriving AIS patients from January 20, 2017 through November 30, 2020.

Implementation of point-of-care blood gas testing at a large community hospital: Cost analysis, sepsis bundle compliance, and employee engagement.

Introduction/background: Point-of-care testing (POCT) platforms support patient-centered approaches to health care delivery and may improve patient care. We evaluated implementation of a POCT platform at a large, acute care hospital in the Midwestern United States.

Methods: We used lactate testing as part of a sepsis bundle protocol to evaluate compliance and mortality outcomes.

Accelerating Rare Disease Drug Development: Lessons Learned from Muscular Dystrophy Patient Advocacy Groups.

With scientific and molecular advancements related to disease pathogenesis, advances in gene and stem cell therapies, and the promise of lucrative markets for biopharmaceutical companies, there has been a rapid expansion in the number of potential new muscular dystrophy (MD) treatments. The first champion for a newly diagnosed MD patient and their caregivers is typically an MD-specific patient advocacy group (PAG). Muscular dystrophy PAGs have been among the most active in the rare disease drug development space.

Use of Big Data to Aid Patient Recruitment for Clinical Trials Involving Biosimilars and Rare Diseases.

Patient recruitment and retention are arguably the greatest challenges to the timely execution of clinical trials. This is particularly true in the case of trials involving biosimilars and those focused on rare diseases. For biosimilars, recruitment success typically hinges on difficulty of access to reimbursement for the originator product and may be hindered by competition from studies with other biosimilars and those with new chemical entities.

Stroke Volume Optimization: Utilization of the Newest Cardiac Vital Sign: Considerations in Recovery from Cardiac Surgery.

The hemodynamic monitoring landscape is rapidly evolving from pressure-based and static parameters to more blood flow-based and dynamic parameters. Consensus guidelines for cardiac surgery state that the pulmonary artery catheter is neither required nor helpful in most patients. In the meantime, critical care has been searching for the alternatives to the pulmonary artery catheter and protocols for use.

Evaluation of Safety and Cost of an Open-Design Oxygen Mask in a Large Community Hospital.

Background: In our large community hospital, we observed that traditional oxygen masks were sometimes set at an inappropriately low flow. We hoped to eliminate this safety concern through adoption of an open-design oxygen mask. We also hoped that more immediate flow changes would lead to a decrease in medical gas consumption.

Multidisciplinary care in the oncology setting: historical perspective and data from lung and gynecology multidisciplinary clinics.

Multidisciplinary care refers to a practice in which physicians from multiple specialties attend to the same patient population. There are many advantages to the model, including reduced time to treatment, coordinated treatment plans, increased patient and physician satisfaction, and increased enrollment onto clinical trials. At Central Dupage Hospital, multidisciplinary clinics have been instituted in lung and gynecologic cancer.

Tracheobronchial tumor cast formation and pneumothorax.

A 34-year-old white man was admitted to the hospital for progressive respiratory difficulty, recurrent left pneumothorax, and a diagnosis of aplastic left lung. Further evaluation, including bronchoscopy and CT scan, demonstrated a cast-forming tracheobronchial obstructing tumor. Surgical resection of the tumor through the left chest with left lower lobectomy resolved his symptomatology.

Hypogammaglobulinemia and anemia 18 years after thymoma resection.

Immunodeficiency with a thymoma (Good's syndrome) is a rare condition occurring in 7% to 13% of patients with adult-onset hypogammaglobulinemia. In 80% of cases, hypogammaglobulinemia is detected within 5 years of the identification of the thymoma. A 70-year-old man was found to have hypogammaglobulinemia 18 years after a thymoma had been resected.

Pulmonary lymphangioleiomyomatosis associated with pulmonary parenchymal, hilar, and mediastinal noncaseating granulomas.

A young nonsmoking woman presented with severe dyspnea, exercise desaturation, and chest discomfort. Pathologic and histochemical findings revealed pulmonary lymphangioleiomyomatosis (LAM) as the primary abnormality. In addition, there were multiple noncaseating granulomas with special stains and cultures negative for organisms.

Office-based assessment of pulmonary function.

PFT is a valuable tool for evaluating the patient with respiratory complaints and for screening the high-risk population. It is no longer only a hospital-based test, but, with current technology, is an efficient, practical procedure that can be performed in an office at minimal cost to the patient. In addition, serial spirometry can be used to identify high-risk populations and gauge response to bronchodilator therapy.