Regioselective and controlled-density branching in amylose esters.

Herein, we report creation of methodology for one-pot synthesis of 2,3-O-acetyl-6-bromo-6-deoxy (2,3Ac-6Br) amylose with controlled degree of substitution of bromide (DS(Br)) followed by quantitative azide substitution as a route to branched polysaccharide derivatives. This methodology affords complete control of "tine" location, and strong control of degree of branching of comb-structured polymers. In this way, we achieved bromination strictly at C6 and esterification at the other hydroxy groups, where the DS(Br) at C6 was well-controlled by bromination/acylation conditions in the one-pot process.

Standardized practice design with electronic support mechanisms for surgical process improvement: reducing mechanical ventilation time.

Background: Hospital surgical care is complex and subject to unwarranted variation.

Objective: As part of a multiyear effort, we sought to reduce variability in intraoperative care and management of mechanical ventilation in cardiac surgery. We identified a patient population whose care could be standardized and implemented a protocol-based practice model reinforced by electronic mechanisms.

From 'solution shop' model to 'focused factory' in hospital surgery: increasing care value and predictability.

The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop.

Improving affordability through innovation in the surgical treatment of mitral valve disease.

Objective: To determine whether technically innovative cardiac surgical platforms (ie, robotics) deployed in conjunction with surgical process improvement (systems innovation) influence total hospital costs to address the concern that expanding adoption might increase health care expenses.

Patients And Methods: We studied 185 propensity-matched patient pairs (370 patients) undergoing isolated conventional open vs robotic mitral valve repair with identical repair techniques and care teams between July 1, 2007, and January 31, 2011. Two time periods were considered, before the implementation of system innovations (pre-July 2009) and after implementation.

Functional recovery in the elderly after major surgery: assessment of mobility recovery using wireless technology.

Purpose: Hospitalization and surgery in older patients often leads to a loss of strength, mobility, and functional capacity. We tested the hypothesis that wireless accelerometry could be used to measure mobility during hospital recovery after cardiac surgery.

Description: We used an off-the-shelf fitness monitor to measure daily mobility in patients after surgery.

Surgical Process Improvement: Impact of a Standardized Care Model With Electronic Decision Support to Improve Compliance With SCIP Inf-9.

The absence of standardization in surgical care process, exemplified in a "solution shop" model, can lead to unwarranted variation, increased cost, and reduced quality. A comprehensive effort was undertaken to improve quality of care around indwelling bladder catheter use following surgery by creating a "focused factory" model within the cardiac surgical practice. Baseline compliance with Surgical Care Improvement Inf-9, removal of urinary catheter by the end of surgical postoperative day 2, was determined.

Recovery bed planning in cardiovascular surgery: a simulation case study.

Recovery beds for cardiovascular surgical patients in the intensive care unit (ICU) and progressive care unit (PCU) are costly hospital resources that require effective management. This case study reports on the development and use of a discrete-event simulation model used to predict minimum bed needs to achieve the high patient service level demanded at Mayo Clinic. In addition to bed predictions that incorporate surgery growth and new recovery protocols, the model was used to explore the effects of smoothing surgery schedules and transferring long-stay patients from the ICU.

The value of a web-based interactive regional health scorecard in setting public health priorities.

Introduction: Community-based health improvement efforts sometimes focus on emerging health issues rather than following a more proactive planning process. Although there is an abundance of easily accessible data on state and national websites, community leaders frequently don't know where to find data that will help them to prioritize local efforts.

Methods: The La Crosse Medical Health Science Consortium (LMHSC) is a formal collaborative of the 2 major health care providers and 3 higher education institutions in La Crosse, Wisconsin, and covers 20 counties in western Wisconsin, southeastern Minnesota, and northeastern Iowa.