A Regional Health System Journey from Volume to Value: Roadmap to the Recognition as a 15 Top Health System in the USA for Quality Excellence.

The 15 Top Health System program, an IBM Watson study, objectively measures health systems' performance overall on an annual basis using publicly reported data available from the Center for Medicare and Medicaid Services (CMS) and state data banks. Genesis Health System was recognized as an IBM Watson Health 15 Top Health System for two consecutive years in 2020 and 2021. A system-based approach with a "physician-lead, professionally-managed" framework, led to accomplishing the 15 Top Health System.

Education of Self-Radial Pulse Palpation and Atrial Fibrillation Signs and Symptoms.

The purpose of this evidence-based education initiative was to increase A Fib detection in a cardiovascular diseased population in which participants were taught radial pulse palpation and signs/symptoms of A Fib. Participants were evaluated after initial education on performance of radial pulse palpation and teach back of signs/symptoms of the arrhythmia and again at three weeks on adherence to daily self-screening and recall of signs/symptoms of A Fib. Post initial education, 88% of eligible participants learned pulse-palpation and 93% could verbalize at minimum one sign/symptom.

Dynavision Normative Data for Healthy Adults: Reaction Test Program.

Importance: Previous research has calculated normative data for the Dynavision D2 Visuomotor Training (D2) System among healthy athletes to understand concussion management, but to date no studies have identified the norms for healthy adults over a large age range (18-80 yr) for physical response speed.

Objective: To provide normative data for the D2 for physical response speed in adults ages 18-80 yr.

Design: Cross-sectional, descriptive study to obtain normative data on physical response speed using the D2 for adults in age categories 18-40, 41-60, and 61-80 yr.

Assessment of Time to Hospital Encounter after an Initial Hospitalization for Heart Failure: Results from a Tertiary Medical Center.

Background: Hospital inpatient readmissions for patients admitted initially with the primary diagnosis of heart failure (HF) can be as high as 20-25% within 30 days of discharge. This, however, does not include admissions for observations or emergency department (ED) visits within the same time frame and does not show a time-dependent hospital encounter following discharge after an index admission. We present data on time-dependent hospital encounter of HF patients discharged after an index admission for a primary diagnosis of HF.

Implementation of a patient safety program at a tertiary health system: A longitudinal analysis of interventions and serious safety events.

Background: We hypothesize that implementation of a safety program based on high reliability organization principles will reduce serious safety events (SSE).

Methods: The safety program focused on 7 essential elements: (a) safety rounding, (b) safety oversight teams, (c) safety huddles, (d) safety coaches, (e) good catches/safety heroes, (f) safety education, and (g) red rule. An educational curriculum was implemented focusing on changing high-risk behaviors and implementing critical safety policies.

Meta-Analysis-Derived Benchmarks of Patency and Target Lesion Revascularization of Percutaneous Balloon Angioplasty from Prospective Clinical Trials of Symptomatic Femoropopliteal In-Stent Restenosis.

Purpose: To establish historic benchmarks of patency and target lesion revascularization (TLR) in a study-level meta-analysis of prospective studies of balloon angioplasty in treating femoropopliteal in-stent restenosis (ISR).

Materials And Methods: Data from the balloon angioplasty control arms of 4 randomized multicenter trials (1 Food and Drug Administration-approved study in the United States and 3 conducted in Europe) and 1 European prospective registry were included. Trials included patients with Rutherford stage 1-5 disease or Fontaine ischemia classification states IIb, III, IV and femoropopliteal ISR lesion lengths of 4-27 cm.

Setting expectations following endoscopic cubital tunnel release.

Background: The objective was to evaluate recovery characteristics of patients undergoing endoscopic cubital tunnel release (ECuTR) by determining the following: (1) return to work (RTW) times following ECuTR compared with RTW times of patients that underwent anterior transposition of the ulnar nerve (ATUN), (2) satisfaction rates and factors affecting satisfaction, (3) resolution rates of common preoperative complaints and findings, and (4) effect of preoperative ulnar nerve subluxation on postoperative outcomes.

Methods: A total of 172 cases in 148 patients undergoing ECuTR were prospectively enrolled including 56 women and 92 men. Kaplan-Meier analyses were performed to determine RTW time for ECuTR patients and for a cohort of 15 patients that underwent ATUN.

The Gap between Compliance with the Quality Performance Measure "Perioperative Temperature Management" and Normothermia.

The National Quality Forum (NQF) has endorsed the process performance measure Perioperative Temperature Management, which is used by the Joint Commission and the Centers for Medicare and Medicaid Services. Compliance requires either using active warming intraoperatively or achieving normothermia near the end of anesthesia. Compliance may actually be achieved by using forced-air warming incorrectly and without maintaining normothermia.

Topical administration of tranexamic acid in primary total hip and total knee arthroplasty.

Major blood loss is a known potential complication in total hip and total knee arthroplasty. We conducted a prospective, stratified, randomized, double-blind, placebo-controlled trial that evaluated 100 patients undergoing total knee or total hip arthroplasty to evaluate the effect on blood loss using the topical application of tranexamic acid. Participants received either 2 g of topical tranexamic acid or the equivalent volume of placebo into the joint prior to surgical closure.

Gender differences in patients treated with the zotarolimus-eluting stent at a tertiary medical center.

Background: Gender-related differences in long-term outcomes of patients receiving the Endeavor zotarolimus-eluting stent (ZES) (Medtronic) have not been well defined. In this study, we evaluate the differences between men (M) and women (W) for 2-year target vessel failure (TVF) in an unselected consecutive series of patients treated with the ZES at our institution.

Methods: Data on 197 consecutive patients (133 M, 64 W) stented with the ZES were retrospectively analyzed.

Arthroscopic resection arthroplasty for treatment of combined carpometacarpal and scaphotrapeziotrapezoid (pantrapezial) arthritis.

Purpose: Arthroscopy of the carpometacarpal (CMC) and scaphotrapeziotrapezoid (STT) joints has been described for the purpose of diagnosing, staging, and treating CMC and STT pathology. This study evaluates the short-term outcome of arthroscopic resection arthroplasty (ARA) for pantrapezial arthritis.

Methods: Thirty-five cases of ARA of the CMC and STT joints were performed in 34 patients with one year minimum follow-up.

Endoscopic cubital tunnel recurrence rates.

Cubital tunnel syndrome is the second most common nerve entrapment in the upper extremity. There are no current publications concerning the recurrence rates after endoscopic cubital tunnel release. The purpose of this study is to evaluate the recurrence rate of endoscopic cubital tunnel release compared to published reports of recurrence following open cubital tunnel procedures.

Gender differences in adhering to national guidelines in a community lipid clinic.

The aggressive treatment of hypercholesterolemia improves morbidity and mortality in patients with a history of cardiovascular disease irrespective of gender. Electronically tracked data on 4324 patients enrolled in a community lipid clinic were analyzed for gender differences in lipid values and adherence to national guidelines in lipid management. Women were older, more likely to be diabetic and/or hypertensive, and have a family history of coronary heart disease.

Twelve-month results of percutaneous endovascular reconstruction for chronically occluded superficial femoral arteries: a quality-of-life assessment.

Background: We report our experience on the technical feasibility and impact on quality of life (QOL) for angioplasty and primary stenting of chronic total occlusion (CTO) of the superficial femoral artery (SFA).

Methods: Forty-four patients (51 legs) underwent attempted percutaneous revascularization for SFA CTO utilizing the self-expanding nitinol SMART stent (Cordis Corp., Miami, Florida).

Eptifibatide in peripheral vascular interventions: results of the Integrilin Reduces Inflammation in Peripheral Vascular Interventions (INFLAME) trial.

An acute inflammatory response occurs following percutaneous coronary and peripheral vascular interventions (PVI), partly mediated by platelet activation. Glycoprotein (GP) IIb-IIIa inhibitors might partially attenuate this inflammation rise in the coronary patient, but data in patients undergoing PVI are lacking. In the Integrilin Reduces Inflammation in Peripheral Vascular Interventions trial (INFLAME), we hypothesized that eptifibatide reduces the acute inflammatory responses following PVI.

Routine visualization of the left internal mammary artery before bypass surgery: is it necessary?

The left internal mammary (LIMA) is an ideal conduit for bypassing the left anterior descending artery (LAD) during coronary artery bypass surgery (CABG). In this study, we evaluate the frequency of significant disease in the LIMA prior to CABG and describe associated significant lateral costal branches (> 1.5 mm), subclavian disease and vertebral disease.

Clinical and angiographic predictors of restenosis following renal artery stenting.

Unlabelled: Percutaneous stenting has become the procedure of choice for treatment of obstructive atherosclerotic renal artery (RA) disease. Restenosis, however, continues to be in the range of 15-25% of treated vessels. In this study, clinical and angiographic predictors of restenosis were assessed.

Bivalirudin in peripheral vascular interventions: a single center experience.

Unfractionated heparin is a widely utilized anticoagulant during peripheral angioplasty procedures (PTA). In contrast to heparin, bivalirudin is a direct thrombin inhibitor with predictable anticoagulation, does not activate platelets, and inhibits both soluble and bound thrombin. The experience with bivalirudin during PTA remains limited.

In-hospital complications of peripheral vascular interventions using unfractionated heparin as the primary anticoagulant.

Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. The rate of in-hospital major complications during peripheral angioplasty procedures (PTA) using heparin as the primary anticoagulant has not been well defined. In this single-center study, the charts of 213 consecutive PTA procedures in a 1-year period were reviewed.

Simultaneous estimation of intrarater and interrater agreement for multiple raters under order restrictions for a binary trait.

It is valuable in many studies to assess both intrarater and interrater agreement. Most measures of intrarater agreement do not adjust for unequal estimates of prevalence between the separate rating occasions for a given rater and measures of interrater agreement typically ignore data from the second set of assessments when raters make duplicate assessments. In the event when both measures are assessed there are instances where interrater agreement is larger than at least one of the corresponding intrarater agreements.

Biological mechanisms underlying voice changes due to dehydration.

Four vocally untrained healthy adults, 2 men and 2 women, completed the study. A double-blind placebo-controlled approach was used to administer three treatments to each participant on separate days. Drugs treatments involved a single 60-mg dose of a diuretic, Lasix (LA), on one day, and a single 50-mg dose of an oral antihistamine, diphenhydramine hydrochloride (DH), on another day.