A naturalistic assessment of the relationship between negative affect and loss of control eating over time following metabolic and bariatric surgery.

Disordered eating behavior has been linked to suboptimal weight outcomes following metabolic and bariatric surgery (MBS), thereby threatening the most efficacious treatment for severe obesity. While up to 40% of patients may experience loss of control (LOC) eating following MBS, mechanisms driving this behavior are not fully understood. Preliminary evidence suggests that high levels of negative affect (NA) in the moment prompt LOC eating post-MBS; however, it remains unclear whether this momentary relationship is stable or changes over the first several years following surgery.

Disordered eating behavior and dietary intake prior to metabolic and bariatric surgery.

Background: Disordered eating is a concern for patients seeking metabolic and bariatric surgery (MBS), but little is known about how these behaviors are reflected in typical dietary intake prior to surgery.

Objectives: This study examined the relationships between disordered eating behavior and the content and context of typical dietary intake among patients seeking MBS using an innovative combination of rigorous self-report and interview assessments.

Setting: Participants were recruited from two academic medical centers in the United States.

Utilizing Clinical Microsystems to Improve Mislabeled Specimen Occurrences in the Emergency Department.

Introduction: Mislabeled specimen collection in the emergency department has the potential to significantly harm patients. Studies suggest that improvement efforts can reduce specimen rejection from the laboratory and reduce mislabeled specimens in emergency departments and hospital-wide.

Methods: The clinical microsystems approach was used to understand the problem of mislabeled specimens in an emergency department that is part of a 133-bed community hospital in Pennsylvania.

Quantifying the impact of patient boarding on emergency department length of stay: All admitted patients are negatively affected by boarding.

Background: Patients boarding in the emergency department (ED) as a result of delays in bed placement are associated with increased morbidity and mortality. Prior literature on ED boarding does not explore the impact of boarding on patients admitted to the hospital from the ED. The objective of this study was to evaluate the impact of patient boarding on ED length of stay for all patients admitted to the hospital.

Does Early Surgical Decompression in Cauda Equina Syndrome Improve Bladder Outcome?: Comments on a Recent Study by Srikandarajah et al.

Study Design And Objectives: This study by Srikandarajah et al is a retrospective cohort study of 200 CES patients. Although parts of the study appear to be well done we identified serious problems that impacted their conclusions.

Summary Of Background Data: There is strong consensus that patients with incomplete cauda equina syndrome (CESI) should be operated upon expeditiously to prevent progression to CES with urinary retention (CESR).

ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

Background: Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration.

Geisinger's ProvenCare methodology: driving performance improvement within a shared governance structure.

Many performance improvement projects fail because they occur in parallel to the organization's shared governance structure. Leveraging the full potential of its nursing shared governance structure, Geisinger Health System's ProvenCare methodology harnessed the full potential of its staff nurses to create truly reliable workflows that benefit patients and that the team finds professionally satisfying. Using ProvenCare Perinatal and its smoking cessation education intervention and outcomes as an example, the authors describe the ProvenCare methodology.

Clinical microsystems, Part 4. Building innovative population-specific mesosystems.

Background: In 2005, the Geisinger Health System (Danville, Pennsylvania) developed ProvenCare, first applied to coronary artery bypass graft (CABG), as an innovative provider-driven quality improvement program to promote reliable delivery of evidence-based best practices. A new mesosystem is created for each ProvenCare model, integrating the care delivery process between contributing microsystems and defining new mesosystem leadership. The approach has been expanded to many patient populations, including percutaneous coronary intervention (PCI).