Beyond-use date: establishment and maintenance.

With the introduction of United States Pharmacopeia Chapters <795> and <797>, the long-standing concept of drug stability (beyond-use dates and expiration dates) came to the forefront of pharmacy compounding practice. Beyond-use date extension can only be done if end-point sterility testing is done on compounded sterile preparations. It is not for everyone and can only be accomplished by using an analytical approach.

Protecting patients from an unsafe system: the etiology and recovery of intraoperative deviations in care.

Objective: To understand the etiology and resolution of unanticipated events in the operating room (OR).

Background: The majority of surgical adverse events occur intraoperatively. The OR represents a complex, high-risk system.

Postgame analysis: using video-based coaching for continuous professional development.

Background: The surgical learning curve persists for years after training, yet existing continuing medical education activities targeting this are limited. We describe a pilot study of a scalable video-based intervention, providing individualized feedback on intraoperative performance.

Study Design: Four complex operations performed by surgeons of varying experience--a chief resident accompanied by the operating senior surgeon, a surgeon with less than 10 years in practice, another with 20 to 30 years in practice, and a surgeon with more than 30 years of experience--were video recorded.

A study of best practices for clinical documentation system implementation.

Nurses are key leaders and team members for the implementation of clinical documentation systems. This paper reviews key success factors during implementation of clinical documentation systems to overcome traditional barriers, ensure commitment to universal goals and facilitate the use of technology for patient safety and continuous quality improvement efforts. Top level management support, particularly from nursing executives, is vital.

2008 HIMSS Survey results: best practices in implementing nursing/interdisciplinary documentation systems.

Health care organizations are increasingly using computer systems to support nursing care documentation; however, processes used to deploy such systems are widely varied. The purpose of this survey was to understand current practices related to implementation of computerized nursing and interdisciplinary documentation systems with the goal to establish best practice guidelines. In Spring 2007, members from the Healthcare Information Management and Systems Society Nursing Informatics Working Group interviewed a sample of 15 hospitals to solicit information regarding the following processes: leadership activities, clinical transformation processes, project management activities, implementation processes, evaluation metrics, terminology and other standards used, and methods used to facilitate end-user adoption.

Distal pancreatectomy is not associated with increased perioperative morbidity when performed as part of a multivisceral resection.

Purpose: To evaluate the indications for and the outcomes from distal pancreatectomy.

Methods: Retrospective chart review of 171 patients who underwent distal pancreatectomy at Brigham and Women's Hospital between January 1996 and August 2005.

Results: Nearly one-third of distal pancreatectomies were performed as part of an en bloc resection for a contiguous or metastatic tumor.

Adenocarcinoma of the gastric cardia: what is the optimal surgical approach?

Background: The incidence of adenocarcinoma of the gastric cardia is rising in Western countries. This study evaluates prognostic factors associated with surgical management of this cancer.

Study Design: Medical records of consecutive patients with gastric cardial cancer treated by surgical resection from 1991 through 2001 were reviewed.

Treatment outcomes associated with surgery for gallbladder cancer: a 20-year experience.

The aim of this study was to evaluate contemporary outcomes associated with the management of gallbladder cancer. The medical records of 48 consecutive patients with gallbladder cancer treated at our institution from January 1981 through November 2001 were reviewed. Survival was analyzed using the Kaplan-Meier method (mean follow-up period 24 months) and the log-rank test.

Appendiceal adenocarcinoma: long-term outcomes after surgical therapy.

Purpose: Appendiceal adenocarcinomas are very rare. We analyzed contemporary outcomes associated with surgical therapies for these malignancies.

Methods: Retrospective outcomes for patients treated at a tertiary academic medical center from 1981 through 2001 were analyzed.

Surgical treatment of small bowel cancer: a 20-year single institution experience.

Small bowel malignancies are rare. The aims of this study were to evaluate the outcomes associated with surgical therapy for small bowel cancers and to define prognostic factors. The medical records of 96 consecutive patients with primary small bowel cancer (excluding lymphoma) treated at our institution over a 20 year period were reviewed.

Benign nonampullary duodenal neoplasms.

Benign duodenal neoplasms (BDNs) are uncommon, and their optimal management remains undefined. We analyzed all cases of BDN treated at our institution during a 10-year period (January 1990 through January 2000). Data are expressed as median (range).

Adjuvant high-dose interferon alfa-2b in patients with high-risk melanoma.

We performed an analysis of toxicity and survival in stage III melanoma patients receiving adjuvant interferon alfa-2b (IFN). This was a retrospective single-arm analysis of 40 patients with stage III melanoma who received (IFN) administered at maximum tolerated doses of 20 mU/m2/day intravenously (i.v.

The National Cancer Data Base report on breast carcinoma characteristics and outcome in relation to age.

Background: Previous data from the National Cancer Data Base have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1993) data for breast carcinoma are described here.

Methods: Five Calls for Data have yielded a total of 508,724 breast cancer cases diagnosed from 1985 to 1993, from hospital cancer registries throughout the U.

The presence of membrane-bound stem cell factor on highly immature nonmetachromatic mast cells in the peripheral blood of a patient with aggressive systemic mastocytosis.

Background: Systemic mastocytosis is characterized by mast cell infiltration of bone marrow and tissues in the absence of identified circulating bone marrow-derived progenitors. A 58-year-old man was first seen with aggressive systemic mastocytosis manifested by urticaria pigmentosa, hepatosplenomegaly, generalized bone lesions, anemia, thrombocytopenia, monoclonal gammopathy, and increased urine histamine levels.

Objectives And Methods: A rapidly progressive anemia and thrombocytopenia dictated a splenectomy.

Patterns of breast cancer care in the elderly.

Background: The elderly represent a large proportion of the women with breast cancer. However, there is a lack of information regarding breast cancer care in the elderly.

Methods: A patient care evaluation survey for breast carcinoma was conducted by the Commission on Cancer of the American College of Surgeons for 1983 and 1990.

A prospective study of conservative surgery alone in the treatment of selected patients with stage I breast cancer.

Background: Randomized clinical trials have clearly demonstrated that the use of radiation therapy (RT) following breast-conserving surgery (CS) substantially reduces the risk of local recurrence. However, the low rate of local recurrence after CS and RT for patients without known risk factors, and the recent increase in the detection of smaller cancers due to mammographic screening have led to the speculation that a subgroup of patients who have a low risk of local recurrence without RT might be identified. In 1986, we initiated a one-arm, prospective clinical trial of CS alone for treatment of highly selected breast cancer patients without known risk factors for local recurrence.

Reconstruction after mastectomy.

Although reconstruction after mastectomy offers an opportunity for cosmetic rehabilitation that should make mastectomy more acceptable and contribute to overall rehabilitation, the procedure is relatively underutilized. The best cosmetic results usually come from breast conservation rather than from mastectomy and subsequent reconstruction, and most small (T0-T2) cancers can be treated by means of breast-conserving measures. The surgeon who is performing the mastectomy plays a key role in explaining reconstruction to the patient and encouraging her to consider the process.

Treatment trends for ductal carcinoma in situ of the breast.

Background: As a result of clinical trial publications, breast conservation treatment has been increasingly used for invasive breast cancer. The patterns of care for ductal carcinoma in situ (DCIS) were analyzed for the years 1985, 1986, 1988, 1990, and 1991 to determine whether the same treatment principles had been applied to patients with non-invasive disease.

Methods: Data submitted on 20,556 patients with DCIS during the 5 study years were analyzed with regard to basic demographics and treatment trends.

A national quality improvement effort: cancer registry data.

Cancer registries are sources of epidemiological, patterns-of-care, and outcome data for local, regional, state, and national studies of patients with cancer. Since 1976, these registries have formed a voluntary network of contributors to annual patient care studies under the aegis of the National Cancer Data Committee of the Commission on Cancer. These annual studies provide timely clinical information that is widely disseminated to physicians, allied health personnel, administrators, health care planners, and public and private agencies.

Insurance coverage of patients with breast cancer in the 1991 commission on cancer patient care evaluation study.

Background: Trends in the care of patients with cancer are monitored annually by the Commission on Cancer of the American College of Surgeons. In 1991 a patient care evaluation study of breast cancer was conducted, which among other questions examined the correlation of health insurance with type or quality of care delivered for breast cancer on a national basis.

Methods: The tumor registry system of the American College of Surgeons was used to obtain data on patients with breast cancer diagnosed in 1983 and 1990.

Selection of patients for breast conserving surgery.

The majority of patients with breast cancer can be treated by partial mastectomy and radiation therapy. Ineligibility for breast conservation usually is related to previous radiation or the inability to receive radiation for other reasons. For patients who can receive radiation, selection for breast conservation involves the estimation of the risk for in-breast recurrence and the ability to achieve a satisfactory cosmetic result.