Who Gets to Determine Whether Home Is "Unsafe" at the End of Life?

Background: At the end of life, some patients wish to be discharged directly home from the hospital, but health care teams may consider this unsafe, raising concerns for capacity and risk. However, defining risk is subjective and impacted by values, preferences, and clinical status. Accommodating patient preferences in discharge destinations can promote autonomy, dignity, and quality of life at the end of life.

In control or along for the ride? Lessons for anesthesiologists from air traffic control.

Purpose Of Review: Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the operating room behaves more like a complex adaptive system, in which events can interact and connect with each other in unpredictable and unplanned ways.

Recent Findings: The increasing complexity of the healthcare environment suggests that the complete elimination of human error is not possible.

Hospitalisations for heart failure: increased palliative care referrals - a veterans affairs hospital initiative.

Objectives: Heart failure (HF) portends significant morbidity and mortality. Integrating palliative care (PC) with HF management improves quality of life and preparedness planning. At a Veterans Affairs hospital, PC was used in 6.

Effects of vaccination status in the United States on willingness to undergo surgery during a pandemic: A prospective survey study.

Purpose Of The Research: Modifiable and non-modifiable patient and hospital characteristics may affect willingness to undergo surgery during a pandemic. We hypothesized that vaccination of hospital staff and patients, type of surgery, and length of stay, would affect willingness to undergo a surgical procedure. 2006 adult participants in the United States were recruited electronically using Amazon's ® Mechanical Turk ® and answered a 26-item survey in English about hypothetical surgery, manipulating requirements for: staff vaccination, patient vaccination, surgical urgency, and time in hospital.

An Interdisciplinary Approach to Metastatic Pancreatic Cancer and Comorbid Opioid Use Disorder Treatment Within a VA Health Care System.

A multidisciplinary approach provided safe and feasible cancer treatment in a patient with advanced pancreatic cancer and coexisting active substance use disorder.

Feasibility of Safe Opioid Prescribing in Outpatient Palliative Care: A Quality Improvement Project.

Background: No guidelines for safe opioid prescribing in palliative care exist, which contributes to limited monitoring of opioid misuse in palliative care.

Measures: Feasibility of a safe opioid prescribing standard operating protocol (SOP) was determined by assessing the percentage of patients in an outpatient cancer center who completed each component of a five-component SOP.

Intervention: A five-component SOP included: risk stratification for misuse, consent form, prescription drug monitoring program review, urine drug testing, and Naloxone for high-risk individuals.

COVID-19, Personal Protective Equipment, and Human Performance.

Clinicians who care for patients infected with coronavirus disease 2019 (COVID-19) must wear a full suite of personal protective equipment, including an N95 mask or powered air purifying respirator, eye protection, a fluid-impermeable gown, and gloves. This combination of personal protective equipment may cause increased work of breathing, reduced field of vision, muffled speech, difficulty hearing, and heat stress. These effects are not caused by individual weakness; they are normal and expected reactions that any person will have when exposed to an unusual environment.

Automation failures and patient safety.

Purpose Of Review: The goal of automation is to decrease the anesthesiologist's workload and to decrease the possibility of human error. Automated systems introduce problems of its own, however, including loss of situation awareness, leaving the physician out of the loop, and training physicians how to monitor autonomous systems. This review will discuss the growing role of automated systems in healthcare and describe two types of automation failures.

Analytical Validation of a Highly Sensitive, Multiplexed Chronic Myeloid Leukemia Monitoring System Targeting BCR-ABL1 RNA.

This study describes the analytical performance of the QuantideX qPCR BCR-ABL IS Kit, the first Food and Drug Administration-cleared assay designed to monitor breakpoint cluster region-Abelson tyrosine-protein kinase 1 (BCR-ABL1) fusion transcripts isolated from peripheral blood specimens from patients with chronic myeloid leukemia. This multiplex real-time quantitative RT-PCR assay amplifies both e13a2 and e14a2 Major BCR-ABL1 transcripts and the reference target ABL1. The test results are provided in international scale (IS) values by incorporating armored RNA-based calibrators that have defined IS values tied directly to the World Health Organization BCR-ABL1 Primary Reference Materials, without the necessity of determining and maintaining conversion factors.

Quantitative characterization of electron detectors for transmission electron microscopy.

A new generation of direct electron detectors for transmission electron microscopy (TEM) promises significant improvement over previous detectors in terms of their modulation transfer function (MTF) and detective quantum efficiency (DQE). However, the performance of these new detectors needs to be carefully monitored in order to optimize imaging conditions and check for degradation over time. We have developed an easy-to-use software tool, FindDQE, to measure MTF and DQE of electron detectors using images of a microscope's built-in beam stop.

"Questionable" guidance.

CMS's recent FAQs on how GME/IME payments will be managed for residents' training in nonhospital settings only add to healthcare providers' confusion on this issue. Several recommendations represent substantial changes in the rules. The new requirements that are expressed or implied in the FAQs make compliance extremely difficult.

Medicare implications of discounts to the uninsured.

Discount policies are likely to face increased scrutiny in light of congressional inquiries on Medicare outlier payments and recent media attention regarding pricing for the uninsured. If you're considering making changes to your hospital's policy, you'll need to understand the current regulatory environment, recognize potential concerns, and develop a plan of action that complies with recent HHS guidance.

Comparison of nickel-titanium file distortion using electric and air-driven handpieces.

The use of rotary instrumentation has increased dramatically in endodontics. Air-driven and electric handpieces are both currently available for use with the nickel-titanium files. To date no studies have compared the frequency of instrument separation and/or distortion while using the two types of handpieces with rotary files.

Ineffectiveness of burst suppression therapy in mitigating perioperative cerebrovascular dysfunction. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.

Background: Cerebral injury is among the most common and disabling complications of open heart surgery. Attempts to provide neuroprotection have yielded conflicting results. We assessed the potential of propofol-induced burst suppression during open heart surgery to provide cerebral protection as determined by postoperative neuropsychologic function.