A "sludge audit" for health system colorectal cancer screening services.

Objectives: "Sludge," or the frictions or administrative burdens that make it difficult for people to attain what they want or need, is an unexplored health care delivery factor that may contribute to deficiencies in colorectal cancer (CRC) screening. We piloted a method to identify and quantify sludge in a southeastern US health system's delivery of CRC screening services.

Study Design: Mixed methods sludge audit.

Reallocating Cervical Cancer Preventive Service Spending from Low- to High-Value Clinical Scenarios.

Unlabelled: Timely follow-up care after an abnormal cervical cancer screening test result is critical to the prevention and early diagnosis of cervical cancer. The current inadequate and inequitable delivery of these potentially life-saving services is attributed to several factors, including patient out-of-pocket costs. Waiving of consumer cost-sharing for follow-up testing (e.

Standardizing and optimizing nutrition evaluation frequency of enterally fed patients in an ambulatory pediatric gastroenterology practice: A single-center study.

Background: Nutrition monitoring is essential in feeding tube-dependent patients receiving home enteral nutrition (HEN). We identified lack of consistency in dietitian evaluations for our pediatric patients receiving HEN. Consequently, after establishing an institutional standard for nutrition reassessment intervals, we underwent a quality improvement (QI) initiative to improve rates of adherence to standard frequency of dietitian consults and referrals among patients receiving HEN.

Improving Patient Safety in Clinical Oncology: Applying Lessons From Normal Accident Theory.

Concerns for patient safety persist in clinical oncology. Within several nonmedical areas (eg, aviation, nuclear power), concepts from Normal Accident Theory (NAT), a framework for analyzing failure potential within and between systems, have been successfully applied to better understand system performance and improve system safety. Clinical oncology practice is interprofessional and interdisciplinary, and our therapies often have narrow therapeutic windows.

The association between event learning and continuous quality improvement programs and culture of patient safety.

Purpose: To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety.

Methods And Materials: We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers.

Quantification of the impact of multifaceted initiatives intended to improve operational efficiency and the safety culture: a case study from an academic medical center radiation oncology department.

Purpose: We have systematically been incorporating several operational efficiency and safety initiatives into our academic radiation oncology clinic. We herein quantify the impact of these initiatives on prospectively collected, clinically meaningful, metrics.

Methods And Materials: The data from 5 quality improvement initiatives, each focused on a specific safety/process concern in our clinic, are presented.

Quantitative assessment of workload and stressors in clinical radiation oncology.

Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO).

From person-centered to relational care: expanding the focus in residential care facilities.

Long-term residential care facilities for older adults currently espouse a philosophy of person-centered care (PCC). However, these facilities operate according to a medical model with highly structured administration and regulation. As a result, there is tension between the priorities of the resident and the organization.

Reducing hospital-acquired infection by quantitative risk modeling of intravenous bag preparation.

Vascular access of patients by peripheral and central venous catheters for the delivery of sterile or aseptically manufactured parenterals is commonly regarded as one of the major causes of blood stream infections. Rigorous evaluation and management of the risks of microbial infection originating from the administration of aseptically manufactured therapies remain imperative to reduce patient infection risks. Healthcare clinicians are continually faced with choosing intravenous (IV) parenteral administration strategies to minimize patient blood stream infection risk.

Deconstructing housework: cuts to home support services and the implications for hospital discharge planning.

Over the last decade, the home support resources in British Columbia have decreased. Specifically, nonmedical tasks such as housekeeping and meal preparation have been severely restricted and are no longer available for hospital discharge planning with elders who are returning to the community. This paper applies analytical deconstruction to three aspects of a case example of an elderly couple: the technical and bureaucratic aspects of who gets home support and what kind, the socially constructed aspects of gender roles and the performance of unpaid labor, and the personally informed aspects that involve an elder's life experiences, social supports, and personal values.

Influence of combined angiotensin-converting enzyme inhibitors and spironolactone on serum K+, Mg 2+, and Na+ concentrations in small dogs with degenerative mitral valve disease.

Objective: To determine if the administration of an angiotensin-converting enzyme inhibitor (ACEI) plus spironolactone caused hyperkalemia, hypermagnesemia, or hyponatremia in elderly small dogs with degenerative mitral valve disease (MVD).

Background: ACEIs and spironolactone can increase serum potassium and magnesium concentrations and lower serum sodium concentrations. It has been recommended to either not combine these drugs or to do so with caution.

Cutting edge: impaired Toll-like receptor expression and function in aging.

Toll-like receptors (TLR) are pattern recognition receptors that recognize conserved molecular patterns on microbes and link innate and adaptive immune systems. We investigated whether the enhanced susceptibility to bacterial, yeast, and viral infections and poor adaptive immune responses in aging are a result of diminished expression and function of TLRs. We examined the expression and function of all murine TLRs on macrophages from young and aged mice.

Creatine supplementation affects muscle creatine during energy restriction.

Introduction: Anaerobic performance and body protein may decrease with energy restriction practiced by some athletes for weight loss.

Methods: This investigation examined the effects of creatine (Cr) supplementation during energy restriction on muscle Cr, exercise performance (10 sprints of 6 s, with 30-s rest), nitrogen balance, and body composition in male resistance trainers. Creatine supplemented (CrS, 20 g x d(-1) of Cr) and those given a placebo (P1) consumed a formula diet of 75.

Predictors of self-care in persons with heart failure.

Objective: The objective of this study was to test a model of individual patient characteristics, covering symptom severity, comorbidity, social support, education, age, socioeconomic status, and gender, derived from Connelly's Model of Self-Care in Chronic Illness as predictors of self-care in heart failure.

Design: This was a nonexperimental correlational study.

Setting: The study took place in 6 hospitals in southern California.

Local anesthetic administration for awake direct laryngoscopy. Are glossopharyngeal nerve blocks superior?

Background: Glossopharyngeal nerve (GPN) blocks may provide reliable analgesia for awake direct laryngoscopy, although this has not been evaluated prospectively. This study was designed to determine if GPN blocks provide a superior route of local anesthetic administration for awake direct laryngoscopy as measured by hemodynamic, gag, and subjective pain responses.

Methods: A prospective, randomized, single-blinded, crossover design was used.

Na+/H+ exchange and PLA2 activity act interdependently to mediate the rapid effects of 1 alpha, 25-dihydroxyvitamin D3.

1 alpha, 25-Dihydroxyvitamin D3 (1 alpha, 25-(OH)2D3) has been shown to rapidly increase cytosolic calcium in freshly isolated and cultured rat hepatocytes. The rise in cytosolic calcium is dependent on phospholipase A2 (PLA2) activation and cell alkalinization through the Na+/H+ antiport system. To further characterize the rapid effects of 1 alpha, 25-(OH)2D3, cultured hepatocytes were treated with inhibitors of PLA2 and the Na+/H+ antiport system.

Weight training decreases vertebral bone density in premenopausal women: a prospective study.

The effect of exercise on bone mass is unclear. To determine the skeletal effect of weight-bearing exercise in premenopausal women, we prospectively evaluated the effects of a weight-training program on lumbar spine bone mass in 10 women (mean +/- SEM, 36.2 +/- 1.