Promoting Opioid Awareness Through a Union-Based Peer Training Model.

Work factors, including physical job demands, appear to be risk factors for opioid overdoses. We collaborated with unions representing workers in high-risk occupations and offered resources to develop tailored educational interventions for their members. An ironworkers' local, a statewide nurses' union, and a Teamsters local union participated, at levels higher than we had anticipated.

A randomized trial of normothermic preservation in liver transplantation.

Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing.

Aligning complex processes and electronic health record templates: a quality improvement intervention on inpatient interdisciplinary rounds.

Background: Interdisciplinary rounds (IDR) with documentation have become a standard of care, but the process has been incompletely described in academic general medical settings. Checklists are promoted, yet standardized formats may not reflect the variability and work flow of rounds or support the cognitive development of medical trainees. We describe IDR processes in an academic general medicine inpatient setting and present a rapid cycle quality improvement (QI) project that improved IDR documentation rates in the electronic health record.

Methadone-induced Torsades de pointes.

Torsades de pointes is a polymorphic ventricular tachycardia that can quickly evolve into ventricular fibrillation and sudden death. This arrhythmia often occurs secondary to medication- induced cardiac repolarization dysfunction with resultant prolonged QTc interval on ECG. Numerous medications can predispose patients to this deadly tachycardia.

A case of intracranial hemorrhage causing stress-induced cardiomyopathy.

The classic finding of Takotsubo's cardiomyopathy is left ventricular systolic dysfunction with echocardiographic evidence of apical ballooning in the absence of significant coronary disease. Intracranial hemorrhage is a known cause for stress-induced cardiomyopathy with a similar echocardiographic presentation. This diagnostic finding suggests a similar pathophysiologic mechanism between neurogenic cardiac damage and the wide array of medical and psychosocial disorders that are known to cause stress-induced cardiomyopathy (Takotsubo's syndrome).