Advance Care Planning Bundle: Using Technical and Adaptive Solutions to Promote Goal Concordant Care.

Background: Advance Care Planning (ACP) is critical to achieve goal-aligned care for patients. However, optimal implementation requires complex coordination and alignment across a healthcare system.

Measures: A survey of rapid response providers assessed usefulness of the ACP quality improvement bundle and perceptions of use and adherence.

Dysfunctional labor and myometrial lactic acidosis.

Objective: Inefficient uterine contractions are the most common cause of poor progress in labor. The global increase in cesarean delivery rate is a cause of considerable concern, and the greatest reason for increase is the result of failure to progress in labor. Following in vitro studies that showed acidification could depress uterine contraction, we hypothesized that it could contribute to dysfunctional labors.