Spontaneous Bacterial Peritonitis Complicated by Loculations Requiring Alteplase.

The state of healthcare is consistently being driven towards evidence-based practices to establish both optimal and consistent healthcare for all patients. From this evidence, treatment guidelines arise to meet these goals. As new data, diseases, and treatments develop, these guidelines that influence evidence-based practice are refined and redefined.

Resident-Driven Clinical Decision Support Governance to Improve the Utility of Clinical Decision Support.

Objectives:  This resident-driven quality improvement project aimed to better understand the known problem of a misaligned clinical decision support (CDS) strategy and improve CDS utilization.

Methods:  An internal survey was sent to all internal medicine (IM) residents to identify the most bothersome CDS alerts. Survey results were supported by electronic health record (EHR) data of CDS firing rates and response rates which were collected for each of the three most bothersome CDS tools.

Preoperative Endoscopic Ultrasound-Guided Hepaticogastrostomy Facilitates Decompression and Diagnosis in Patients With Suspected Malignant Biliary Obstruction: A Case Series.

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is increasingly being used as an alternative to percutaneous transhepatic biliary drainage (PTBD) after unsuccessful endoscopic retrograde pancreatography (ERCP). This technique has also been utilized for diagnosis of malignant biliary obstruction by providing biliary access for antegrade cholangioscopy with biopsies and brushings for cytology and fluorescent in situ hybridization (FISH). However, the potential impact of EUS-HG on surgical candidacy in cases with resectable disease remains unknown.

Stretching single fibrin fibers hampers their lysis.

Unlabelled: Blood clots, whose main structural component is a mesh of microscopic fibrin fibers, experience mechanical strain from blood flow, clot retraction and interactions with platelets and other cells. We developed a transparent, striated and highly stretchable substrate made from fugitive glue (a styrenic block copolymer) to investigate how mechanical strain affects lysis of single, suspended fibrin fibers. In this suspended fiber assay, lysis manifested itself by fiber elongation, thickening (disassembly), fraying and collapse.