Optimizing obstetric venous thromboembolism protocol adherence: The experience of a hospital system.

The purpose of this review is to explore the role of hospital systems in reliably providing high quality obstetric venous thromboembolism (VTE) prophylaxis focusing on the example of the Kaiser Permanente Southern California hospital system. While providers ultimately administer thromboprophylaxis on a patient-by-patient basis, hospital-level protocols, practices, and resources may be the most important determinants of whether a patient receives appropriate care. In comparison to the complex maternal and fetal emergencies that obstetricians are routinely called on to manage, VTE prophylaxis can often be simplified and integrated into the workflow, making decision-making time efficient and straightforward for the provider.

Putting the "M" back in maternal-fetal medicine: A 5-year report card on a collaborative effort to address maternal morbidity and mortality in the United States.

The Centers for Disease Control and Prevention have demonstrated continuous increased risk for maternal mortality and severe morbidity with racial disparities among non-Hispanic black women an important contributing factor. More than 50,000 women experienced severe maternal morbidity in 2014, with a mortality rate of 18.0 per 100,000, higher than in many other developed countries.

Factors That Influence Selectionof Urinary Diversion Among Bladder Cancer Patients in 3 Community-based Integrated Health Care Systems.

Objective: To assess the relative contributions of patient and surgeon factors for predicting selection of ileal conduit (IC), neobladder (NB), or continent pouch (CP) urinary diversions (UD) for patients diagnosed with muscle-invasive/high-risk nonmuscle invasive bladder cancer. This information is needed to enhance research comparing cancer survivors' outcomes across different surgical treatment options.

Methods: Bladder cancer patients' age ≥21 years with cystectomy/UD performed from January 2010 to June 2015 in 3 Kaiser Permanente regions were included.

Effect of a region-wide incorporation of an algorithm based on the 2012 international consensus guideline on the practice pattern for the management of pancreatic cystic neoplasms in an integrated health system.

Aim: To examine the practice pattern in Kaiser Permanente Southern California (KPSC), ., gastroenterology (GI)/surgery referrals and endoscopic ultrasound (EUS), for pancreatic cystic neoplasms (PCNs) after the region-wide dissemination of the PCN management algorithm.

Methods: Retrospective review was performed; patients with PCN diagnosis given between April 2012 and April 2015 (18 mo before and after the publication of the algorithm) in KPSC (integrated health system with 15 hospitals and 202 medical offices in Southern California) were identified.

A novel mutation in the proopiomelanocortin (POMC) gene of a Hispanic child: metformin treatment shows a beneficial impact on the body mass index.

Background Proopiomelanocortin (POMC) is a complex polypeptide that produces a variety of biologically active substances via cleavage in a tissue-specific manner [Challis BG, Millington GW. Proopiomelanocortin deficiency. GeneReviews® [Internet].

Leukocytoclastic vasculitis presenting in association with Coxiella burnetii (Q fever): A case report.

Q fever caused by Coxiella burnetii usually presents asymptomatically or as an undifferentiated febrile disease and rarely as rash or other cutaneous manifestations of the disease. Here we present a 41-year-old male complaining of body ache, fever, nausea, malaise, bilateral knee pain and vomiting. Clinical examination revealed a notable erythematous blanching rash all over his body.

National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism.

National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism.

Merkel cell carcinoma of unknown primary with lymph node and mesenteric metastasis involving the pancreas and duodenum.

Merkel cell carcinoma (MCC) of skin is a rare, aggressive cutaneous malignancy of neuroendocrine origin. MCC predominantly affects elderly Caucasians and has high predilection for sun exposed areas. Histologic exam and immunohistochemical profile is required to establish the diagnosis.

The Painful Total Knee Arthroplasty.

There are many causes of residual pain after total knee arthroplasty (TKA). Evaluation and management begins with a comprehensive history and physical examination, followed by radiographic evaluation of the replaced and adjacent joints, as well as previous films of the replaced joint. Further workup includes laboratory analysis, along with a synovial fluid aspirate to evaluate the white blood cell count with differential as well as culture.

Contemporary changes with the use of facial nerve monitoring in chronic ear surgery.

Objective: There is a growing trend for the routine use of the facial nerve monitor (FNM) in chronic ear surgery. We aimed to examine current patterns in the use of FNMs in chronic ear surgery.

Study Design: Descriptive design (survey).

Effect of direct physician involvement on tobacco abstinence rates and other variables affecting participants of a freedom from tobacco class.

Context: Kaiser Permanente measures how often tobacco users are offered strategies to quit but not the success of such strategies.

Objective: To compare tobacco abstinence rates for participants of the Kaiser Permanente Riverside (California) Medical Center's Freedom from Tobacco Class in 2008, before direct physician involvement, and in 2009, after direct physician involvement, and to compare other variables affecting these rates.

Design: In a retrospective study, participants were divided into two groups based on year of participation.

Departmental role and scope in infection control: use of a template that meets Joint Commission requirements.

Since its inception in 1990, departmental role and scope in the infection control program have developed into the five important aspects currently defined by the Joint Commission. Each health care worker needs to understand his or her role in infection prevention and control, integrate it into daily activities, and articulate this role to others. This strategy for complying with Joint Commission standards meets customer needs and can easily be adapted for use in other medical centers.