Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center.

Background: Delays in first cases contribute to multiple operating room (OR) inefficiencies and decreases in OR productivity.

Methods: Lean process improvement methods were used to redesign the existing workflow for elective first cases of the day in a large, urban, public hospital. First case start times were prospectively recorded from May 2, 2016 through December 29, 2017.

Early Seizure Prophylaxis in Traumatic Brain Injuries Revisited: A Prospective Observational Study.

Introduction: Pharmacological prophylaxis for early seizures following traumatic brain injury (TBI) is a recommendation in the Brain Trauma Foundation Guidelines. However, several studies have challenged the efficacy and safety of this practice, resulting in varied practice across centers around the world. The purpose of the present study was to compare the incidence of early clinical seizures following TBI, between two large centers, a US Center that practises routine seizure prophylaxis and a Chinese Center that does not use seizure prophylaxis following TBI.

Advice for my chief resident.

I have been privileged to have served as a division of rheumatology chief and/or program director for 18 years and as a department of medicine chair and medicine residency program director for another 22 years. During the latter, I collected and codified advice for my chief residents. Selected highlights are presented as follows.

How to Pitch an Antibiotic Stewardship Program to the Hospital C-Suite.

Hospitals will soon require antibiotic stewardship programs. Infectious diseases specialists must craft business plans to engage hospital leadership to fund such programs. In this article, we review key cost and revenue elements that should be covered in such plans.

Kidney retransplantation in children following rejection and recurrent disease.

Retransplantation accounts for approximately 15 % of the annual transplants performed in the USA, and in the recent International Collaborative Transplant Study report on pediatric patients 15.2 % of the 9209 patients included in the report were retransplant recipients. Although the significant advances in clinical management and newer immunosuppressive agents have had a significant impact on improving short-term allograft function, it is apparent that long-term allograft function remains suboptimal.

Painful ophthalmoplegia of the right eye in a 20-year-old man.

Background: Painful ophthalmoplegia is an infrequent but very important presentation in the acute care setting and requires a thorough neurologic evaluation to determine its cause. This clinical sign has a large differential and generally indicates a serious cerebrovascular process.

Case Report: We describe a patient with a subacute presentation of painful ophthalmoplegia, ultimately diagnosed as Tolosa-Hunt syndrome, a rare inflammatory process of the cavernous sinus.

Invasive and noninvasive hemodynamic monitoring of patients with cerebrovascular accidents.

Seventeen patients with hemodynamic instability from acute cerebrovascular accidents were evaluated shortly after arrival at the emergency department of a university-run county hospital with both invasive Swan-Ganz pulmonary artery catheter placement and a new, noninvasive, thoracic electrical bioimpedance device. Values were recorded and temporal patterns of survivors and nonsurvivors were described. Cardiac indices obtained simultaneously by the 2 techniques were compared.

A review of donor alanine aminotransferase testing. Implications for the blood donor and practitioner.

To reduce the incidence of post-transfusion non-A, non-B hepatitis, the American Association of Blood Banks has required that serum alanine aminotransferase activity be used to screen blood donors. Consequently, approximately 2% to 3% of all blood donations will be discarded owing to an elevated alanine aminotransferase level. In addition, approximately 0.