Outcomes of a Multisite Mentored Implementation Approach to Promoting Goals of Care Conversations.

Context: The Preference-Aligned Communication and Treatment (PACT) Project is a multisite quality improvement effort that has been shown to increase the frequency of goals of care (GOC) conversations in hospitalized patients with serious illness.

Objectives: To evaluate the effect of PACT on goal-discordant care and resource utilization.

Methods: Hospitals enrolled in a multiyear mentored implementation quality improvement initiative to facilitate GOC conversations for seriously ill hospitalized patients.

The PACT Project: Feasibility of a Multidisciplinary, Multi-Faceted Intervention to Promote Goals of Care Conversations.

Background: Patients living with serious illness generally want their physicians to facilitate Goals of Care conversations (GoCc), yet physicians may lack time and skills to engage in these conversations in the outpatient setting. The problem may be addressed by supporting multiple members of the clinical team to facilitate GoCc with the patient while admitted to the hospital.

Methods: A multi-modal training and mentored implementation program was developed.

Decreased Leak Rate and Need for Reintervention with Use of Closed Suction Calibration System: a Bariatric Surgery Quality Improvement Project.

Background: Laparoscopic sleeve gastrectomy (SG) continues to grow in popularity as a primary bariatric procedure. The purpose of this study is to determine if leak rates and need for subsequent interventions are changed by the standardized use of a closed suction calibration system (CSCS) at a high-volume urban hospital.

Methods: A retrospective review was conducted between January 1, 2016, and December 31, 2018, on SG patients.

RETINAL TOXICITY FOLLOWING PRESUMED INADVERTENT INTRAOCULAR INJECTION OF MITOMYCIN C DURING TRABECULECTOMY.

Purpose: To describe a case of postoperative retinal toxicity following the use of mitomycin C during a routine trabeculectomy.

Methods: Case report of a single patient who underwent complete ophthalmic examination and multimodal imaging, including color fundus photos, optical coherence tomography, fundus autofluorescence, and fluorescein angiography. The study was declared exempt by the Institutional Review Board of Northwestern University.

Evaluation of Opioid Prescribing Patterns and Drivers of Variation Following Endoscopic Procedures for Benign Prostatic Hyperplasia Across an Integrated Academic Health System.

Objectives: To evaluate patient, provider, and facility factors associated with variation in opioid prescribing after endoscopic procedures for benign prostatic hyperplasia across a large academic health system to drive improvement efforts.

Methods: Opioids prescribed at discharge for patients who underwent an endoscopic prostate procedure March 2018-November 2019 were analyzed. Multivariable logistic and linear regression were used to evaluate the relationship between patient, provider, and facility factors and the receipt of any opioid prescription and the quantity prescribed.

Benefit of systematic selection of pairs of cases matched by surgical specialty for surveillance of bacterial transmission in operating rooms.

Background: Bacterial transmission within and between successive surgical cases occurs in operating rooms (ORs), often includes anesthesia equipment as a reservoir, and can be monitored by collecting samples and identifying bacteria by genetic testing. We evaluated how to choose cases for active surveillance to quantify the effectiveness of interventions in 2 groups of ORs (eg, rooms with germicidal lighting vs those without).

Methods: Data were from a 7 OR single-specialty gastrointestinal endoscopy suite and from a typical 8 OR multispecialty surgical suite.

Linezolid-induced photoreceptor dysfunction masquerading as autoimmune retinopathy.

Purpose: To report a case of linezolid-induced reversible retinopathy.

Methods: Case report with literature review.

Results: Clinical examination and imaging are presented over a 7-month interval, from initial presentation to subsequent follow-up (6 months after discontinuation of linezolid).

Citrobacter rodentium Induces Tissue-Resident Memory CD4 T Cells.

Tissue-resident memory T cells (T cells) are a novel population of tissue-restricted antigen-specific T cells. T cells are induced by pathogens and promote host defense against secondary infections. Although T cells cannot be detected in circulation, they are the major memory CD4 and CD8 T-cell population in tissues in mice and humans.

Faculty Communication Knowledge, Attitudes, and Skills Around Chronic Non-Malignant Pain Improve with Online Training.

Objective: Many physicians struggle to communicate with patients with chronic, non-malignant pain (CNMP). Through the use of a Web module, the authors aimed to improve faculty participants' communication skills knowledge and confidence, use of skills in clinical practice, and actual communication skills.

Subjects: The module was implemented for faculty development among clinician-educators with university faculty appointments, outpatient clinical practices, and teaching roles.

Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database.

Purpose: To evaluate locoregional recurrence (LRR) after mastectomy and impact of postmastectomy radiation (PMRT) by breast cancer subtype.

Methods And Materials: Between 2000 and 2009, 5673 patients with stage I to III breast carcinoma underwent mastectomy and nodal evaluation; 30% received PMRT. Isolated LRR (iLRR) and LRR were compared across groups defined by biological subtype and receipt of trastuzumab: luminal A (estrogen [ER]/progesterone [PR]+, HER2-, low/intermediate grade), luminal B (ER/PR+, HER2-, high grade), HER2 with trastuzumab, HER2 without trastuzumab, and triple negative (TN; ER-, PR-, HER2-).

Gender differences in achieving optimal lipid goals in patients with coronary artery disease.

To investigate gender differences in lipid goal attainment, we conducted a retrospective analysis of outpatient electronic health records from a large cardiology practice from September 2008 to September 2009. The most recent lipid profile and lipid-lowering medications and doses were extracted from electronic medical record. We identified 9,950 patients with coronary artery disease of whom 3,366 (34%) were women.

University of Michigan Comprehensive Cancer Center opportunities for improvement project.

The University of Michigan Comprehensive Cancer Center (UMCCC) Opportunities for Improvement project involved a detailed patient-level medical record review, feedback to medical providers and clinical leadership, and discussion of potential predictors of discordant or delayed care. The medical record review revealed that reasons for discordant or delayed care were well documented by clinical providers, and medical comorbidity was the most common predisposing factor. Another common theme was the difficulty in obtaining treatment records for patients who received a portion of their care outside UMCCC.

Implementing distress management guidelines in ambulatory oncology: a quality improvement project.

Distress assessment and referral to psychosocial services is an essential component of evidence-based oncologic nursing care. Oncology nurses have an opportunity to address patient distress needs through leadership of implementation programs and support for the positive outcomes that engaging in psychosocial services provides. This quality improvement project was conducted to evaluate the feasibility and utility of the National Comprehensive Cancer Network's distress management clinical practice guidelines in ambulatory oncology.

Empowering staff nurses to use research to change practice for safe patient handling.

Although evidence supports safe patient handling practices, nurses are not always involved in the process of evaluating and selecting lifting equipment. This study used a descriptive design to: (1) assess staff's perceived barriers and attitudes toward safe patient handling, (2) identify staff needs for equipment and education concerning safe patient handling, and (3) involve staff in the equipment selection process before implementing a safe patient handling program. Overall, staff on all units indicated that they wanted more equipment and education.

Percutaneous repair of a nonunion pubic ramus fracture using a metallic stent scaffold and cement osteoplasty.

This report describes a case of repair of a nonunion pubic ramus fracture with intramedullary placement of a self-expanding nitinol stent across a fracture gap to provide a permeable scaffold for polymethylmethacrylate (PMMA) cement to track across the fracture gap and to restrict leakage into surrounding soft tissues. The patient presented with an 8-month history of pelvic pain and debility. His pain remains resolved after 14 months.