Meeting the Center for Medicare & Medicaid Services requirements for quality assessment and performance improvement: a model for hospitals.

The Quality Assessment and Performance Improvement (QAPI) model seeks to improve the structures and processes of delivering healthcare to gain better outcomes in patient care. The goal of the model described in this article is to create an integrated approach for hospitals to meet the Center for Medicare & Medicaid Services (CMS) quality requirements. This article describes the results of this data-driven QAPI method via utilization of this model and its processes.

Discussing life-sustaining treatments: an overview and communications guide for primary care physicians.

Physicians must be skilled communicators with patients, families, and multidisciplinary health care teams to meet ethical decision-making challenges arising in end-stage disease care. We offer practical suggestions for collaborative communication in the "perfect storm" of contemporary critical care settings.

Delayed-onset cerebral arterial gas embolism in a commercial airline mechanic.

A commercial airline mechanic was evaluated for right-sided hemianesthesia. Thorough diagnostic testing failed to identify a definitive etiology, and the mechanic was assessed as having symptoms of a left internal capsule lesion, likely from an ischemic event. On day 12 after symptom onset, he consulted a diving medicine specialist for clearance to continue recreational scuba diving.

Caring for the patient with Alzheimer's Disease.

Treating the patient with Alzheimer's disease requires compassion and creativity. Polly Zimmermann and Anna Ortigara outline some inventive care strategies.

Teddy says "Hi!": Teddy bear clinics revisited.

Teddy bear/doll clinics continue to offer a feasible, effective opportunity to reach the community's children and their health information needs. Many thanks to Sunny B. Lee, RN, BS (Swedish Covenant Hospital, Chicago), and Kathy Powell, RN, PhD, and Barb Pierce, RN, MS (Children's Hospital, Birmingham).

Hypnosis and the treatment of Huntington's disease.

Huntington's Disease is an inherited fatal disorder of the central nervous system. Literature on the hypnotic treatment of this disease is extremely sparse. We treated two patients with Huntington's Disease using a wide variety of hypnotic interventions.

Fine needle aspiration cytologic diagnosis of focal intrahepatic extramedullary hematopoiesis.

A computed tomographic scan in an 80-year-old man with a urinary obstruction demonstrated a solitary space-occupying liver lesion, which was clinically suspected to be a metastatic carcinoma. Fine needle aspiration (FNA) of the mass produced a smear containing atypical, possibly malignant, cells. Correlation of the FNA findings with the patient's history resulted in a cytologic diagnosis of an intrahepatic focus of extramedullary hematopoiesis (EMH).