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Revising, Testing, and Evaluating Current Training Modules with Direct Instruction to Enhance Ambulatory Orders Communication
No full textIntroduction and Context
Effective computerized provider order entry (CPOE) and orders communication are critical to safe, efficient care in ambulatory settings. Following an electronic health record (EHR) merger at Advocate Health, inconsistencies and knowledge gaps were identified, posing risks to patient safety and team workflows. This innovation addresses those gaps by redesigning training to support consistent, technology-enabled care delivery.
Implementation Strategy
Using cognitive learning theory and direct instruction, existing CPOE training modules were revised to enhance clarity, relevance, and retention. Content was aligned with nursing workflows and integrated into Advocate Health’s online learning platform for system-wide accessibility. Real-world scenarios and interprofessional considerations were incorporated to promote practical application and standardization.
Outcomes and Impact
Pre- and post-assessments measured knowledge gains and confidence in order entry processes. Preliminary results show improved comprehension, fewer workflow errors, and greater consistency across teams. These outcomes contribute to safer patient care and reduced variability in practice.
Insights
The project underscores the value of structured, theory-based education in supporting clinical excellence. Feedback indicates increased engagement, reduced training-related confusion, and better alignment with frontline needs—especially for nursing and care coordination roles.
Implications
This scalable innovation offers a sustainable model for improving technology-driven processes through targeted education. As Advocate Health continues to integrate systems and redesign care, the approach demonstrates how nursing-led initiatives can enhance patient safety, optimize workflows, and drive organizational improvement
Enhancing Patient Experience Through Virtual Nursing Assessments in Hospital at Home
No full textThe expansion of home-based care has reshaped holistic healthcare delivery. Atrium’s Hospital at Home program explored the role of nurses in virtual assessments, highlighting the potential of remote evaluations to improve outcomes. Research supports this approach: “Patients receiving acute, virtual, home care with remote monitoring… had markedly shorter hospital stays than patients receiving standard inpatient care, with no significant increase in mortality, ED revisits, or return hospitalizations” (Banerjee et al., 2024).
In March 2025, a pilot initiative launched to develop a workflow enabling nurses to conduct effective virtual assessments, aiming to enhance NRC Patient Experience Scores through more comprehensive care plans. Formal assessments began April 1, 2025, with 30% of a nurse’s caseload requiring virtual assessments based on acuity and readmission risk. This follows a phased rollout: 60% by May 1, and full implementation by June 1.
Initial results showed an NRC Likelihood to Recommend score of 78.6% (benchmark 88.5%; target 90%), Information on Symptoms Provided at 56.3% (benchmark 67.7%), and Care Provider Explained Things at 60.2% (benchmark 63.9%). Outcomes by the end of June are expected to show improved access, satisfaction, and patient engagement. Strong communication is noted to foster trust and satisfaction: “Good communication with providers results in patients feeling a more personal connection… leading to the greatest influence on patient satisfaction” (Wilson, 2002 as cited in Maniaci et al., 2022).
Challenges such as tech barriers, digital literacy, and compliance concerns emerged. Nurses stressed the need for communication training, tech support, and organizational backing.
As care shifts to hybrid models, nurses are key to ensuring quality, patient-centered care. “Telehealth empowers nurses to monitor, educate, and engage patients, promoting self-care and reducing hospitalizations” (Koh et al., 2016 as cited in Kwok et al., 2022)
Navigating the Aftermath: Evaluating the Impact of COVID-19 on Nurse Well-Being Resource Use
No full textObesity-related glomerulopathy, a growing kidney burden in the obesity pandemic
No full textObesity can cause the progression of kidney disease through hemodynamic, structural, and metabolic changes, and predispose individuals to arterio-nephrosclerosis, diabetic nephropathy, and focal segmental glomerulosclerosis (FSGS), leading to chronic kidney disease (CKD). Obesity-Related Glomerulopathy (ORG) is defined as clinical obesity and biopsy-proven glomerulomegaly with or without the existence of FSGS. However, pathologic changes of ORG are not pathognomonic or specific. Glomerular hypertrophy, maladaptive segmental glomerulosclerosis, as well as in some cases diabetic-like changes may be seen secondary to any cause of acquired or congenital reduced nephron mass with compensatory hypertrophy as well as glomerular hypoxia. This review aims to provide a comprehensive overview of the mechanisms causing ORG and explore current diagnostic challenges and therapeutic strategies, emphasizing the role of weight management and emerging targeted therapies
Acute febrile neutrophilic dermatosis in the setting of pembrolizumab in a patient with nonsmall cell lung cancer
No full textSweet syndrome, or acute febrile neutrophilic dermatosis is an inflammatory condition that may be idiopathic, paraneoplastic, parainflammatory, or drug associated. Recently, immune checkpoint inhibitors have been implicated in Sweet syndrome. Herein, we describe a patient with nonsmall cell lung cancer who developed Sweet syndrome in the setting of the immune checkpoint inhibitor, pembrolizumab. We also include a discussion of current literature of immune checkpoint inhibitors-induced Sweet syndrome and the histopathologic differential diagnosis of Sweet syndrome
EMBOLISE randomized surgical trial for subdural hematoma: Clinical benefits beyond reoperation with middle meningeal artery embolization
No full textBackground: Randomized clinical trials have demonstrated that middle meningeal artery embolization (MMAe) reduces reoperation rates in surgically treated patients with subacute/chronic subdural hematoma (SDH). The effect of embolization on outcomes beyond reoperation remains to be determined. We analyzed the impact of reoperation and healthcare encounters among patients enrolled in the EMBOLISE trial.
Methods: Symptomatic subacute/chronic SDH patients were randomized to surgical evacuation alone (control) or surgical evacuation plus Onyx MMAe (treatment). Changes in modified Rankin Scale (mRS) scores, frequency of unscheduled follow-up visits, and radiographic evolution of hematomas in patients with versus without reoperation were analyzed.
Results: A total of 197 patients were randomly assigned to the treatment group and 203 to the control group. Patients who required reoperation compared with those who did not exhibited a ~threefold higher incidence of mRS \u3e2 (37.0% vs 12.9%, P=0.0025) and an ~2.5 fold increase in mRS worsening (22.2% vs 9.5%, P=0.0503) at 180 days. In patients who did not receive MMAe, there was a ~threefold fold increase in rate of SDH recurrence/progression even among those who did not require reoperation (14.3% vs 5.3%, P=0.0045) and a ~twofold increase in unscheduled physician follow-up visits (27.1% vs 14.7%, P=0.0031).
Conclusion: Among patients with symptomatic subacute/chronic SDH, reoperation was associated with increased rates of mRS worsening and higher mRS scores at follow-up. Adjunctive Onyx MMAe resulted in lower rates of hematoma recurrence/progression and fewer unscheduled physician follow-up visits. Thus, in addition to reducing surgical reoperation rates, adjunctive MMAe led to improved clinical outcomes and reduced healthcare encounters
Abstract 4357581: Prophylactic left atrial appendage occlusion during mitral valve repair in patients without atrial fibrillation: A meta-analysis with reconstructed time-to-event data
No full textNationwide patterns of cardiac-related mortality in amyloidosis cases: An epidemiologic study
No full textIntroduction: Cardiac amyloidosis is frequently overlooked, leading to delayed diagnosis and underestimation of its true impact on cardiac mortality.
Methods: Using CDC WONDER (1999-2020), we identified U.S. decedents aged ≥ 25 years with amyloidosis (ICD-10 E85) as the underlying cause of death and at least one cardiac-related condition as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and trends were analyzed using Joinpoint regression and autoregressive integrated moving average (ARIMA) forecasting through 2040.
Results: Among 16,673 deaths, the AAMR rose from 0.261 in 1999 to 0.608 in 2020, with inflection points in 2012 and 2017 and an overall annual increase of 3.96%. Mortality was higher in men (0.537 vs. 0.210) and Black individuals (0.83 vs. 0.32), with a sharp post-2017 rise, especially among Black decedents. Geographic disparities were also observed, with the highest rates in the Northeast and urban areas. Most deaths occurred in hospitals (43.2%) or at home (31.4%), and mortality rates peaked in those aged 85 and older. Forecasting models project continued increases in AAMR through 2040, reaching approximately 2.0 overall, with especially elevated rates among Black (≈ 5.9) and male (≈ 3.8) decedents.
Conclusion: Cardiac mortality in amyloidosis has risen sharply since 2017, likely driven by improved ATTR-CM detection through non-biopsy imaging and guideline adoption. Disparities by sex, race, and geography persist, reflecting uneven diagnostic capacity concentrated in urban and Northeastern centers. Forecasts project continued increases, particularly among Black and male individuals, underscoring the need for more equitable access to diagnosis and treatment
Anesthesia for a patient with angelman syndrome undergoing dental rehabilitation
No full textIntroduction: Angelman syndrome (AS) is a rare genetic disorder with a prevalence of 1:52,000 live births. It is characterized by severe developmental disability, craniofacial abnormalities, ataxia, seizures, sleep disturbances, hand flapping, and frequent laughing and smiling. It is mostly caused by a maternal deletion of the ubiquitin-protein ligase gene in chromosome 15. This deletion also affects the gamma-aminobutyric acid (GABA) (A) β3 subunit gene which contributes to the high rate of epilepsy seen in these patients. Due to the rarity of AS, there are no large studies to address whether these patients may have specific anesthetic complications. Case Presentation: A 20-year-old female with a history of AS, morbid obesity (159 cm, 106 kg), and severe intellectual disability was presented for dental rehabilitation under General Anesthesia. Her parents denied any history of seizures. The patient verbalized minimally and was un-cooperative. The physical exam was notable for an enlarged tongue and mandibular prognathism. Initial heart rate was around 75 /minute, arterial blood pressure 120/70 mmHg and SpO2 99%. She was premedicated with intramuscular ketamine 300 mg and midazolam 5 mg and transferred to the operating room after 30 minutes. Intravenous access was established, and intravenous induction of anesthesia was made with propofol 100 mg, fentanyl 50 mcg, lidocaine 100 mg, and rocuronium 50 mg. Mask ventilation was easy, and SpO2 was above 97%. Nasal Endotracheal intubation was easily performed under direct laryngoscopy revealing a Cormack - Lehane Grade I. Immediately after intubation, the heart rate dropped to 35 /minute, Glycopyrrolate 0.4 mg IV was given with a return of the heart rate to baseline in 1 minute. Maintenance of anesthesia was achieved with sevoflurane in an air–oxygen mixture. The surgery lasted for 5 hours and was uneventful, she did not experience any other episodes of bradycardia. The muscle relaxant was reversed with neostigmine and glycopyrrolate, and the patient was smoothly extubated and transferred to the postoperative care unit where she had an uneventful course. She was discharged home the same day. Conclusion: Patients with Angelman syndrome tolerate anesthesia well. Anesthetic considerations include possible difficult airway secondary to craniofacial abnormalities, intellectual disability, cheerful disposition which may confound pain perception, epilepsy, muscular atrophy, vagal tone predominance predisposing to bradycardia, and GABA-A receptor abnormalities which may lead to unpredictable response to benzodiazepines. Patients may benefit from premedication with an anticholinergic to blunt the high vagal tone. 1. Warner, M. E. et al. (2017) Anesth Pain Med 7(5) : e57826 2. Makris, A. et al. (2018) J Clin Anesth 46: 65-6