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Colors of Life, 2025, close-up
No full textArtist(s): Miranda Ruiz
Materials: Plastic, glass, wood
This piece is a glass pane decorated with pieces of recycled plastic (laundry detergent lids, plastic placemats, a clipboard, clear plastic folders, and a plastic pencil container) to imitate the effect of stained glass and mosaic. The center of the piece is a mosaic of the before mentioned recycled plastic that creates the MD Anderson logo. The glass pane is affixed into a wooden frame with glue and is able to be hung with a metal wire. The recycled materials were sourced from the Texas Art Asylum, an art supply store that sells recycled materials to use in creative ways.https://openworks.mdanderson.org/recycledart2025/1079/thumbnail.jp
Colors of Life, 2025
No full textArtist(s): Miranda Ruiz
Materials: Plastic, glass, wood
This piece is a glass pane decorated with pieces of recycled plastic (laundry detergent lids, plastic placemats, a clipboard, clear plastic folders, and a plastic pencil container) to imitate the effect of stained glass and mosaic. The center of the piece is a mosaic of the before mentioned recycled plastic that creates the MD Anderson logo. The glass pane is affixed into a wooden frame with glue and is able to be hung with a metal wire. The recycled materials were sourced from the Texas Art Asylum, an art supply store that sells recycled materials to use in creative ways.https://openworks.mdanderson.org/recycledart2025/1078/thumbnail.jp
出入口 (deiriguchi; exit and entrance), close-up
No full textArtist(s): Anthony Romo
Materials: Mixed media
During a recent vacation to Japan, the lack of public trash cans in Tokyo meant I had to carry my trash usually until I got back to my hotel for disposal. The quantity of material I brought back to the hotel daily was surprising, so I collected most of my receipts, ticket stubs, and other paper and plastic packaging. This collage became a meditation on the flow of trash into and out of my life and was born of reflection on how much recyclable material I dispose of. The kanji in the center of the piece designate an exit and entrance, i.e., one passage for both, and are used to depict this dynamic flow. The collage is composed solely of material I brought back from Japan and includes receipts, ticket stubs, shopping bags, napkins, paper bibs, stickers, flyers, newspaper, product labels, theme park wristbands, wrapping paper, paper fans, candy wrappers, gacha prize decals, ribbon, price tags, and street food packaging.https://openworks.mdanderson.org/recycledart2025/1057/thumbnail.jp
Dilbert the Armadillo, 2025
No full textArtist(s): Kayla Reyes
Materials: Cardboard, newspaper, glue
Sculpture and paper mache techniques using cardboard, newspaper and glue.https://openworks.mdanderson.org/recycledart2025/1043/thumbnail.jp
Childhood Memories, 2025, flowers
No full textArtist(s): Camila Xavier
Materials: Plastic, paper, foil
This canvas set is designed using recycled materials typically left over after birthday parties—plastic cups and plates, napkins, foil, and pieces of used gift wrapping paper. The scene depicts a child\u27s playful day in Hermann Park.https://openworks.mdanderson.org/recycledart2025/1035/thumbnail.jp
Reducing the Percentage of Intubation Time on Continuous Infusion Midazolam
Get PDFThis quality improvement study was conducted at a comprehensive cancer care center with the aim to decrease the percentage of on continuous infusion (CI) midazolam by 30% by May 5, 2023. The pre-intervention and post-intervention data collection phases occurred from January 1, 2022, to October 31, 2022, and March 7, 2023, to May 5, 2023, respectively. Sedation was assessed utilizing the Richmond Agitation and Sedation Scale (RASS), and delirium was assessed utilizing the Intensive Care Delirium Screening Checklist (ICDSC). A sedation pathway and associated educational materials were developed by a multidisciplinary team and frontline staff. Interventions in the sedation pathway included prioritization of analgesics and non-benzodiazepine sedatives or intermittent lorazepam following intubation and incorporation of a provider time-out 4 hours after the start of CI midazolam. Secondary endpoints were the percentage of RASS within target range, percentage of ICDSC greater than or equal to 4, number of days to positive ICDSC, percentage of inappropriate titrations, and total number of benzodiazepine infusions. A total of 59 patients were included for analysis, with 39 in the pre-intervention group and 20 in the post-intervention group. The percentage of intubation time on CI midazolam decreased from 76% to 59% in the post-intervention group (P = .545). The time within intended RASS range improved by 45% in the post-intervention group (P \u3c .0001), which was driven primarily by reduction in the percentage of RASS \u3c -1. The percentage of inappropriate titrations was reduced from 30% to 22%; these included inappropriate up and down titrations of CI midazolam and omissions of a midazolam bolus when warranted. Generation of an interdisciplinary algorithm helped to reduce intubation time on CI midazolam in critically ill patients. Time spent within the targeted RASS range and adherence to the sedation order set improved, and the number of days to positive ICDSC following intubation was reduced. Future studies should evaluate an extended follow-up period to determine the full effect of the sedation algorithm’s implementation on clinical practice
Persistent Improvement in Opioid Perceptions and Prescribing for Cancer Surgery: 5-Year Follow-Up
Get PDFBackground and Objectives
We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.
Methods
Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement and implementation studies, as well as integration of opioid stewardship measures into usual clinical care. Providers’ perceptions of expected pain scores, opioid requirements, and ideal prescribing habits were assessed with the same survey administered at 1-month (2018) and 1-year post-initial education (2019).
Results
Eighty-seven of 162 (53.7%) providers responded to the follow-up survey. More providers expressed strong agreement with the statement, “After an inpatient procedure, a patient who has not required opioids for 24 hours before discharge should not receive a discharge opioid prescription.” Significant decreases in the number of opioid pills providers would prescribe at discharge for five sample operations were also observed between 2018-2023. Stepwise decreases in opioid volume prescribed in both inpatient and outpatient settings were reported since the initial 2018 education sessions.
Conclusions
Dedicated department-wide opioid education, ongoing quality improvement and prospective evaluation, and integration of opioid stewardship into clinical practice were associated with sustained improvement over five years in perceptions of postoperative pain management and decreased discharge opioid prescription recommendations.
Keywords: narcotic, pain, cancer surgery, quality improvement, education, prescriptio
5x-Multiplier vs 3-Tier Model for Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery: Randomized Clinical Trial Protocol
Get PDFBackground
Surgeons provide up to 10% of total opioid prescriptions across all specialties, and more than one-third of surgeon-prescribed medications are opioids. Patient-reported opioid consumption and risk of persistent opioid use beyond the postoperative recovery period correlate with the initial opioid quantity prescribed at discharge. Interventions to reduce postoperative opioid prescribing have demonstrated no adverse effects on pain control or increased need for prescription refill; however, in the absence of standardized prescription protocols, opioid prescribing practices vary widely.
Objective
The study objective is to identify the opioid prescribing model that provides the lowest oral morphine equivalents (OME) volume prescribed at discharge and OME consumed in the 14 days after discharge, with no adverse effect on refills and patient quality of life or satisfaction.
Methods and Analysis
This is a pragmatic single-center, multispecialty, double-arm phase II randomized clinical trial of two discharge opioid prescribing models. All adult (≥18 years) patients who undergo any one of five open abdominal oncologic operations (pancreatectomy, hepatectomy, retroperitoneal sarcoma resection, nephrectomy, or cytoreductive surgery for ovarian cancer) with curative intent and have a planned postoperative inpatient stay of at least 48 hours will be eligible. Patients will be stratified by their managing clinical service and randomized to receive a discharge opioid prescription based on either the 5x-multiplier algorithm or the 3-tier model. The co-primary outcomes are initial discharge OME volume and OME consumption in the 14 days after hospital discharge. Secondary outcomes include rates of patients with zero OME at discharge; rates of refill requests and completions, number of unused or leftover pills, persistent opioid use, and patient-reported quality-of-life metrics at various follow-up times; patient, prescriber, and oncologic factors predictive of persistent opioid use; and patient satisfaction. Each co-primary endpoint will be analyzed using two-sample t-test to compare means and linear regression models to assess differences between the two arms.
Ethics and Dissemination
This study was approved by the Institutional Review Board of The University of Texas MD Anderson Cancer Center (2023-0818). The study will evaluate the difference in initial discharge OME volume and in 14-day post-discharge OME consumption between two discharge opioid prescribing models. Upon completion of the data collection and analyses, a manuscript describing the study results will be submitted to a peer-reviewed journal for publication and dissemination. Trial Registration Number: NCT06232577.
Keywords: narcotics, oncologic surgery, prescribing model, pragmati
AI-Enabled Systems in Medical Imaging: Regulatory Pathways and Innovations
Get PDFJune 4, 2025
Kyle J. Myers, PhDPuente Solutions LLC Fellow, Hagler Institute of Advanced Studies, Biomedical Engineering at Texas A&M Universityhttps://openworks.mdanderson.org/igct_seminars/1022/thumbnail.jp
Evaluating the Effects On Surface Skin Dose When Using Linen During Pelvic Radiation Therapy
No full texthttps://openworks.mdanderson.org/rmps25/1009/thumbnail.jp