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Healthcare organisations face mounting challenges to maintain financial sustainability given increasing expenses, decreasing reimbursements and changing patient needs. Because of the increasing costs of operating a healthcare institution, it is no longer viable to pursue achieving financial sustainability just by adding more clinical visits and capacity, increasing hospital admission and throughput, performing more surgeries or simply working harder. To address these challenges, healthcare leaders should adopt a culture of continuous process improvement that engages and empowers clinical and operational teams to identify and eliminate waste, optimise revenue and enhance quality and safety. This paper presents a case study of Project ROSE (Revenue Optimization and Supply Enhancement), a project initiated by a community-based integrated health system in the upper Midwest. The goal was to achieve substantial financial savings within one year through revenue optimisation, supply chain improvements and service and maintenance contract enhancements. We describe the vision, goals, methods, results and lessons learned. We also discuss the implications and recommendations for other healthcare institutions that seek to implement similar initiatives that may reduce the burden on their clinical teams and allow them to work smarter, not harder. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.

Background: Sleep-related symptoms are known to influence cardiovascular health (CVH), but the relative importance of sleep duration versus quality remains uncertain. This study evaluates whether a combined measure – “satisfactory sleep health,” incorporating both adequate sleep duration and good sleep quality – better correlates with CVH status in middle-aged and older adults living near the Equator. Methods: In this population-based, cross-sectional study, 1781 middle-aged and older adults living in rural villages of coastal Ecuador were assessed for sleep duration and quality using structured interviews and the Pittsburgh Sleep Quality Index (PSQI). Satisfactory sleep health was defined as 7- to 8 h of sleep plus a PSQI score ≤5 points. CVH status was evaluated using the American Heart Association’s Life’s Simple 7 construct. Multivariate logistic regression models were used to determine the investigated associations, after adjustment for relevant confounders. Results: While adequate sleep duration alone showed no significant association with CVH, good sleep quality, and satisfactory sleep health were inversely associated with poor CVH in unadjusted models. After adjustment for demographics, level of education, and symptoms of depression, satisfactory sleep health was associated with a 21% reduction in the odds of poor CVH status (OR = 0.79; 95% CI = 0.64-0.99; P < 0.05). Conclusions: A combined assessment of sleep duration and quality provides a more robust predictor of CVH than either component alone. These findings support the inclusion of multidimensional sleep metrics in public health frameworks evaluating cardiovascular risk and highlight their potential utility in guiding targeted prevention strategies.

ABSTRACT An electrochemical bandage (e‐bandage) that generates hydrogen peroxide (H 2 O 2 ) through a combination of working, counter and reference electrodes used with an electrolyte‐providing hydrogel is being developed for wound infection management. e‐Bandage biocidal activity was previously demonstrated using Xanthan gum hydrogel. For clinical use, clinically used hydrogels would be ideal, but their use with the described e‐bandage has not been shown. The goal of this work was to evaluate the biocidal activity of off‐the‐shelf, clinically used hydrogels when used with a 1.77 cm 2 H 2 O 2 ‐producing e‐bandage. e‐Bandage electrochemical parameters and activity against methicillin‐resistant Staphylococcus aureus IDRL‐6169 and Acinetobacter baumannii ATCC‐17978 biofilms were assessed with six off‐the‐shelf hydrogels. Variations in hydrogel composition affected electrochemical parameters, which was associated with differences in biocidal activity. Results of this study inform the selection of off‐the‐shelf hydrogels for use with H 2 O 2 ‐producing e‐bandages.

Background and Objectives: There are few trainings for primary care physicians (PCPs) on how to navigate a psychiatric crisis (such as suicidal ideation, homicidal ideation, psychosis, and/or intoxication that impairs decision making capacity) in the outpatient setting. We previously published an approach to fill this gap and now report the results of our efforts to improve the curriculum and assess if confidence was maintained over time. Methods: Four, 1-h didactic sessions on screening and logistically managing patients in need of inpatient or outpatient psychiatric care were created. Objectives were based on the complexities of state law, institutional policy, and expert opinion. All 15 residents in a family residency program participated in the didactic series. Resident confidence to complete all aspects of these scenarios was measured by questionnaire before (Time 1), immediately after (Time 2), and 5 months after completion of the didactic series (Time 3). Results: From Time 1 to Time 3, resident confidence significantly increased for 10/17 (58%) aspects of assessing and managing psychiatric crises (all P < .017). There was no evidence that confidence for any measure decreased from Time 2 to Time 3. Conclusions: The revised curriculum increased family medicine resident confidence to assess and manage outpatient psychiatric crises 5 months after the training was completed.

Background: Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases. Methods: We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ⩽5. The primary outcome measure, END, was defined as a shift of ⩾4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END. Results: Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (adjusted odds ratio [aOR] 2.37, 95% CI 1.12–5.02, p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46, 95% CI 0.26–0.81, p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65, 95% CI 0.69–3.98, p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END. Conclusion: MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.

Objective: Pulmonary air trapping is critical for diagnosing and prognostication of various lung diseases. Expiratory CT imaging serves as an accessible method to assess air trapping, which correlates with small airway disease outcomes. Air trapping manifests as mosaic attenuation on inspiratory chest CT that is difficult for visual estimation. The primary aim of this study was to develop an automated tool to quantify mosaic attenuation on inspiratory CT and air trapping on paired expiratory CT. Secondary aims included comparing CT-derived parameters with PFT measurements and dyspnea scores. Methods: This retrospective analysis of noncontrast chest CTs from 2 academic hospitals was conducted between January 1, 2018, and December 31, 2019. Patients with paired inspiratory and expiratory CT chest scans and PFTs performed on the same day were included. A chest radiologist manually annotated lung parenchyma in a reference cohort. Several histogram-based metrics were computed from lung parenchymal CT values, with the maximum peak position showing the strongest correlation with manually determined thresholds. This threshold, derived from the histogram peak, was applied in the adaptive thresholding process to quantify mosaic attenuation and air trapping. Results: We analyzed 267 patients (65.5% female, median age 68). Most exhibited normal physiological patterns (44.0%). Patients with elevated residual volume (RV) by PFTs (28.1%) had significantly higher inspiratory CT mosaic attenuation (1629.6 vs. 1311.5 mL, P <0.01) and expiratory CT air trapping volumes (1413.7 vs. 886.2 mL, P <0.01). Correlation analyses demonstrated strong relationships between CT-derived mosaic attenuation and air trapping measures and RV. The correlation with PFT parameters was even stronger in subgroup analyses in patients with obstructive PFT patterns. These models had good predictive ability for an abnormal RV (AUC of 0.92, sensitivity of 72.4%, and specificity of 92.0%) and clinical utility based on good correlation with the mMRC dyspnea score ( r =0.71; 95% CI: 0.65-0.77). Conclusions: This automated adaptive thresholding on inspiratory and expiratory chest CT scans showed a high correlation of lung volume and air trapping parameters with PFTs, revealing that measures of lung function have a complex interplay with air trapping.

Objective: The purpose of this study was to evaluate the potential clinical value of spectral CT for image guidance during percutaneous thermal ablation, particularly investigating high monoenergetic (MonoE) for metal artifact reduction. Materials and Methods: A phantom experiment was performed in which an ablation probe was scanned in “continuous CT” (CCT) mode on a spectral CT scanner. ROI measurements quantified metal artifacts for conventional and MonoE CCT images. Subsequently, a retrospective reader study was conducted with 10 patient cases. Three radiologists reviewed cases to select the optimal MonoE setting and perform a Likert score rating (+2: MonoE preferred, −2: conventional preferred). Results: Phantom measurements indicated a reduction in metal artifact for high MonoE (150 keV: −46 HU) relative to conventional CCT (−122 HU). The MonoE setting preference was 151±21 keV. The mean Likert score was 1.2±0.7. Radiologists indicated a perceived benefit of high MonoE CCT when probe placement was near a critical structure. Conclusions: This study indicates a clinical preference for high MonoE CCT compared with conventional CCT. Insofar as spectral CCT can be offered at a clinically feasible time frame, our results support the assessment of 150 keV image to reduce metal artifact while maintaining satisfactory soft tissue contrast.

OBJECTIVE The Centers for Medicare & Medicaid Services (CMS) requires a low C-peptide level for insulin pump coverage unless the individual is β-cell autoantibody positive, which precludes coverage of automated insulin delivery (AID) systems for many people with type 2 diabetes. RESEARCH DESIGN AND METHODS In the Randomized Trial Evaluating the Efficacy and Safety of Control-IQ+ Technology in Adults With Type 2 Diabetes Using Basal-Bolus Insulin Therapy study evaluating the t:slim X2 insulin pump with Control-IQ+ technology, adults with insulin-treated type 2 diabetes were categorized into high C-peptide (n = 195) and low C-peptide (n = 59) groups based on CMS criteria. RESULTS In the AID group, mean HbA1c decreased from baseline by 0.8%, which was significantly greater than in the control group with both high (P &lt; 0.001) and low (P = 0.02) C-peptide levels. Results were similar in participants ≥65 years old. CONCLUSIONS The benefit of AID is present with high and low C-peptide levels. Thus, requiring a low C-peptide level as a prerequisite for AID therapy is not warranted.