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The incorporation of comprehensive nutrition education into medical education and training is essential for equipping physicians with the knowledge and skills necessary to enhance patient health and outcomes. However, a deficiency in nutrition education persists in medical education, rendering physicians ill-prepared to address the vital role of nutrition in health and disease. This article summarizes the key themes and recommendations generated during the Summit on Medical Education in Nutrition, hosted in March 2023 by the Accreditation Council for Graduate Medical Education in collaboration with American Association of Colleges of Osteopathic Medicine and Association of American Medical Colleges., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Simulation has become an integral part of physician education, and abundant evidence confirms that simulation-based education improves learners' skills and behaviors and is associated with improved patient outcomes. The resources required to implement simulation-based education, however, have led some stakeholders to question the overall value proposition of simulation-based education. This paper summarizes the information from a special panel on this topic and defines research priorities for the field. Future work should focus on both outcomes and costs, with robust measurement of resource investments, provider performance (in both simulation and real settings), patient outcomes, and impact on the health care organization. Increased attention to training practicing clinicians and health care teams is also essential. Clarifying the value proposition of simulation-based education will require a major national effort with funding from multiple sponsors and active engagement of a variety of stakeholders., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Several studies demonstrating that central line-associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections., Methods: We conducted a collaborative cohort study to evaluate the impact of the national "On the CUSP: Stop BSI" program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented., Results: A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16-18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50-0.65) at 16-18 months after implementation., Conclusion: Coincident with the implementation of the national "On the CUSP: Stop BSI" program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.

The authors' goal was to determine if a national intensive care unit (ICU) collaborative to reduce central line-associated bloodstream infections (CLABSIs) would succeed in Hawaii. The intervention period (July 2009 to December 2010) included a comprehensive unit-based safety program; a multifaceted approach to CLABSI prevention; and monitoring of infections. The primary outcome was CLABSI rate. A total of 20 ICUs, representing 16 hospitals and 61 665 catheter days, were analyzed. Median hospital bed size was 159 (interquartile range [IQR] = 71-212) and median ICU bed size was 10 (IQR = 8-12). Median unit catheter days per month were 112 (IQR = 52-197). The overall mean CLABSI rate decreased from 1.5 infections per 1000 catheter days at baseline (January to June 2009) to 0.6 at 16 to 18 months postintervention (October to December 2010). The median rate was zero CLABSIs per 1000 catheter days at baseline and remained zero throughout the study period. Hawaii demonstrated that the national program can be successfully spread, providing further evidence that most CLABSIs are preventable.

Trustee performance evaluations have been around for a long time, but now they might actually be useful.

Objective: To develop a taxonomy of governing board roles in U.S. hospitals., Data Sources: 2005 AHA Hospital Governance Survey, 2004 AHA Annual Survey of Hospitals, and Area Resource File., Study Design: A governing board taxonomy was developed using cluster analysis. Results were validated and reviewed by industry experts. Differences in hospital and environmental characteristics across clusters were examined., Data Extraction Methods: One-thousand three-hundred thirty-four hospitals with complete information on the study variables were included in the analysis., Principal Findings: Five distinct clusters of hospital governing boards were identified. Statistical tests showed that the five clusters had high internal reliability and high internal validity. Statistically significant differences in hospital and environmental conditions were found among clusters., Conclusions: The developed taxonomy provides policy makers, health care executives, and researchers a useful way to describe and understand hospital governing board roles. The taxonomy may also facilitate valid and systematic assessment of governance performance. Further, the taxonomy could be used as a framework for governing boards themselves to identify areas for improvement and direction for change.

Medicaid, the nation's health care safety net, has come under increasing pressure as most state governments face a fiscal crisis. Cutbacks in funding that decrease already inadequate reimbursement, the tightening of eligibility, and a reduction of benefits will lead to an increase in the under- and uninsured, further straining the ability of hospitals to remain solvent and provide care to this vulnerable population. The federal government must increase funding to the Medicaid program and the Medicaid hospital disproportionate share while state governments must continue a level of funding that will not cause a loss of federal matching funds. Both state and federal governments must be held accountable for providing the necessary financial support to providers through the Medicaid program so that they can continue to serve their nearly 51 million poor, disabled, and elderly patients.

Speaking at the first national Summit on Medical Errors and Patient Safety Research last September, former American Hospital Association Chairman Gordon Sprenger called for plugging the research holes in several areas to improve patient safety. He identified critical areas where more research to improve patient safety would be helpful: changing the culture of health care, learning from other high-risk fields, studying the value of current safety practices, examining safety in nonhospital setting, closing the gaps between knowledge and practice, creating early warning systems, and looking at the human factors. Specifically, Sprenger raised the following questions to explore: What are the critical factors that make for a more open learning environment? What regulatory and legislative changes are necessary to create a nonpunitive, blameless environment? What has worked to improve safety in other fields? What is transferable to health care? Which of the current safety practices work well and how can they be improved? Which don't? How can systems solutions that prevent errors be adapted for settings outside of the hospital that are smaller and have less organizational structure? How can accepted standards of care and appropriate use of new technologies to improve care be better shared? Are they properly used? How can we make better use of precursor events to predict the occurrence of medical error? How can we involve patients in identifying potential errors? How can we advance our understanding of why humans err?

Over the past several years there has been an increasing public interest in the quality of health care provided by professionals, institutions and health plans. In the spring of 1998, the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued its final report, Quality First: Better Health Care for All Americans. It identified four areas of needed improvement in health care quality--errors in health services, the underuse of services, the overuse of services, and variation in the use of services.

Conventional heterogeneous dispersion polymerizations of unsaturated monomers are performed in either aqueous or organic dispersing media with the addition of interfacially active agents to stabilize the colloidal dispersion that forms. Successful stabilization of the polymer colloid during polymerization results in the formation of high molar mass polymers with high rates of polymerization. An environmentally responsible alternative to aqueous and organic dispersing media for heterogeneous dispersion polymerizations is described in which supercritical carbon dioxide (CO(2)) is used in conjunction with molecularly engineered free radical initiators and amphipathic molecules that are specifically designed to be interfacially active in CO(2). Conventional lipophilic monomers, exemplified by methyl methacrylate, can be quantitatively (>90 percent) polymerized heterogeneously to very high degrees of polymerization (>3000) in supercritical CO(2) in the presence of an added stabilizer to form kinetically stable dispersions that result in micrometer-sized particles with a narrow size distribution.

Several invasive and noninvasive techniques used in determining the size of experimental myocardial infarction were evaluated after acute ligation of the left anterior descending (LAD) coronary artery in ten dogs. Systemic blood pressure, left ventricular end-diastolic pressure (LVEDP), and heart rate did not change significantly for up to 24 hours after coronary occlusion. Left ventricular wall motion abnormalities were detected by left ventriculography in the distribution of the LAD but these changes did not correlate well with the infarct weight determined at autopsy. On the other hand, the number of epicardial sites with ST-segment elevation of greater than or equal to 2 mm (mean 15.1 sites +/- 0.6 SEM) and the infarct area as measured by 99mTc-glucoheptonate (TcGH) myocardial imaging (15.7 sq cm +/- 0.6) did correlate strongly with the infarct weight (16.8 g +/- 0.7) determined by the nitroblue tetrazolium (NBT) technique (r = 0.91). TcGH myocardial scintigraphy and epicardial ST-segment mapping allowed early and accurate quantification of experimental myocardial infarcts ranging from less than 1 g to 28 g.