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Purpose: The WeeFIM is a tool commonly used in pediatric rehabilitation settings to measure objective patient progress while receiving comprehensive therapy services on inpatient rehabilitation units. This Quality Improvement (QI) project aimed for 95% of inpatients to have complete, on-time documented and displayed WeeFIM scores upon admission and discharge by 12/2017., Methods: An interdisciplinary team examined historic WeeFIM completion rates. Using Plan-Do-Study-Act cycles, a unified flowsheet was developed in the electronic health record (EHR) to revamp workflow and identify opportunities for improvement, data accuracy, and finally sustainability. Progress was monitored in real time via an automated data visualization tool which monitored score timeliness and completeness., Results: On-time admission completion rates increased from 0% to 95% during the intervention period. On-time discharge completion rates increased from 0% to 89% during the intervention period. This change has been sustained over two years with on-time admission and discharge scores averaging 79.4% and 77.9% respectively, and 96.4% of scores completed., Conclusion: Changes in the completion rate of WeeFIMs are sustainable, evidenced by ongoing maintenance of our initial gains over the course of multiple months. The incorporation of WeeFIM documentation into the workflow increased on-time and overall completion rates. The success of this project shows that integrating new tasks into provider workflows helps drive completion.

Objective: Inconsistent assessment and treatment may impair juvenile idiopathic arthritis (JIA) outcomes. We aimed to improve polyarticular JIA (rheumatoid factor-positive and -negative) outcomes by standardizing point-of-care disease activity monitoring and implementing clinical decision support (CDS) to reduce treatment variation., Methods: We performed a quality improvement initiative in an outpatient pediatric rheumatology practice. The interventions, implemented from April to November 2016, included standardized disease activity measurement, disease activity target review, and phased introduction of polyarticular JIA CDS to guide medication selection, dosing, treatment duration, and tapering. Process measures included visit-level target attestation (goal: 50%) and CDS use (goal: 15%). Our goal was to reduce the polyarticular JIA clinical Juvenile Arthritis Disease Activity Score (cJADAS-10) by at least 10%. Included patients had at least 2 visits from April 2016 through July 2017, and were classified as having early (≤ 6 mos) or established disease (> 6 mos)., Results: Patients with polyarticular JIA (n = 97; 81% established disease) were observed for 10.3 months (interquartile range: 6.4-12.3). Target attestation and CDS use occurred in a mean of 77% and 45% of polyarticular JIA visits, respectively. The median cJADAS-10 decreased significantly in both early (16.5 to 2.7, p < 0.001) and established polyarticular JIA (2.1 to 1.0, p = 0.01). A high proportion of patients with early disease received biologic therapy (73.7%). In established disease, although prescription of nonbiologic and biologic disease-modifying antirheumatic drugs remained similar overall, adalimumab prescribing increased (12.8% to 23.1%, p = 0.008)., Conclusion: Implementation of structured disease activity monitoring and CDS in polyarticular JIA was associated with significant reductions in disease activity scores in both early and established disease.

Context: Complete blood count (CBC) testing commonly occurs to determine the need for blood transfusions after surgical procedures. Many clinicians believe postoperative CBCs are "routine.", Objective: To decrease unnecessary routine CBC testing in a low-risk cohort of postoperative patients in the pediatric intensive care unit (PICU) at The Children's Hospital of Philadelphia by 50% in 6 months., Design: Quality-improvement study. Data from our institution regarding frequency of ordering laboratory studies and transfusion requirements were collected for prior quality-improvement work demonstrating the safety and feasibility of avoiding routine postoperative CBCs in this cohort. Baseline survey data were gathered from key stakeholders on attitudes about and utilization of routine postoperative laboratory testing. Patient and clinician data were shared with all PICU clinicians. Simple Plan-Do-Study-Act cycles involving education, audit, and feedback were put into place., Main Outcome Measures: Percentage of postoperative patients receiving CBCs within 48 hours of PICU admission. Balancing measures were hemoglobin level below 8 g/dL in patients for whom CBCs were sent and blood transfusions up to 7 days postoperatively for any patients in this cohort., Results: Sustained decreases below our 50% goal were seen after our interventions. There were no hemoglobin results below 8 g/dL or surgery-related blood transfusions in this cohort within 7 days of surgery. Estimated hospital charges related to routine postoperative CBCs decreased by 87% during 6 postintervention months., Conclusion: A simple approach to a systemic problem in the PICU of unnecessary laboratory testing is feasible and effective. By using local historical data, we were able to identify a cohort of patients for whom routine postoperative CBC testing is unnecessary.

Rheumatological care in Germany is influenced by limited resources and education and qualification of health professionals is a way to optimize utilization of these resources.The curriculum for rheumatology health professionals of the Academy of the German Association of Rheumatologists (DGRh) was developed to qualify clinical nursing specialists of rheumatology clinics as well as specialized rheumatology hospitals on a systematic basis.Since 2006 499 participants have each been trained over 4 weekends and certification was achieved by examinations. The topics cover the principles of anatomy and the pathology of diseases up to modern diagnostic methods and treatment, including practical skills. Additional specialized courses for nurses of rheumatology hospitals and refresher courses give the participants the opportunity to increase their depth of knowledge.After 8 of the basic courses questionnaires were sent to all participants for evaluation and 143 (51%) out of 277 participants responded. Of the responders 95% found that their knowledge of understanding rheumatic diseases improved considerably or very considerably, 90% found that their ability to determine urgent cases and 86% to correctly judge emergency situations had improved and 50% agreed with the statement that their field of work and their tasks had changed after the training courses. Increased responsibilities, documentations of patient history, involvement in clinical trials and infusions and information of the patients about their disease or the treatment were listed as new tasks of the participants. In conclusion the evaluation shows that the curriculum for rheumatology health professionals is an effective step towards qualification for clinical nursing specialists. We believe that this will support the work of medical doctors in rheumatology and will improve the quality of care for patients with rheumatic diseases.

Electromyography was used on calves, sheep, and goats to study limit values and behaviours of the action potentials of motoric units of M. Flexor digitorum superficialis. Average potentials were 10.5 ms in calf, 8.2 ms in sheep, and 8.1 ms in goat, and peak potentials were 4.8 ms, 5.7 ms, and 6.3 ms. Roughly 85 per cent of the potentials were diphasic and triphasic in calf, 92 per cent in sheep, and 93 per cent in goat. Monophasic, tetraphasic, and polyphasic action potentials were also exhibited by motoric units. Average potential amplitudes were 377 microV in calf, 253 microV in sheep, and 322 microV in goat.