CHI Health Good Samaritan

Introduction: Post-acute care (PAC) facilities across Montana, Nebraska, and North Dakota participated in the American Heart Association’s (AHA) Tri-State Mission: Lifeline Stroke PAC Initiative, a quality improvement initiative focused on improving stroke rehabilitation across Midwest states from 2022 to 2024. Participating facilities agreed to implement evidence-based practice outlined by AHA’s PAC Stroke Program Standards. Purpose: The Tri-State Mission: Lifeline Stroke PAC Initiative aimed to assist facilities to implement evidenced-based care and track key performance measures and outcome metrics to facilitate ongoing quality improvement. 15 skilled nursing facilities, 7 inpatient rehabilitation facilities, and 15 critical access hospitals participated across three states with emphasis on developing programs in rural communities. Methods: Participating facilities collected quarterly data for six clinical measures and three outcome metrics detailed in the PAC stroke program standards. Data was entered on the Quality and Certification Tool (QCT) platform to track progress and compare to other sites in the initiative. Group data was reviewed with facilities each quarter on virtual learning collaboratives. Results: Positive improvements were reported in four measures: percentage of patients with aphasia receiving speech therapy, patients receiving comprehensive stroke education, patients with impaired mobility who are on a VTE prophylaxis plan, and patients receiving a phone call within 3 business days of discharge. Performance remained consistent in two measures: percentage of patients receiving a depression screening and patients that had an admission assessment completed by an MD or APP in the first 24 hours. Outcome metrics of average length of stay, number of patients, and discharge disposition remained consistent. Conclusion: Focused quality improvement efforts can positively impact key measures and metrics in post-acute stroke programs. While positive trends were observed in four measures, further evaluations need to be done with larger patient volumes and extended periods of time.

We report a case of a young male patient presenting with accidental carbon monoxide poisoning leading to pulmonary embolism, acute myocardial infarction, right and left ventricular thromboses, acute limb ischemia, and acute renal failure. We review clinical aspects of carbon monoxide poisoning with a specific focus on cardiovascular and systemic thrombotic complications.

The aim of this study was to determine the effect of demographics, substance abuse, and chronic illnesses on length of hospitalization and mortality of pneumonia. 866 patients admitted to a community hospital with diagnosis of community-acquired pneumonia were studied. Linear and logistic regression analyses were performed for the effect of chronic illnesses on length of stay and mortality. Age (p=0.064), coronary artery disease (p=0.017), congestive heart failure (p=0.011), history of neoplasm (p=0.079) and chronic kidney disease (p<0.001) were associated with increased length of stay. Age (p<0.001), history of stroke (p=0.013), history of neoplasm (p=0.028), and chronic kidney disease (p=0.005) were associated with higher mortality from community-acquired pneumonia. Asthma was associated with decreased length of stay (p=0.006) but no difference in mortality. Respiratory failure and congestive heart failure exacerbation were associated with longer length of stay (p<0.001) but no difference in mortality. ICU admission was associated with longer hospital stay and higher mortality (p<0.001). Septic shock secondary to pneumonia was associated with longer length of stay and higher mortality (p<0.0001). Age (p=0.04), alcohol abuse (p=0.03), coronary artery disease (p=0.05), congestive heart failure (p=0.009) and chronic kidney disease (p=0.011) were predictors of higher level of care needed during hospital stay for community acquired pneumonia.

To propose an attenuation integral digital imaging (AIDI) technique for the treatment portal verification of conventional and intensity-modulated radiotherapy (IMRT). In AIDI technique, an open in air fluence image Io and a patient fluence image I were acquired under the same exposure. Then after doing the dark field correction for both the Io and I, the AIDI image was simply calculated as log(Io/I), which is the attenuation integral along the ray path from the x-ray source to a detector pixel element. Theoretical analysis for the low contrast detection and the contrast to noise ratio (CNR) of AIDI was presented and compared to those for the fluence imaging. With AIDI, the variation of x-ray fluence and the variation of individual detector pixel's response can be automatically compensated without using the flood field correction. The AIDI image for a contrast detail phantom demonstrated that it can efficiently suppress the background structures such as the couch and generate better visibility for low contrast objects with megavoltage x rays. The AIDI image acquired for a Catphan 500 phantom using a 60 degrees electronic dynamic wedge field also revealed more contrast disks than the fluence imaging did. Finally, AIDI for an IMRT field of a head/neck patient successfully displayed the anatomical structures underneath the treatment portal but not shown in fluence imaging. For IMRT and high degree wedge beams, direct imaging using them is difficult because their photon fluence is highly nonuniform. But AIDI can be used for the treatment portal verification of these beams.

College of Nursing, University of Nebraska Medical Center, Omaha, NE and Good Samaritan Health Systems, Kearney, NE