Distal Ileitis Caused by Diffuse Large B-Cell Lymphoma in an Elderly Patient From Honduras.

Primary gastrointestinal non-Hodgkin lymphoma, while rare, most often presents as diffuse large B-cell lymphoma located in the stomach or ileocecal region. Presenting symptoms include abdominal pain, gastrointestinal bleeding, weight loss, or obstructive symptoms. Imaging can reveal ileitis or obstruction. We report a case of a man from Honduras with latent tuberculosis and chronic hepatitis B who presented with features of Crohn's disease through clinical, radiologic, and endoscopic findings but was ultimately diagnosed with diffuse large B-cell lymphoma by histology. We emphasize the importance of maintaining a broad differential for ileitis and the importance of histologic sampling when evaluating ileitis.

Pseudophakic Pupillary Block due to the Capsular Bag Intraocular Lens Implant Located in the Sulcus: A Case Report.

Introduction: Pupillary block, a concerning complication of cataract surgery, is heightened when a single-piece acrylic (SPA) intraocular lens (IOL) is implanted in the ciliary sulcus. We report an unusual occurrence of relative pupillary block and chronic angle-closure glaucoma (ACG) identified in the late postoperative period due to unintentional SPA IOL implantation in the sulcus. Case Presentation: An 82-year-old woman presented with a history of chronic ACG 5 years after bilateral cataract extraction. Postoperatively, she experienced anterior chamber shallowing, elevated intraocular pressure (IOP), and two acute angle-closure attacks in the left eye, successfully managed with laser peripheral iridotomies (LPIs). Despite neodymium:YAG capsulotomy, elevated IOP persisted. Maximal medical therapy effectively controlled IOP; however, a shallow anterior chamber remained, prompting referral to our glaucoma service. Slit-lamp examination revealed a shallow peripheral anterior chamber, patent LPIs, and an Alcon SA60WF SPA IOL situated posteriorly with the optic against the pupil margin OS. Gonioscopy indicated a closed angle with peripheral anterior synechiae (PAS). Ultrasound biomicroscopy (UBM) confirmed haptics in the sulcus, with the lens optic and haptics anterior to the bag. These findings suggest relative pupillary block as the cause of her chronic ACG. The SPA IOL's bulky haptics in the sulcus likely induced iris bowing, leading to prolonged appositional angle-closure and chronic PAS formation. Conclusion: IOLs designed for the capsular bag should not be placed in the sulcus. Therefore, IOLs of varying dimensions should be taken to the operating room in the event of complicated cataract extraction. Finally, UBM proves valuable in identifying causes of pupillary block.

Description and Impact Evaluation of a Statewide Collaboration to Reduce Preventable Hospital Readmissions.

This article describes how a Medicare-funded Quality Improvement Organization collaborated with a hospital association and multiple cross-continuum partners on a statewide effort to reduce hospital readmissions. Interventions included statewide education on quality improvement strategies and community-specific technical assistance on collaboration approaches, data collection and analysis, and selection and implementation of interventions. Fifteen communities, comprising 16 acute care hospitals, 119 nursing homes, 70 home health agencies, and 32 other health care or social service providers, actively participated over a 4.5-year period. Challenges included problems with end-of-life discussions (80.0%), physician engagement (70.0%), staffing (70.0%), and communication between settings (60.0%). Thirty-day all-cause readmission rates in fee-for-service Medicare patients decreased in most hospital service areas across the state (22/24), and the aggregate statewide readmission rate dropped from 15.2/1000 to 12.1/1000, a relative decrease of 20.3% ( P < .001). Despite these positive findings, the specific impact of this collaboration could not be determined because of multiple confounding interventions.

Decreasing central-line-associated bloodstream infections in Connecticut intensive care units.

Central-line-associated bloodstream infections (CLABSIs) are a significant cause of preventable harm. A collaborative project involving a multifaceted intervention was used in the Michigan Keystone Project and associated with significant reductions in these infections. This intervention included the Comprehensive Unit-based Safety Program, a multifaceted approach to CLABSI prevention, and the monitoring and reporting of infections. The purpose of this study was to determine whether the multifaceted intervention from the Michigan Keystone program could be implemented in Connecticut and to evaluate the impact on CLABSI rates in intensive care units (ICUs). The primary outcome was the NHSN-defined rate of CLABSI. Seventeen ICUs, representing 14 hospitals and 104,695 catheter days were analyzed. The study period included up to four quarters (12 months) of baseline data and seven quarters (21 months) of postintervention data. The overall mean (median) CLABSI rate decreased from 1.8 (1.8) infections per 1,000 catheter days at baseline to 1.1 (0) at seven quarters postimplementation of the intervention. This study demonstrated that the multifaceted intervention used in the Keystone program could be successfully implemented in another state and was associated with a reduction in CLABSI rates in Connecticut. Moreover, even though the statewide baseline CLABSI rate in Connecticut was low, rates were reduced even further and well below national benchmarks.