The Mayo Clinic Hospital Mortality Reduction Project: Description and Results.

EXECUTIVE SUMMARY: Quality improvement, regulatory, and payer organizations use various definitions of hospital mortality as clinical outcome measures. In this prospective study, the authors evaluated a multicomponent intervention aimed at reducing inpatient mortality in a multistate healthcare delivery system. The project was initiated because of a statistically nonsignificant upward trend in mortality suggested by a six-quarter rise in the observed/expected mortality ratio generated by the Vizient Clinical Data Base and Resource Manager. The design of the mortality reduction plan was influenced by the known limitations of using hospital-wide mortality as a quality improvement measure. The primary objective was to reduce mortality through focused care redesign. The project leadership team attempted to implement standardized system-wide improvements while allowing individual hospitals to simultaneously pursue site-specific practice redesign opportunities. Between Q3, 2015, and Q4, 2017, system-wide mortality reduced from 1.78 to 1.53 (per 100 admissions; p = .01). The actual plan implemented in Mayo Clinic's hospitals is included as Appendix A to this article, published online as Supplemental Digital Content. The authors included it to allow comparison with similar efforts at other healthcare systems, as well as to stimulate criticism and discussion by readers.

Learning and support preferences of adult patients with cancer at a comprehensive cancer center.

PURPOSE/OBJECTIVES: To identify content items for an inclusive education curriculum for adult patients with cancer, as well as describe their learning and support preferences, determine the level of information provided to them, and assess the patients' interest in potential new services. DESIGN: Exploratory, descriptive survey research. SETTING: A National Cancer Institute-designated Comprehensive Cancer Center. SAMPLE: All consenting adult patients with cancer who had appointments in the outpatient care setting during a two-week period (N = 1,310). METHODS: A 3-phase study identified core components of an inclusive educational curriculum, conducted structured interviews of patients with cancer, and validated findings in a selected sample. FINDINGS: The surveys were completed and returned by 48% (n = 625) of the patients. The most favored method for learning about all cancer topics was discussions with physicians (66%). Other preferred methods included brochures or booklets provided by physicians or nurses (33%), discussions with nurses (34%), self-selecting print media from information displays (20%), and talking with other patients with cancer (14%). Statistically significant differences in learning preferences were found among subgroups defined by age, gender, and education. CONCLUSIONS: Patients preferred interactive, interpersonal communication with physicians or nurses. In addition, the prevailing method of education delivery for patients with cancer was providing print materials that support and enhance knowledge shared in the patient-healthcare team communication. IMPLICATIONS FOR NURSING: This study confirms the importance of the learning and support preferences of patients with cancer. To implement a successful education program for their patients, nurses must be aware of patients' preferences for learning new information. Time must be set aside for one-on-one communication with patients, and print materials must be easily accessible to healthcare providers to support the patient-education process.

Vitamin E prevents oxidative modification of brain and lymphocyte band 3 proteins during aging.

Antioxidants may play an important role in preventing free radical damage associated with aging by interfering directly in the generation of radicals or by scavenging them. We investigated the effects of a high vitamin E and/or a high beta-carotene diet on aging of the anion transporter, band 3, in lymphocytes and brain. The band 3 proteins function as anion transporters, acid base regulators, C02 transporters, and structural proteins that provide a framework for membrane lipids and that link the plasma membrane to the cytoskeleton. Senescent cell antigen (SCA), which terminates the life of cells, is a degradation product of band 3. This study was conducted as a double-blind study in which eight groups of middle-aged or old mice received either high levels of beta-carotene and/or vitamin E or standard levels of these supplements in their diets. Anion transport kinetic assays were performed on isolated splenic lymphocytes. Immunoreactivity of an antibody that recognizes aging changes in old band 3 preceding generation of SCA was used to quantitate aged band 3 in brain tissue. Results indicate that vitamin E prevented the observed age-related decline in anion transport by lymphocytes and the generation of aged band 3 leading to SCA formation. beta-Carotene had no significant effect on the results of either assay. Since increased aged band 3 and decreased anion transport are initial steps in band 3 aging, which culminates in the generation of SCA and cellular removal, vitamin E prevents or delays aging of band 3-related proteins in lymphocytes and brain.