Colorectal cancer (CRC) is the second leading cause of cancer death in USA, and CRC screening remains suboptimal. The aim of this quality improvement was to increase CRC screening in the internal medicine clinic (IMC) patients, between the ages of 50–75 years, from a baseline rate of 50%–70% over 12 months with the introduction of faecal immunochemical test (FIT) testing. We used the Plan–Do–Study–Act (PDSA) method and performed a root cause analysis to identify barriers to acceptance of CRC screening. The quality improvement team created a driver diagram to identify and prioritise change ideas. We developed a process flow map to optimise opportunities to improve CRC screening. We performed eight PDSA cycles. The major components of interventions included: (1) leveraging health information technology; (2) optimising team work, (3) education to patient, physicians and IMC staff, (4) use of patient navigator for tracking FIT completion and (5) interactive workshops for the staff and physicians to learn motivational interview techniques. The outcome measure included CRC screening rates with either FIT or colonoscopy. The process measures included FIT order and completion rates. Data were analysed using a statistical process control and run charts. Four hundred and seven patients visiting the IMC were offered FIT, and 252 (62%) completed the test. Twenty-two (8.7%) of patients were FIT positive, 14 of those (63.6%) underwent a subsequent diagnostic colonoscopy. We achieved 75% CRC screening with FIT or colonoscopy within 12 months and exceeded our goal. Successful strategies included engaging the leadership, the front-line staff and a highly effective multidisciplinary team. For average-risk patients, FIT was the preferred method of screening. We were able to sustain a CRC screening rate of 75% during the 6-month postproject period. Sustainable annual FIT is required for successful CRC screening.

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Modified fronto-temporo-zygomatic approach is a relatively direct and less time-consuming approach to infratemporal fossa and orbital apex. This approach has a smaller learning curve and sutures are hidden in hairs, hence beneficial to both the patient and the surgeon.

Reparative giant cell granuloma is a rare benign tumor. Mandible is the most common site. The case is reported for its rarity in maxilla and difficulty in differentiating it from other giant cell lesions. Differentiation is only based on the clinical test and histopathological examination. Midfacial degloving approach popularized by Caisson et al and Conley in 1974 is best suited for bilateral facial lesions. This approach gives a wide exposure with no facial scar or deformity. The advantages of the degloving technique in exposure of the midface, maxilla, mandible, nasal cavities, and paranasal sinuses, have led to its increasing importance in the otorhinolaryngology.