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Abstract. Objectives: To study the performance of a centralized regional follow-up program organized by a municipal department of health (DH) for female patients presenting to the emergency department (ED) with Neisseria gonorrhoeae and/or Chlamydia trachomatis, who are not diagnosed or treated at the time of presentation. Methods: This was a retrospective observational study of female patients seen in the ED with positive cervical specimens, and their subsequent treatment and follow-up by the DH. Medical records were reviewed to determine the female patients seen in the ED who had positive specimens for N. gonorrhoeae or C. trachomatis. The DH followed up those not treated in the ED. Analysis of how long it took for these patients to be treated and the proportion lost to follow-up was performed. Results: Of 2,121 specimens, 342 were positive for N. gonorrhoeae or C. trachomatis. Of the 342, 154 (45%) were recognized and appropriately treated in the ED. One hundred fifty-nine of the 342 (46.5%) patients were discharged from the ED without treatment but were contacted by the DH and appropriate treatment was provided. The DH could not locate 23 (6.7%) patients, and four (1.2%) refused treatment. One died before treatment. Only 21 of the 159 were treated within nine days. Median time to treatment was 36 days. Conclusions: Centralized laboratory analysis and follow-up by the DH for N. gonorrhoeae and C. trachomatis identified many female patients undiagnosed and untreated in the ED. The DH follow-up program provided appropriate treatment to most female patients.

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Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease and often develop adverse cardiac remodeling as a result of obesity. Bariatric surgery can alter cardiac structure and function in these patients; however, this has not been fully investigated. Hypothesis: We hypothesized that patients undergoing bariatric surgery would demonstrate favorable cardiac remodeling and improvement in diastolic parameters according to the American Society of Echocardiography (ASE) guidelines. Methods: All patients undergoing bariatric surgery at our institution from 2014-2018 were reviewed. In patients with pre- and post-operative echocardiograms, the following were measured: left ventricular (LV) size, pulmonary artery systolic pressure (PASP), LV mass, mitral E/A, LV ejection fraction (EF), medial and lateral E/e’, medial e’ and a’, lateral e’ and a’, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVI), degree of LV hypertrophy, and relative wall thickness (RWT). The grade of diastolic dysfunction (DD) was calculated according to ASE guidelines. Results: A total of 69 patients met criteria for inclusion, with 77% (n=53) female, 87% (n=60) non-white, and mean age 49±10.7. Mean decrease in BMI one year post-operatively was 14.6±5.7 kg/m 2 . Median time between bariatric surgery and post-operative echocardiogram was 21.8 months. Post-operatively, there was a mean 17.8 cm/s decrease in TR velocity (p=0.0064) and 4.2 mmHg decrease in PASP (p=0.02). LAVI increased by 3.4 mL/m 2 (p=0.048). There was no significant change in LV size, LV mass, LVEF, LV hypertrophy, or RWT. Out of the 29 patients with pre-existing DD (grade 1, n=20; grade 2, n=8; grade 3, n=1), 45% (n=13) demonstrated improvement in grade of DD. When compared to pre-operative DD, post-operatively, 5 of 20 patients with G1DD had no DD, 2 of 8 patients with G2DD had no DD, 5 of 8 patients with G2DD had G1DD, and 1 patient with G3DD had G1DD. This was driven by a decrease in TR velocity and medial E/e’. Conclusions: In patients undergoing bariatric surgery, TR velocity and PASP improved while LAVI paradoxically increased. Patients with pre-existing DD demonstrated improvement in diastology, driven by changes in TR velocity and medial E/e’.

Despite lagging other US industries, effective healthcare quality improvement (QI) programs are expected by patients, insurers, government agencies, and hospital leadership. Quality is important in any field, but even more so in medicine, where life and death are at stake. As the finances of medicine become more important, it is stressed more that we should look to produce quality medicine with fewer resources. The chapter looks at quality improvement projects to help streamline and provide better patient care while reducing expenses and increasing productivity. Anesthetists need to look at their culture, teamwork, current safety guidelines to help guide us and develop new methods for achieving quality and safe medicine.