Background: Intravenous (IV) amiodarone has multiple indications including treatment of hemodynamically unstable patients and the prevention of atrial or ventricular arrhythmias after thoracic surgery. Inflammation of the vein, or phlebitis, is the most common adverse event associated with peripherally administered amiodarone. In 2017, a rise in reported phlebitis incidents was occurring at one large academic medical center. Aim: This evidence-based quality improvement initiative aimed to decrease and enhance early detection of phlebitis in patients receiving amiodarone. Methods: Due to the variation in assessment and management standards, evidence-based practice (EBP) methodology was utilized to establish a process for quality improvement. A thorough literature search was completed, identifying evidence-based interventions to decrease phlebitis and enhance early detection. Thorough critiques of the literature and synthesis of the evidence were completed. Multidisciplinary guidelines based on the literature were created. The guidelines included interventions such as an increase in IV assessment frequency, vein selection criteria, and the utilization of a standardized grading tool for assessment. Results: Phlebitis was reduced by 30%-88%. In the first 6 months post-intervention, there was a 48% reduction in phlebitis cases. In addition, the severity of phlebitis and the quality of reporting also improved dramatically. Linking Evidence to Action: This evidence-based quality improvement process led to identifying relevant knowledge gaps in care that could be streamlined into everyday nursing practice to decrease patient harm. This paper describes an in-depth process of how EBP helped to quickly take a clinical inquiry and adapt change based on findings from the evidence. Other organizations can utilize EBP to solve patient safety concerns using similar processes.

Reasonable compensation is an often litigated issue in the Tax Court. This frequency of discord arises from the tax codes lack of definitive criteria for determining reasonableness. Moreover, classification of payments to shareholder-employees of closely held corporations can have a significant impact on their cash flows and tax burdens. According to 162 of the Internal Revenue Code, reasonable compensation can be deducted from taxable income of a corporation, but amounts paid to shareholders in excess of the reasonable amount should be classified as dividend payments. Dividend payments are not deductible from taxable income. The courts use a variety of factors in determining whether the compensation paid qualifies as reasonable. The main objective of this study is to determine which factors have the greatest influence on Tax Court decisions concerning the reasonable amount of compensation. Using logistic regression, the following factors are found to be significant in predicting the courts decision: comparison of salaries paid to net and gross income, the comparison of salaries with distributions to shareholders, the prevailing rates of compensation for comparable positions in comparable companies, and the employers salary policy as to all employees.

not significant predictors. In an analysis restricted to 88 pts with cardiopulmonary stress test data, peak VO2 was a significant predictor of event-free survival time (p= 0.004). In this model, CI retained significance, but SHFS did not. Conclusion: Among pts with advanced HF who are not yet inotrope dependent, low Fick CI and SHFS are associated with rate of HF disease progression. These data may help to further inform shared-decision making during patient selection for cardiac transplantation. It is possible that the association between HF disease progression and CI also reflects the influence of this metric on clinical decision making.

Background: Lung cancer remains the leading cause of cancer related death worldwide. Surgery is the mainstay of curative therapy for lung cancer. However, 75% of patients present over the age of 65yrs, many with co-morbidities which impact on the resection rate. Post treatment many cancer survivors experience fatigue, reduced physical capacity and quality of life. We have established a Macmillan funded service at our institution. Our aim is to optimise the patient pre-operatively, encourage self-management post operatively and extend the role of recovery beyond the immediate post-operative period and establish survivorship as the goal. Method: Each referred patient is offered a key worker and a tailored pre and post operative programme based on individual needs, which may incorporate some or all of the following; opportunity to discuss concerns, education regarding their condition, smoking cessation, healthy eating, pre and post-operative exercises. Baseline and follow up data is collected regarding the patient's current health status, respiratory parameters and qualitative data about patient experiences. Result: 249 patients (as of March 2018) have been referred since the service was established in September 2016. The level of contact these patients have received is summarised in the table. 212 (85%) of patients met with either the ANP or ATP, 56% of those engaged in further support. Early evaluation of the project indicates that there are challenges in gaining patient engagement with the exercise classes. The reasons are multi factorial and include patients perceiving their current level of activity is sufficient and the need for multiple attendances (time, cost and difficulty parking) acting as deterrents. A home based exercise programme and exercise DVD is offered to address this challenge. Conclusion: The project has had a positive start; changes have been made based on our early experiences. Work continues to develop the service; ensuring patients receive a tailored programme to meet their needs.