BC Patient Safety & Quality Council: Using network and social movement theory to improve healthcare

The BC Patient Safety & Quality Council has a mandate to bring health system stakeholders together in a collaborative partnership to improve quality of care. Our experience has demonstrated the value of networks to provide a forum for individuals to “think like a system,” considering the perspectives of others in addressing system issues. This transition from silo-based thinking is important as we move to improve the quality of care at the pace that is required.     

Small bowel transplantation

Thirty-seven patients were listed for small bowel transplantation; 16 were transplanted and 15 died while waiting for a donor. Cyclosporine (N=6) or tacrolimus (N=10) were used for immune suppression. Graft rejection rates were lower in the combined liver/small bowel grafts than the isolated intestinal transplants (1/7 vs 5/7;P<0.01) All of the cyclosporine group have died; the median survival was 25.7 months with two patients living more than five years. The tacrolimus group had fewer infections and a shorter hospital stay. All but two are alive with a median survival of 13 months. Seven of eight long-term survivors are off intravenous feedings. We conclude that small bowel transplantation is a life-saving option for patients with intestinal failure who cannot be maintained on total parenteral nutrition.     

Late dysphagia after presternal colon interposition

Esophageal replacement by colon interposition is done for a variety of esophageal diseases. Dysphagia occasionally develops many years after successful colon interposition. Redundancy of the colon graft is usually responsible. We report a patient with onset of dysphagia 24 years after presternal colon interposition for long segment esophageal atresia. Pathophysiology, prevention, and treatment of late colon interposition dysfunction are discussed.     

Mullerian cyst of the uterus misdiagnosed as ovarian cyst on pelvic sonography

Mullerian cyst of the uterus, also known as endosalpingiosis, is rare and often can be misdiagnosed as adnexal cyst on pelvic sonography. A 47‐year‐old woman was referred for an incidental finding of a right adnexal mass on pelvic sonography, suspected to be an ovarian cyst. During laparoscopy, a pedunculated cystic mass arising from the right anterior uterine wall was seen. The mass was resected laparoscopically and histologic examination showed a benign Mullerian cyst of the uterus. Diagnosis of Mullerian cyst of the uterus can be challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible sonographically. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :183–184, 2014     

Effect of scleral expansion band on ocular hypertension: Canadian phase 1 study

A prospective, nonrandomized, controlled, phase 1 clinical trial was conducted to evaluate use of the scleral expansion band (SEB) for lewering elevated intraocular pressure (IOP) in patients with ocular hypertension or primary open-angle, glaucoma. Morning IOP was measured while the patients received topical glaucoma medications; after washout of medication; and 2, 3, and 6 months after the SEB procedure without medication. The SEB procedure lowered elevated IOP by increasing outflow. The authors, have no commercial or proprietary interest in any products or methods mentioned in this article.