Billings Clinic

OBJECTIVE:To test the effectiveness of a surgical web-based decision aid (DA) in improving knowledge. SUMMARY OF BACKGROUND DATA:DAs support decision making by providing information about the options. METHODS:A stepped wedge trial was conducted in 10 National Cancer Institute Community Oncology Research Program clinics (Alliance for Clinical Trials in Oncology). Clinics were randomized to time of transition from usual care (UC) to delivery of a web-based DA. Patients with stage 0 through 3 breast cancer being considered for surgery were enrolled. Knowledge (primary outcome) was measured using the Breast Cancer Surgery Decision Quality Instrument and patients were asked, "How informed do you feel?" Intervention effects were tested with linear mixed-effects models, accounting for surgeon and clinic-level clustering, time, and enrollment after COVID. Additional models controlled for demographics. RESULTS:A total of 44% of DA arm patients reviewed the DA and 58% in UC arm reported reviewing "any information." Being in the DA arm versus UC was not associated with knowledge. However, "review of information" was associated with higher knowledge. In addition, non-White race and lower education were associated with lower knowledge. The DA arm was associated with higher perceptions of feeling informed (parameter estimate 1.36; 95% CI, 0.18-2.55; p = .02); this persisted even when controlling for review of information or demographics. CONCLUSION:Improved knowledge was not demonstrate with a web-based DA versus UC. Interestingly, the DA was associated with a higher likelihood of feeling informed. Future research will explore the discrepancy between patients feeling informed but having low knowledge, especially for disadvantaged patients. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT0376600.

Background and Objectives: Determination of disease activity is important for appropriate treatment selection and clinical follow-up in ulcerative colitis (UC). Colonoscopic examination is the gold standard in the evaluation of disease activity in current clinical practice. However, colonoscopic procedures are invasive, expensive, and not comfortable for the patients; also, possible complications that may develop during the procedure have led clinicians to seek practical, economical, and reproducible new biomarkers that can be used in the clinical follow-up of UC patients. In our study, we aimed to analyze the relationship between the nutritional markers, such as prognostic nutritional index (PNI) and controlling nutritional status score (CONUT), with clinical and endoscopic activities of the disease in ulcerative colitis disease. Materials and Methods: The study included 196 patients who were followed up with the diagnosis of ulcerative colitis in the Internal Medicine Clinic and Gastroenterology Outpatient Clinic of our hospital. Demographic data, laboratory parameters, and endoscopy reports of the patients were reviewed retrospectively. Patients were divided into two groups: remission-mild disease and moderate-severe disease in terms of clinical activity, and endoscopic remission and active disease in terms of endoscopic activity. The relationship between the PNI and CONUT scores calculated from the results of the examinations at the hospital admissions with the Mayo score and Rachmilewitz endoscopic activity index scores stated in the endoscopy reports was analyzed. Results: In our study, 78 (39.8%) cases were female and 118 (60.2%) were male. The mean age was 40.28 ± 13.74 years. According to clinical activity, 90 (45.9%) of the cases had remission-mild disease, and 106 (54.1%) had moderate-to-severe disease. According to endoscopic activity, endoscopic remission was observed in 66 (33.7%) cases, and active disease was observed in 130 (66.3%) cases. PNI score was detected to be statistically significantly lower in the moderate-to-severe clinical activity group and endoscopically active patient group compared to the other groups, while the CONUT score was detected to be statistically significantly higher (p < 0.001; p < 0.001). Conclusions: PNI and CONUT scores are not only effective predictors of clinical and endoscopic disease activity in UC but also emphasize the critical role of nutritional assessment in the holistic management of inflammatory bowel disease. These findings suggest that integrating routine nutritional screening into gastroenterology practice can provide dual benefits: serving as a non-invasive biomarker for mucosal inflammation and identifying patients who may require early nutritional intervention to improve clinical outcomes.

Rising financial pressures and the need to revitalize culture prompted a renewed emphasis on patient experience at Billings Clinic. This case study describes the impact of redefining patient experience as a measure of trust and a set of care processes. It presents an alternative to the more traditional view of patient experience as an outcome metric based on meeting patient expectations. Billings Clinic chose the patient survey question likelihood of recommending as an organizational goal or key performance indicator (KPI). Under the direction of executive leadership, the patient experience team developed a new strategic framework aimed at driving improvement for this metric. Key features of this framework include reframing likelihood to recommend as a measure of trust, creating strong executive and departmental leadership connections, engaging directly with care teams, developing a patient experience tactic library, sharing patient survey data transparently and utilizing industry developed patient survey goal setting and improvement tools. In all service lines where goals were set, there was an increase in the likelihood of recommending scores. The increase also outpaced the national average increase in several service lines. Patient experience metrics were viewed as a reflection of process consistency rather than individual performance. Overall, this approach created a more focused, collaborative, and actionable way to improve patient experience. By simplifying data, refining communication, and connecting insights to daily workflows, teams were better able to understand their impact and take meaningful action.

Aims:Surgical management of intermediate and malignant tumours in the pelvis is complex. Complications are frequent and either related to the surgery itself or to post-surgical failure of the reconstruction technique. This systematic review and meta-analysis aims at analyzing all reported complications following PI to PIII pelvic resections for intermediate and malignant tumours. Methods:Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis. Results:Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001). Conclusion:Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs.

Hospital epidemiologists and infection prevention professionals are frequently required to make high-stakes decisions in complex clinical scenarios where evidence-based guidance is limited or absent. These decisions often carry significant implications for patient safety, healthcare worker protection, hospital operations, and legal or financial risk. This article presents three challenging cases originally featured during the “Interesting Cases” session at the Society for Healthcare Epidemiology of America (SHEA) Spring 2025 Conference, with the goal of sharing practical lessons learned and contributing to the evolving literature in healthcare epidemiology. The first case describes the intraoperative contamination of a polyethylene liner during emergency revision total hip arthroplasty, highlighting limited data guiding implant salvage and the role of antiseptic decontamination, interdisciplinary communication, and institutional preparedness. The second case examines infection prevention risks associated with a temporary hospital heating, ventilation, and air conditioning (HVAC) shutdown during a COVID-19 surge, emphasizing the use of real-time ventilation assessment tools such as carbon dioxide monitoring to guide mitigation strategies. The third case details the application of failure mode and effect analysis (FMEA) to develop an infection prevention and control policy for the educational use of non-transplant cadaveric tissue in patient care areas—an area with no existing guidelines. Collectively, these cases illustrate the realities of decision-making under uncertainty in hospital epidemiology and demonstrate how structured risk assessment, proactive planning, and cross-disciplinary collaboration can mitigate potential harm. Sharing these experiences provides practical insights and reinforces that, even in the absence of definitive guidance, systematic approaches can support safe infection prevention decision-making.