John M. Eisenberg Patient Safety Awards. System innovation: Concord Hospital

BACKGROUND: The Cardiac Surgery Program at Concord Hospital (Concord, NH) restructured clinical teamwork for improved safety and effectiveness on the basis of theory and practice from human factors science, aviation safety, and high-reliability organization theory. A team-based, collaborative rounds process--the Concord Collaborative Care Model--that involved use of a structured communications protocol was conducted daily at each patient's bedside. METHODS: The entire care team agreed to meet at the same time each day (8:45 AM to 9:30 AM) to share information and develop a plan of care for each patient, with patient and family members as active participants. The cardiac surgery team developed a structured communications protocol adapted from human factors science. To provide a forum for discussion of team goals and progress and to address system-level concerns, a biweekly system rounds process was established. RESULTS: Following implementation of collaborative rounds, mortality of Concord Hospital's cardiac surgery patients declined significantly from expected rates. Satisfaction rates of open heart patients scores were consistently in the 97th-99th percentile nationally. A quality of work life survey indicated that in every category, providers expressed greater satisfaction with the collaborative care process than with the traditional rounds process. Practice patterns in the Cardiac Surgery Program at Concord Hospital have changed to a much more collaborative and participatory process, with improved outcomes, happier patients, and more satisfied practitioners. A culture of continuous program improvement has been implemented that continues to evolve and produce benefits.     

Immuno gold nanocages with tailored optical properties for targeted photothermal destruction of cancer cells

Gold nanocages with a relatively small size (e.g., approximately 45 nm in edge length) have been developed, and the structure of these nanocages was tailored to achieve strong absorption in the near-infrared (NIR) region for photothermal cancer treatment. Numerical calculations show that the nanocage has a large absorption cross section of 3.48 x 10(-14) m(2), facilitating conversion of NIR irradiation into heat. The gold nanocages were conjugated with monoclonal antibodies (anti-HER2) to target epidermal growth factor receptors (EGFR) that are overexpressed on the surface of breast cancer cells (SK-BR-3). Our preliminary photothermal results show that the nanocages strongly absorb light in the NIR region with an intensity threshold of 1.5 W/cm(2) to induce thermal destruction to the cancer cells. In the intensity range of 1.5-4.7 W/cm(2), the circular area of damaged cells increased linearly with the irradiation power density. These results suggest that this new class of bioconjugated gold nanostructures, immuno gold nanocages, can potentially serve as an effective photothermal therapeutic agent for cancer treatment.