Hyponatremia at admission was associated with increased LOS and cost of care for hospitalized patients. Interventions or pharmacotherapies for the prompt treatment of hyponatremia could potentially reduce morbidity and LOS, thereby reducing the utilization of health care resources.

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Objectives To determine pre-implementation perspectives of institutional, practice and vendor leadership regarding best practice for implementation of two ambulatory electronic health records (EHRs) at an academic institution. Design Semi-structured interviews with ambulatory care network and information systems leadership, medical directors, practice managers and vendors before EHR implementation. Results were analysed using grounded theory with ATLAS.ti version 5.0. Measurements Qualitative data on perceived benefits of EHRs as well as facilitators and barriers to successful implementation. Results Interviewees perceived data accessibility, quality and safety measurement, improvement and reporting as benefits of EHR use. Six themes emerged for EHR implementation best practice: effective communication; successful system migration; sufficient hardware, technical equipment, support and training; safeguards for patient privacy; improved efficiency; and a sustainable business plan. Conclusions Achieving the benefits of EHRs identified by our interviewees depends on successful implementation and use. Further identification of best implementation practices for EHRs is required, given the financial and clinical consequences of poor implementation.

Background. Several studies have proven that neoadjuvant endocrine therapy (NET) has a similar beneficial therapeutic effect in estrogen-positive (ER ?) breast cancer (BC) with improved breast conservation rate in patients undergoing NET versus neoadjuvant chemotherapy (NAC). The impact of axillary complete pathologic response (pCR) is less clear. We evaluate the impact of NET on axillary downstaging and surgical management. Methods. Using the National Cancer Database (NCDB), we identified all patients with node positive (N ?), ER ? , HER 2-BC undergoing NET and performed a systemic review of literature using PRISMA guidelines. Results. The literature review identified 1479 clinically N ? patients in four studies, 148 of whom had axillary pCR (10.0%). In the two studies of patients with invasive lobular carcinoma (ILC), 7.8% (69/883) of clinically N ? patients had axillary pCR. The NCDB query identified 4580 female patients with clinically N ? ER ? HER 2-BC who underwent NET from 2010 to 2016 with mean age of 61.4 years. Patients who achieved a pCR were more likely to have N1 disease (p 0.008), moderately differentiated tumors (p 0.003), and ductal histology (p 0.04). There was no statistically significant difference in race, comorbidity score, education, income, hospital setting, or clinical tumor stage. Of the 4580 total patients, 663 (14.48%) had an axillary pCR (pN0) after NET, and 3917 (85.52%) remained pN?. Conclusions. We found that patients who underwent NET for N ? disease had a higher axillary pCR than previously reported (10%) in smaller studies. Although NET is not a common treatment option for women with N ? ER ? HER 2-BC, it may be a suitable option for axillary downstaging, which is currently underutilized. In 2019, approximately 268,600 new cases of invasive breast cancer (IBC) and 48,100 cases of ductal carcinoma in situ (DCIS) were diagnosed among U.S. women, and more than 80% of breast cancers (BC) were diagnosed among women aged C 50 years. 1 Hormone receptor-positive (HR ?)/human epidermal growth factor receptor 2 (HER2)-negative BC is by far the most common subtype. 1 In patients with HR ? breast cancer, the innate exposure to endogenous estrogen results in dimerization of the estrogen receptor (ER) promoting estrogen gene transcription. 2 Multiple endocrine therapies have been developed for adjuvant use, such as selective ER downregulators, aromatase inhibitors (AIs), and luteinizing hormone releasing agonists. 3 The role of neoadjuvant endocrine therapy (NET) in the setting of HR ? breast cancer in the US is underutilized, typically being reserved for elderly patients,

NSM provides patients with favorable results in psychosocial, sexual, and physical well-being and overall satisfaction. Sexual well-being showed significant improvement for NSM.