HIV quality of care assessment at an academic hospital: outcomes and lessons learned.

Rapid changes in HIV treatment guidelines and antiretroviral therapy drug safety data add to the increasing complexity of caring for HIV-infected patients and amplify the need for continuous quality monitoring. The authors created an electronic HIV database of 642 patients who received care in the infectious disease (ID) and general medicine clinics in their academic center to monitor HIV clinical performance indicators. The main outcome measures of the study include process measures, including a description of how the database was constructed, and clinical outcomes, including HIV-specific quality improvement (QI) measures and primary care (PC) measures. Performance on HIV-specific QI measures was very high, but drug toxicity monitoring and PC-specific QI performance were deficient, particularly among ID specialists. Establishment of HIV QI data benchmarks as well as standards for how data will be measured and collected are needed and are the logical counterpart to treatment guidelines.

Splenosis and sepsis: The born-again spleen provides poor protection.

Splenosis describes ectopic splenic tissue found in patients after rupture of the spleen. These implants are commonly located on the omentum but can be scattered throughout the body in varying number and size. Although splenosis was first documented over a century ago, the precise mechanism for its development remains unknown. The degree of immunoprotection offered by this tissue remains unclear. Much of the human data is in the form of case reports documenting failure of splenotic tissue to protect against septicemia. Even accessory spleens may not offer complete protection once the primary spleen is removed. This review of the literature demonstrates that no amount of splenosis should be considered protective against overwhelming post-splenectomy infection.