Treatment Approach of Refractory Helicobacter pylori Infection: A Comprehensive Review.

H. pylori is the most common infection in the world and is associated with gastrointestinal and extra-gastrointestinal manifestations, including peptic ulcer disease, gastrointestinal bleeding, and lymphoproliferative disorders. Despite being discovered less than half a century ago, antibiotic resistance, exacerbated by medication non-adherence and inefficacy of proton pump inhibitors, has grown substantially, explaining the rising incidence of refractory H. pylori infection. In this review, we discuss risk factors, treatment options, surveillance and follow-up, as well as emerging therapies for refractory H. pylori.

A Rapid Cycle Improvement Approach to Increase Patient Readiness at Their Scheduled Appointment Time.

BACKGROUND: Patient unpunctuality negatively affects quality care. We found that 39% of patients at an academic primary care center were not ready to be evaluated at their scheduled appointment time. Our aim was to reduce this to 20% in 3 months' time. INTERVENTION: A multidisciplinary quality improvement team utilized quality improvement tools and methodology to determine that patient punctuality was a major modifiable factor contributing to the care gap. Reforming the scheduling process to include a built in 15-minute early arrival was implemented for acute visits for a 2-week trial period. Based on the successful results, this was then disseminated to all appointment types for a 3-month trial. RESULTS: Of the 182 patients seen during the 2-week trial period, 34 (19%) were not ready to be seen at the time of their appointment, a 20% improvement (P value < .001) from baseline. A total of 2832 patients were followed up for all visits during the next 3 months and 590 (21%) were not ready on time (P value < .001). Physician and patient satisfaction results improved after the intervention. CONCLUSIONS: Utilizing quality improvement tools we were able to find a simple and inexpensive intervention to improve patient punctuality as well as patient and provider satisfaction.