The LOTUS: A Journey to Value-Based, Patient-Centered Care.

In response to the merger of our 248-bed community hospital with a new health system, a multidisciplinary team began a journey of holistic transformation via the evolution of a new rounding process called Leadership, Ownership, Transformation, Unity, and Sustainability (LOTUS) in the 20-bed ICU. Morphing from a hierarchical practice structure with limited engagement of multidisciplinary members, the LOTUS initiative (named for the blossom whose petals surround its core, the patient) afforded each discipline (petal) an equal voice and allowed a once-fragmented team to work cohesively, collaboratively, and at the highest level of the scope of practice for each discipline, thus affording expert guidance during care planning while providing a method to collect quality metrics. LOTUS allows us to view our patients in a new way as we refocused goal determination on patients and their families. The restructuring and evolution into a high-functioning team was targeted with the goal of enhancing quality critical care for patients, which, in the literature, has correlated with improved patient safety and decreased mortality and ICU length of stay.

Enhanced external counter pulsation (EECP) as a novel treatment for restless legs syndrome (RLS): a preliminary test of the vascular neurologic hypothesis for RLS.

BACKGROUND AND PURPOSE: Enhanced external counter pulsation (EECP) is used to treat angina. With sustained treatment this increases collateral circulation to the coronary arteries as well as to the body as a whole. We found some patients who underwent EECP for angina or congestive heart failure who also coincidentally had severe Restless Legs Syndrome (RLS). Case reports are presented. PATIENTS AND METHODS: Six patients with RLS (1F, 5M, ages 55-80) underwent EECP treatment. All patients were given the International RLS Study Group rating scale for RLS (the IRLS) before and immediately after 35 days of EECP treatment. RESULTS: The average IRLS rating scale score of the six patients before treatment was 28.8 (range 23-35), which indicates frequent and moderate to very severe RLS. After 35 days of EECP treatment the IRLS score was 6 (P<0.03), which indicates clinically insignificant RLS. Long-term follow-up in three patients indicates sustained improvement in all three at 3-6 months after EECP was completed (IRLS score 28.3-3.33). Further follow-up in four patients showed sustained improvement in two patients 1 year after EECP was completed. CONCLUSION: EECP improves RLS symptoms significantly and could be considered as an adjunct treatment for patients with RLS. In some cases, the improvement lasts for months after the course of treatment. In this way EECP is unique and unlike pharmacotherapy which requires continuous daily treatment. Furthermore, our results suggest that decreases in vascular flow influence the peripheral or central nervous system leading to the sensory symptoms of RLS. A larger number of patients studied under blinded conditions is needed to draw further conclusions.