The Monroe Carell Jr. Children’s Hospital at Vanderbilt won the Top Performer Award for “Inpatient Services — Children’s Hospitals” in the 2014 Excellence in Healthcare Award, sponsored by Professional Research Consultants Inc. (PRC), Vanderbilt’s patient satisfaction surveyor. The recognition means that the hospital scored the highest of the 20 children’s hospitals in the PRC national benchmark group. In total, Vanderbilt University Medical Center providers and teams with exceptional patient satisfaction scores have won 22 Top Performer Awards and 330 5-Star Awards in PRC’s surveys of patient attitudes, which it conducts for hundreds of hospitals and health systems. The company’s annual awards are based on the survey question asking patients to rate the care they’ve received from a team or an individual provider. Awards are based on how often respondents gave a rating of excellent on the survey question. Top Performer Awards go to individuals and teams who score in the 100th percentile within their clinical discipline or service category, and 5-Star Awards go to those who score within the 90th to 99th percentiles.

The awards were presented at the PRC Excellence in Health Care Conference held this week in St. Louis. “Congratulations to our Top Performers and 5-Star Award winners, and special congratulations to Children’s Hospital,” said C. Wright Pinson, MBA, M.D., deputy vice chancellor for Health Affairs and CEO of the Vanderbilt Health System. “The satisfaction of our patients for outstanding service is our greatest reward.” Luke Gregory, chief executive officer of Children’s Hospital, added his praise.Folding Camper For Sale Liverpool “Each day our staff and faculty serve more than 1,000 children and their families from Middle Tennessee and across the Southeast. Briggs Oil Bath Air CleanerThey work as a team dedicated to the comfort, care and healing of all children. Duromine Weight Loss Eating Plan

This special award reflects their impact on patients’ lives. “It is such a unique accomplishment for a hospital and all its caregivers to be recognized as the very best in the nation,” Gregory said. This year’s awards are based on survey responses from 2013. Not all individuals and groups at VUMC were eligible for awards. PRC limits eligibility for 5-Star Awards to individuals and groups having 50 or more survey responses over the previous year, and limits eligibility for Top Performer Awards to individuals with 50 or more survey responses and groups with 100 or more responses. The Monroe Carell Jr. Children’s Hospital at Vanderbilt: Inpatient Services — Children’s Hospitals Alison B. Barlow, APRN, MSN Michelle Foote-Pearce, MSN, D. Min., R.N. Mark C. Kelley, M.D. Emily Graham Kurtz, M.D. Jonathan C. Nesbitt, M.D. David S. Raiford, M.D. Charles B. Rush, M.D. Kyle Derek Weaver, M.D. Kathryn L. Zahour, CRNP 4 NICU Children’s Hospital

10T3 Myelosuppression/Stem Cell Transplant Clinical Research Center — Inpatient Pediatric Cardiology — Echo Lab Vanderbilt Orthopaedics Cool Springs Below is the full list of winners provided by PRC:The early clinical diagnosis of pancreatic cancer is fraught with difficulty. Unfortunately, the initial symptoms of the disease are often quite nonspecific and subtle in onset. Consequently, these symptoms can be easily attributed to other processes unless the physician has a high index of suspicion for the possibility of underlying pancreatic carcinoma. Patients typically report the gradual onset of nonspecific symptoms such as anorexia, malaise, nausea, fatigue, and midepigastric or back pain. Significant weight loss is a characteristic feature of pancreatic cancer. Midepigastric pain is a common symptom of pancreatic cancer, with radiation of the pain to the midback or lower-back region sometimes occurring. Radiation of the pain to the back is worrisome, as it indicates retroperitoneal invasion of the splanchnic nerve plexus by the tumor.

Often, the pain is unrelenting in nature, with nighttime pain often being a predominant complaint. Some patients may note increased discomfort after eating. The pain may be worse when the patient is lying flat. Weight loss may be related to cancer-associated anorexia and/or subclinical malabsorption from pancreatic exocrine insufficiency caused by pancreatic duct obstruction by the cancer. Patients with malabsorption usually complain about diarrhea and malodorous, greasy stools. Nausea and early satiety from gastric outlet obstruction and delayed gastric emptying from the tumor may also contribute to weight loss. The onset of diabetes mellitus within the previous year is sometimes associated with pancreatic carcinoma. Even so, only about 1% of cases of new-onset diabetes mellitus in adults are related to occult pancreatic cancer.[37] Nevertheless, pancreatic cancer should be at least thought of in a patient older than 70 years with a new diagnosis of diabetes and without any other diabetic risk factors.

The most characteristic sign of pancreatic carcinoma of the head of the pancreas is painless obstructive jaundice. Patients with this sign may come to medical attention before their tumor grows large enough to cause abdominal pain. These patients usually notice a darkening of their urine and lightening of their stools before they or their families notice the change in skin pigmentation. Physicians can usually recognize clinical jaundice when the total bilirubin reaches 2.5-3 mg%. Patients and their families do not usually notice clinical jaundice until the total bilirubin reaches 6-8 mg%. Urine darkening, stool changes, and pruritus are often noticed by patients before clinical jaundice. Pruritus may accompany and often precedes clinical obstructive jaundice. Pruritus can often be the patient's most distressing symptom. Depression is reported to be more common in patients with pancreatic cancer than in patients with other abdominal tumors. In some patients, depression may be the most prominent presenting symptom.