Endogenous Bacterial Endophthalmitis: A Five-Year Retrospective Review at a Tertiary Care Academic Center

2019 ◽  
Vol 28 (6) ◽  
pp. 975-983 ◽  
Author(s):  
Thomas L. Jenkins ◽  
Katherine E. Talcott ◽  
Douglas R. Matsunaga ◽  
Martha E. Ryan ◽  
Anthony Obeid ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Tertiary Care ◽  
Bacterial Endophthalmitis ◽  
Academic Center ◽  
Endogenous Bacterial Endophthalmitis

scholarly journals Changing Trends in Dermatopathology Case Complexity: A 9-Year Academic Center Experience

2020 ◽  
Author(s):  
Anna M. Stagner ◽  
Steven R. Tahan ◽  
Rosalynn M. Nazarian
Keyword(s):  
Retrospective Review ◽  
Tertiary Care ◽  
Clinical Service ◽  
Case Volume ◽  
Academic Setting ◽  
Case Complexity ◽  
Changing Trends ◽  
Academic Center ◽  
Explanatory Note ◽  
Increasing Trend

Context.— Pathology case volume and complexity impact clinical service burden, staffing, and reimbursement, particularly in an academic setting. Objective.— To investigate dermatopathology case complexity by using indicators of challenging cases, which require increased clinical service effort. Design.— A retrospective review was performed of dermatopathology cases during a 9-year period at a tertiary care academic center. A subset of cases was analyzed for which extractable data were available. Cases requiring the following metrics of complexity were identified: rush processing, consensus agreement, performance of immunohistochemistry, use of special histochemical stains, use of immunofluorescence, examination of additional tissue levels, review of a prior case, addition of an explanatory note, presence of multiple specimen parts, and use of intradepartmental consultation. Results.— A total of 8173 cases were reviewed. During the same 3-month period of the year, there was a statistically significant increase in use of rush processing/interpretation, consensus review, number of cases requiring immunostains, special stains, levels, and an explanatory note, and cases reviewed by other subspecialists in the department from 2010 to 2019. Conclusions.— This study shows an increasing trend in dermatopathology case complexity, suggesting that overall clinical service efforts have increased. These findings may inform clinical service staffing and reimbursement.

scholarly journals Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

2017 ◽  
Vol 4 ◽  
pp. 237428951773634
Author(s):  
Chelsea R. Mehr ◽  
Amrom E. Obstfeld ◽  
Amanda C. Barrett ◽  
Kathleen T. Montone ◽  
Lauren E. Schwartz
Keyword(s):  
Resident Education ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Surgical Pathology ◽  
Primary Sources ◽  
Road Map ◽  
Academic Center ◽  
Organ Systems ◽  
Before And After ◽  
Time Required

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

scholarly journals Bilateral endogenous bacterial endophthalmitis: a report of four cases

2004 ◽  
Vol 82 (3p1) ◽  
pp. 306-310 ◽  
Author(s):  
Steen Rugaard Christensen ◽  
Ann-Brit Eg Hansen ◽  
Morten La Cour ◽  
Hans Callo Fledelius
Keyword(s):  
Bacterial Endophthalmitis ◽  
Endogenous Bacterial Endophthalmitis

scholarly journals Primary Care Approach to Hearing Loss: The Hidden Disability

2005 ◽  
Vol 84 (1) ◽  
pp. 26-44 ◽  
Author(s):  
Seth M. Cohen ◽  
Robert F. Labadie ◽  
David S. Haynes
Keyword(s):  
Primary Care ◽  
Hearing Loss ◽  
Cochlear Implants ◽  
Hearing Aids ◽  
Primary Care Physicians ◽  
Care Center ◽  
Tertiary Care ◽  
Local Resources ◽  
Academic Center ◽  
Care Approach

We report the results of a survey designed to investigate audiologic referral patterns of primary care physicians and, more specifically, their referral of patients for hearing aids and cochlear implants. Three hundred internal medicine and family medicine physicians were identified from a referral basin of a tertiary care center and chosen randomly to be faxed questionnaires concerning their views about patients with hearing loss, hearing loss screening and referral practices, and availability of local resources. Of the 260 physicians who received a questionnaire, 85 (32.7%) responded. Of their communities (60% of which had populations of fewer than 50,000), 82.4% had an otolaryngologist and 40% had access to an academic center. Although 97.6% of the responding physicians indicated that hearing loss affected patients’ quality of life, only 60% assessed patients for hearing loss. “Lack of time” and “more pressing issues” were the most common reasons given for not evaluating patients for hearing loss. Although 76 physicians (89.4%) said they were aware of cochlear implants, only 22 (25.9%) had referred patients for implant evaluation. Lack of referral most commonly resulted from uncertainties about “where to refer” and “which patients were potential candidates.” The results of this survey suggest that a large percentage of primary care physicians do not routinely test for hearing impairment in adults.

Patient Perception and Duration of Pain after Microdirect Laryngoscopy

2020 ◽  
Vol 162 (5) ◽  
pp. 702-708
Author(s):  
Trylon Matthew Tsang ◽  
Oliver Brett ◽  
Amanda Hu
Keyword(s):  
Short Form ◽  
Tertiary Care ◽  
Case Series ◽  
Patient Perception ◽  
Mcgill Pain Questionnaire ◽  
Academic Center ◽  
Mallampati Score ◽  
Sensory Score ◽  
Present Pain Intensity ◽  
Pain History

Objective Postoperative pain is an important part of the patient’s surgical experience. The objective was to evaluate patient perception and duration of pain after microdirect laryngoscopy (MDL). Study Design Case series with planned data collection. Setting Tertiary care, academic center. Subjects and Methods Adult patients undergoing MDL were administered the short-form McGill Pain Questionnaire (SF-MPQ) before surgery and on postoperative days (PODs) 1, 3, and 7. Demographic and clinical data were collected. Results In total, 130 patients (mean age 52.6 years, 84 male) participated in the study. About 46.2% required analgesia on POD 1, but only 23.1% required opioids. Overall, mild levels of pain were reported on the SF-MPQ: sensory score, affective score, total score, present pain intensity (PPI), and visual analog scale (VAS). Patients reported a significant increase in pain on POD 1, with decreases in pain on PODs 3 and 7. Pain score returned to preoperative values for total score and affective score on POD 7 but remained significantly elevated for PPI, VAS, and sensory score. None of the following factors were associated with increased pain: age, sex, body mass index, Mallampati score, Cormack score, laryngoscope used, type of MDL, time under anesthesia, employment status, intubation, Voice Handicap Index 10, and chronic pain history. Conclusion Although mild levels of pain were reported after MDL, the pain persisted for up to 7 days. No demographic or clinical factors were found to be associated with increased pain. This study was one of the few prospective studies evaluating pain after MDL.

Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center

2019 ◽  
Vol 129 (4) ◽  
pp. 369-375
Author(s):  
Caitlin Bertelsen ◽  
Janet S. Choi ◽  
Anna Jackanich ◽  
Marshall Ge ◽  
Gordon H. Sun ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Tertiary Care ◽  
Surgical Care ◽  
Safety Net ◽  
Clinic Visit ◽  
Level Of Evidence ◽  
Sociodemographic Differences ◽  
Academic Center ◽  
Safety Net Hospital ◽  
Type Of Surgery

Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c

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