Management Patterns and Outcomes for Intravitreal Injection–Related Endophthalmitis

Purpose: This work describes the clinical management and outcomes in cases of presumed infectious endophthalmitis following intravitreal injection at a tertiary academic medical center. Methods: A retrospective review took place of eyes that presented to the Duke Eye Center over a 9-year period and were diagnosed with intravitreal injection–related endophthalmitis. Clinical presentation, management, microbiologic yield, visual outcomes, and complications were abstracted from medical records. Results: Of 23 eyes diagnosed with postinjection endophthalmitis, 52.2% underwent anterior chamber tap (33.3% of which first underwent dry needle vitreous tap), 47.8% underwent needle vitreous tap, 17.4% underwent neither, and none underwent pars plana vitrectomy (PPV) for initial management. Subsequent PPV was performed in 6 eyes (26.1%). Mean visual acuity (VA) improved by 50 Early Treatment Diabetic Retinopathy Study letters at 6 months. Eyes that underwent initial anterior chamber tap had worse presenting VA than those that did not ( P = .01). Eyes undergoing subsequent PPV had worse VA at presentation ( P = .02) and at 6 months ( P < .001). Eyes presenting with VA of hand motion (20/8000) or worse were more likely to undergo subsequent PPV ( P = .02). Conclusions: Eyes with intravitreal injection–related endophthalmitis presenting with VA of hand motion or worse were more likely to undergo subsequent PPV. Future studies with larger cohorts may reveal whether earlier vitrectomy should be considered in these patients.

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A real-time spatiotemporal AI model analyzes skill in open surgical videos

10.21203/rs.3.rs-1129461/v1 ◽

2021 ◽

Author(s):

Serena Yeung ◽

Emmett Goodman ◽

Krishna Patel ◽

Yilun Zhang ◽

William Locke ◽

...

Keyword(s):

Real Time ◽

Medical Center ◽

Academic Medical Center ◽

Building Blocks ◽

Dominant Form ◽

Hand Motion ◽

Academic Medical ◽

Data Limitations ◽

Invasive Techniques ◽

Surgical Videos

Abstract Open procedures represent the dominant form of surgery worldwide. Artificial intelligence (AI) has the potential to optimize surgical practice and improve patient outcomes, but efforts have focused primarily on minimally invasive techniques. Our work overcomes existing data limitations for training AI models by curating, from YouTube, the largest dataset of open surgical videos to date: 1997 videos from 23 surgical procedures uploaded from 50 countries. Using this dataset, we developed a multi-task AI model capable of real-time understanding of surgical behaviors, hands, and tools—the building blocks of procedural flow and surgeon skill—across both space and time. We show that our model generalizes across diverse surgery types and environments. Illustrating this generalizability, we directly applied our YouTube-trained model to analyze open surgeries prospectively collected at an academic medical center and identified kinematic descriptors of surgical skill related to efficiency of hand motion. Our Annotated Videos of Open Surgery (AVOS) dataset and trained model will be made available for further development of surgical AI.

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Conversion to an electronic missing medication request system at an academic medical center

Health Informatics Journal ◽

10.1177/1460458221994862 ◽

2021 ◽

Vol 27 (1) ◽

pp. 146045822199486

Author(s):

Michael J Peters ◽

Chris K Finch ◽

Lauchland Roberts ◽

Angela Covington ◽

Joseph Krushinski

Keyword(s):

Medication Safety ◽

Medical Center ◽

Academic Medical Center ◽

Electronic System ◽

Future Studies ◽

Daily Number ◽

Academic Medical ◽

The Impact ◽

Triage Time

Missing medications can negatively contribute to the financial and operational workflows of pharmacy departments and add medication safety challenges. The missing medication request (MMR) system at the study institution converted to entirely electronic in June 2018 from a hybrid electronic system. This study evaluated 4-week periods pre- and post-conversion. The objective of this study was to evaluate the impact of conversion to an electronic MMR system on the quantity of requests received at an academic medical center. The average daily number of MMR’s decreased from the pre-conversion group to the post-conversion group (1.77 (±0.16) vs 1.48 (±0.17), p < 0.001). During post-conversion, the median triage time was 8 min [3 min–19 min], pharmacists triaged 62.4% of requests, and 29.6% of requests were declined. Conversion to an electronic MMR system represents one solution to decreasing missing medications. Future studies are needed to evaluate the financial, operational, and medication safety impact of conversion.

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