The impact of polymerase chain reaction (PCR) on diagnosis and management of infectious uveitis at a tertiary care facility

Background Polymerase Chain Reaction (PCR) is a well-accepted adjunct in the management of infectious uveitis. In turn, few reports in the literature have evaluated how PCR then impacts patient care. This study aims to evaluate the impact of PCR sampling on diagnosis and treatment of infectious uveitidies at a large tertiary care facility. Main body This is a retrospective, observational study of patients with aqueous and vitreous PCR samples obtained from 2014 to 2019. The study was undertaken at a single institution. At least one follow up visit following results of PCR testing was required for inclusion. If a patient had multiple PCR samples taken, only the first sample was included. The patients were divided into three categories based on pre-sampling diagnosis. A chi-square test was used to analyze the data. 108 cases were available for analysis. PCR did not change diagnosis or management in any of the cases where pre-sampling diagnosis carried a high clinical suspicion for negative PCR. Overall, the results of PCR testing had a more significant impact on diagnosis in those cases where pre-sampling diagnosis was unknown versus those where it was confirmatory in nature, thus presumed to be related to an infectious entity tested by PCR (74% vs. 29%, p = 0.00006). The rate of treatment change based on PCR was similar between those cases where there was a high clinical suspicion for positive PCR and those where pre-sampling diagnosis was unknown (32% vs. 33%, p = 0.95). Further analyzing specimens separately depending on source of sample, this pattern persisted for aqueous samples, with PCR showing a more significant impact on diagnosis in those cases where the diagnosis was unknown versus those where sampling was confirmatory (86% vs. 31%, p = 0.00004). The rate of change in treatment between the two groups was similar (35% vs. 31%, p = 0.79). Vitreous samples followed a similar pattern with a higher rate of diagnosis change for those cases where pre-sampling diagnosis was unknown and a similar rate in treatment change between the two groups, however this did not reach statistical signifigance (44% vs. 25%, p = 0.28; 27% vs. 33%, p = 0.74). Conclusion There is no well-defined algorithm as to when to employ PCR testing in uveitis. As expected, in our experience, it has the largest impact on diagnosis when the diagnosis is unknown, however even when confirmatory in nature, it continues to impact patient management.

Exploring Dementia Care in an Acute Care Setting: Perspectives of Social Workers and Nurses

Nurses and social workers in acute care settings have unique perspectives about providing care to persons living with dementia (PLwD) who experience behavioral and psychological symptoms of dementia (BPSD). Their distinctive roles and training have important implications for the recovery and well-being of PLwDs during hospital stays. This study utilized the "rigorous and accelerated data reduction" (RADaR) technique to compare perspectives of social workers (n=12) and nurses (n=5) in a Midwestern tertiary care facility about their caring for PLwds with BPSD. Three major themes were identified: 1) patient engagement and coordination with family and professionals, 2) treatment and medical management, and 3) barriers to care. Similarities between social workers and nurses emerged within the themes, including the importance of family involvement and providing person centered care. Differences emerged particularly within the treatment and medical management theme, as nurses utilize medications to treat BPSD and social workers were more likely to use redirection. While there is distinctive training for nurses and social workers, both identified similar barriers to providing care to PLwDs with BPSD, including time constraints, competing demands, and lack of training on BPSD management. Results demonstrate how an understanding of the critical and complementary roles that nurses and social workers play in dementia care and work together to build a care team can inform best practices to support symptom management and quality of life in PLwDs. Continuing education and training could be beneficial for both professionals to improve the quality of care for PlwDs.

Depression and coping strategies used among adolescents with cystic fibrosis

Background: Cystic fibrosis (CF), an autosomal recessive monogenic chronic disorder affects the lungs, pancreas, and other exocrine glands, and manifests as recurrent respiratory infections, malabsorption, and a myriad of complications pertaining to other systems like hepatobiliary, endocrine and reproductive systems. Objectives were to assess the level of depression among adolescents with CF, to assess the coping strategies used by adolescents with CF and to find an association between selected sociodemographic and clinical variables with depression.Methods: In a cross-sectional survey, 30 adolescents with CF in the age group of 12-18 years, attending the specialty clinic of a selected tertiary care facility were enrolled using a purposive sampling technique. Tools consisting of sociodemographic and clinical profile, patient health questionnaire (PHQ)-9, and ways of coping with CF were used for data collection.Results: Most of the adolescents with CF (66.7%) had depression of varying severity with 36.7% having moderate-severe to severe depression. The frequently used coping strategies by the adolescents with CF were hopefulness (76.66±11.29), followed by optimistic acceptance (70.23±13.04). The individual coping strategy with the highest mean score was “having confidence on doctor and treatment” (3.83±0.37), while ‘I cry, eat, drink or take drugs’ had the lowest score (1.6±1.00).Conclusion: Depression is a common problem among adolescents with CF requiring regular screening and referral to experts for enhancing their coping strategy of optimistic acceptance.

Patient Knowledge of Opioid Usage and Side Effects Prior to Surgery

BackgroundGiven the increasing morbidity and mortality related to prescription opioids in the United States, it is critical for patients to understand the risks and proper usage of opioid analgesics.MethodsWe surveyed 166 patients undergoing elective surgery at a single tertiary care facility preoperatively. We queried patients regarding aspects of prescription opioid use, side effects and adverse effects, and storage and disposal behaviors.ResultsOverall knowledge regarding prescription opioids was high (mean score = 8.05/12, range 0–12). The average number of questions answered correctly was not significantly different based on opioid use at the time of the survey (65% vs 67.5%, p = 0.52). Characteristics significantly associated with higher knowledge included young age (p = 0.01), female gender (p < 0.01), and white race (p = 0.01).ConclusionsPatient knowledge regarding prescription opioids is high preceding surgery, but gaps remain regarding side effects and adverse effects. Knowledge did not differ by prior or current opioid use, and these findings may help target important knowledge gaps to improve patient education regarding opioids during the preoperative period.

Role of stroboscopy in evaluation of patients with vocal abnormalities

<p class="abstract"><strong>Background:</strong> Stroboscopy is an examination in which strobe light is combined with laryngoscopy, to visualize the vocal fold vibration. It makes use of the Talbot’s law for visualizing the vibrating vocal fold having frequency of around 250 times per sec. This technique was used for studying voice abnormalities and evaluate related pathologies. The aim and objective was to evaluate patients with vocal abnormalities with the help of stroboscope and to study the mucosal wave pattern pre and post treatment of vocal cord pathologies.</p><p class="abstract"><strong>Methods:</strong> A prospective observational study was conducted at a tertiary care facility in central India. 50 patients with vocal abnormalities for more than 2 weeks were subjected to stroboscopy. Written informed consent from eligible patients was obtained and they were evaluated by stroboscopy using Karl Storz stroboscope with 70 degree 8 mm telescope, model no.: 20140020032. A second follow up stroboscopy was done two months post treatment and the parameters were recorded.</p><p class="abstract"><strong>Results:</strong> VC nodule was observed as the most common pathology followed by vocal polyp, carcinoma and chronic laryngitis. It was also observed that there was statistically significant difference (p&lt;0.001) in pre and post treatment findings of different parameters of voice evaluated using stroboscopy.</p><p class="abstract"><strong>Conclusions:</strong> Video stroboscopic evaluation proved to be a useful and reliable tool for evaluation and treatment of the patients with voice abnormalities as the changes in pre and post treatment voice parameters were found to be statistically significant.</p>

Understanding the Role of the Otolaryngology Hospitalist: Tracheostomies and Tracheostomy Care

Introduction: The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT). Methods: Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed. Results: Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult. Conclusion: In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis

Background: Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). Methods: Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI T scores were analyzed with paired t tests. The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling. Results: The sample had mean age of 57.69 years; 48% were male, and 55% were obese. Patients who underwent ankle and hindfoot arthrodesis had statistically significant improvements from preoperative to 12 months postoperative in mean PF (36.26±7.85 vs 39.38±6.46, P = .03) and PI (61.07±7.75 vs 56.62±9.81, P = .02). Triple arthrodesis saw the greatest increases in physical function (▵PF = 7.22±7.31, P = .01) and reductions in pain (▵PI = –9.17±8.31, P = .01), achieving minimal clinically important difference (MCID). Patients who underwent tibiotalar fusion had significant improvement in physical function (▵PF = 4.18±5.68, P = .04) and pain reduction that approached statistical significance (▵PI = –6.24±8.50, P = .09), achieving MCID. Older age (≥60 years ) was associated with greater improvements in PF ( β = 0.20, P = .07) and PI ( β = –0.29, P = .04). Preoperative PF and PI T scores were significantly associated with the 12-month change in PF and PI T scores, respectively ( β = –0.74, P < .01; β = –0.61, P < .01). Conclusion: Hindfoot and ankle fusions are procedures with favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation. Level of Evidence: Level II, prospective comparative study.