scholarly journals First do no harm: Moving beyond universal pre-procedural testing for COVID-19

2021 ◽  
Author(s):  
Jessica Penney ◽  
Sajani Shah ◽  
Shira Doron
Keyword(s):  
Patient Outcomes ◽  
Healthcare Workers ◽  
Test Results ◽  
Patient Centered ◽  
Do No Harm ◽  
Community Transmission ◽  
Polymerase Chain ◽  
Community Infection ◽  
Improve Patient ◽  
Rate Threshold

Abstract Pre-procedural testing for SARS-CoV-2 was introduced early in the pandemic in an effort to protect healthcare workers, direct appropriate use of personal protective equipment (PPE), and improve patient outcomes. In light of our appreciation for the efficacy of PPE and the nuances associated with interpretation of polymerase chain reaction (PCR) testing for SARS-CoV-2, particularly as community transmission decreases, we call for a re-evaluation of universal pre-procedural testing. We propose a transition to a patient-centered approach, focusing on testing patients whose outcomes would be improved by a delayed procedure in the event of a positive test and a greater reliance on appropriate PPE rather than pre-procedural test results. We recommend that a community infection rate threshold be set at which point pre-procedural testing is discontinued, understanding that there is an inflection point at which testing downsides outweigh the benefits.

Not all that vesicles is herpes

Diagnosis ◽  
2017 ◽  
Vol 4 (4) ◽  
pp. 261-264 ◽  
Author(s):  
Robert R. Gruhl ◽  
Andrew Wu ◽  
Micah Niermann ◽  
Andrew Olson
Keyword(s):  
Patient Outcomes ◽  
Antibiotic Prescription ◽  
Febrile Child ◽  
Chain Reaction ◽  
Case Presentation ◽  
Multiple Exposures ◽  
Vesicular Rash ◽  
Polymerase Chain ◽  
Simplex Virus ◽  
Improve Patient

AbstractBackground:Eczema coxsackium (EC) can manifest in patients with underlying atopic dermatitis (AD) as a diffuse vesicular rash in a febrile child. The presentation overlaps clinically with the feared diagnosis of eczema herpeticum (EH), which makes differentiating between the conditions very important.Case presentation:A 6-month-old girl with known AD presented with fever and rapidly spreading vesicular rash. The patient had multiple exposures including a new antibiotic prescription, introduction of new foods, 6-month vaccinations and a sick contact. She was treated empirically with acyclovir for EH until herpes simplex virus (HSV) polymerase chain reaction (PCR) returned negative and enterovirus PCR returned positive. Once the diagnosis of EC was confirmed, antiviral therapy was discontinued and she was treated successfully with supportive measures without sequelae.Conclusions:Differentiating EC from EH is important clinically as EC is self-limiting and resolves spontaneously whereas EH may cause severe complications if not treated early. While morphology alone cannot reliably distinguish between the conditions, clinical suspicion based on history can prompt proper testing and improve patient outcomes.

scholarly journals Systematic Review: Enhanced Recovery After Cholecystectomy Surgery

2019 ◽  
Author(s):  
Meghan Cole
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Improve Patient Care ◽  
Healthcare Spending ◽  
Patient Centered ◽  
Systems Model ◽  
Lengths Of Stay ◽  
Improve Patient

This systematic review aimed to answer the clinical question, which perioperative enhanced recovery after surgery (ERAS) techniques are most effective in decreasing recovery time and length of stay for adults, aged 18-65, undergoing cholecystectomy surgery? In an effort to curb healthcare spending, ERAS is one way to reduce hospital- associated costs. Originally developed in Denmark, ERAS is a patient-centered initiative that aims to reduce the body’s stress response, leading to improved patient outcomes and decreased hospital lengths of stay. Betty Neuman’s Systems Model was used as a theoretical framework to enrich the understanding of enhanced recovery and how it works to improve patient care.

scholarly journals Prevalence of IgG antibodies against the severe acute respiratory syndrome coronavirus-2 among healthcare workers in Tennessee during May and June, 2020

2020 ◽  
Author(s):  
Peter F. Rebeiro ◽  
Kara J. Levinson ◽  
Lindsay Jolly ◽  
Elizabeth Kassens ◽  
George J. Dizikes ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
American South ◽  
Severe Disease ◽  
Large Population ◽  
Antibody Test ◽  
Test Results ◽  
Younger Workers ◽  
Community Transmission ◽  
The American South ◽  
Susceptible Populations

AbstractSARS-CoV-2 seroprevalence was low (<1%) in this large population of healthcare workers (HCWs) across the state of Tennessee (n=11,787) in May-June 2020. Among those with PCR results, 81.5% of PCR and antibody test results were concordant. SARS-CoV-2 seroprevalence was higher among HCWs working in high-community-transmission regions and among younger workers.ImportanceThese results may be seen as a baseline assessment of SARS-CoV-2 seroprevalence among HCWs in the American South during a period of growth, but not yet saturation, of infections among susceptible populations. In fact, this period of May-June 2020 was marked by the extension of renewed and sustained community-wide transmission after mandatory quarantine periods expired in several more populous regions of Tennessee. Where community transmission remains low, HCWs may still be able to effectively mitigate SARS-CoV-2 transmission, preserving resources for populations at high risk of severe disease, and these sorts of data help highlight such strategies.

scholarly journals Many People Are Afraid of White Coats. They Should Be

2018 ◽  
Author(s):  
Kathryn Tente
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Multidisciplinary Team ◽  
Healthcare Workers ◽  
Cross Contamination ◽  
Potential Source ◽  
Do No Harm ◽  
Figure Of Speech ◽  
Culture And Sensitivity

The concept of “do no harm” is not a figure of speech. It is a pledge to our patients to insert ourselves between them and anything that can harm them physically or emotionally. “Do lab coats harbor microbes that are detrimental to our clients’ health?” was the question that drove this systematic review. Using a search to cover articles regarding the microbial integrity of the coat, several studies were found to include culture and sensitivity reports along with participants’ surveys that increase the data to include demographics, handling habits of the coat along with laundering habits of the owners of the coats. Eight studies were reviewed, seven of the eight did provide survey information, to extract data and conclusions for the summarization of the integrity of the coat. The microbial compromise of the garment was confirmed, and solutions were uncovered as the eight studies were examined. All studies referred to the garment as a source or a potential source of cross contamination. Using education guided by a multidisciplinary team, nurse practitioners can lead an effective approach to aid in the safe handling of the white coat. Standards for the handling of the coat along with monitoring of the compliance of healthcare workers can lead to a safer environment and better patient outcomes.

Combined Approaches to the Skull Base for Intracranial Extension of Tumors via Perineural Spread can Improve Patient Outcomes

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Sheri Palejwala ◽  
Jonnae Barry ◽  
Crystal Rodriguez ◽  
Chandni Parikh ◽  
Stephen Goldstein ◽  
...  
Keyword(s):  
Skull Base ◽  
Patient Outcomes ◽  
Intracranial Extension ◽  
Perineural Spread ◽  
Improve Patient

Microporous Polysaccharide Hemosphere Absorbable Hemostat (AristaAH®) in Re-Operative Cardiac Surgical Procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 96-98
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe
Keyword(s):  
Patient Outcomes ◽  
Surgical Procedures ◽  
Systematic Approach ◽  
Surgical Intervention ◽  
Transfusion Requirement ◽  
Cardiac Surgical Procedures ◽  
Platelet Inhibitors ◽  
Hemostatic Agents ◽  
Surgical Field ◽  
Improve Patient

Patients undergoing re-operative cardiac surgical procedures present a great challenge with regard to obtaining hemostasis in the surgical field. Adhesions are ever-present and these patients are often on oral anti-coagulants and platelet inhibitors. As part of a well-planned surgical intervention, a systematic approach to hemostasis should be employed to decrease blood transfusion requirement and improve patient outcomes. Topical hemostatic agents can be a great help to the surgeon in achieving surgical field hemostasis and are increasingly being employed. Our approach, to these difficult patients, includes the systematic and planned use of AristaAH, which is a novel hemostatic agent whose use has proven safe and efficacious in our patient population.

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