SafeSwab, a sample collection and dispensing device for near-patient testing

The COVID-19 pandemic has accelerated the pace of innovation around virtual care visits and testing technology. Here we present the SafeSwab (Safe Health Systems, Los Angeles, CA), an integrated, universal sample collection and dispensing device that is designed to minimize user error and enable rapid testing in a point of care or self-testing format. The SafeSwab was used with the Safe Health Systems HealthCheck digital health application to enable self-testing by patients using lateral flow tests for SARS-CoV-2 antigen or for antibodies against SARS-CoV-2. Patients (n=74) using the SafeSwab produced a valid rapid test result in 96% of attempts, and 96% of patients felt confident that they had collected a good sample. The Safe HealthCheck app has an integrated image analysis algorithm, AutoAdapt LFA, that interprets a picture of a rapid test result, and the algorithm interpreted the result correctly 100% of the time. The SafeSwab was found to be versatile and easy to use for both self-collected nasal sampling as well as fingerstick blood sampling. The use of Safe Health Systems HealthCheck app allows an integrated solution for patient instruction and test interpretation

Adrenally Directed Medical Therapies for Cushing Syndrome

Context Endogenous Cushing syndrome (CS) is characterized by excess cortisol secretion, which is driven by tumorous secretion of corticotropin in the majority of patients. Untreated, CS results in substantial morbidity and mortality. Tumor-directed surgery is generally the first-line therapy for CS. However, hypercortisolism may persist or recur postoperatively; in other cases, the underlying tumor may not be resectable or its location may not be known. Yet other patients may be acutely ill and require stabilization before definitive surgery. In all these cases, additional interventions are needed, including adrenally directed medical therapies. Evidence Acquisition Electronic literature searches were performed to identify studies pertaining to adrenally acting agents used for CS. Data were abstracted and used to compile this review article. Evidence Synthesis Adrenally directed medical therapies inhibit one or several enzymes involved in adrenal steroidogenesis. Several adrenally acting medical therapies for CS are currently available, including ketoconazole, metyrapone, osilodrostat, mitotane, and etomidate. Additional agents are under investigation. Drugs differ with regards to details of their mechanism of action, time course of pharmacologic effect, safety and tolerability, potential for drug-drug interactions, and route of administration. All agents require careful dose titration and patient monitoring to ensure safety and effectiveness, while avoiding hypoadrenalism. Conclusions These medications have an important role in the management of CS, particularly among patients with persistent or recurrent hypercortisolism postoperatively or those who cannot undergo tumor-directed surgery. Use of these drugs mandates adequate patient instruction and close monitoring to ensure treatment goals are being met while untoward adverse effects are minimized.

CONTACT LENS PRACTITIONER PRACTICES IN RELATION TO PATIENT COMPLIANCE AT LIONS SIGHT FIRST EYE HOSPITAL, KENYA

Background: Contact lens practitioners (CLPs) play a vital role in the fitting of contact lenses (CL) and thus have a great influence on patient compliance. Studies have often focused on investigating levels of compliance and thus limited knowledge of CLP practices. Thus, this study aimed to investigate CLP practices on CL wear and care. Methods: The study employed a cross-sectional research design. Purposive sampling technique was used to select consenting CLP’s working Lions Sight First Eye Hospital (LSFEH). A self-administered questionnaire, containing questions on current Practices, was used to collect information. Once ethical clearance from MMUST IERC, NACOSTI and permission LSFEH were obtained data collection process began. A total of fifteen (15) CLP participated in the study. Results: The mean age of the practitioners was 31± 3.87. Most (67%) of the CLPs had worked for between 5 to 10 years. A majority (73%) of the practitioners had bachelor’s degree. Most (87%) of them specialized in soft lenses. Majority of the CLP use of written appointment card, 53% of the CLP use of manufacturer guidelines and oral communication is the most used form of training patients as said by 60% of the CLP. Conclusion: CLPs at LSFEH had good wear and care practices on patient instruction. For successful CL wear, patients need to follow instructions given by CLPs on CL wear and care. It is, therefore, necessary for CLPs to practice according to the recommended guidelines to avoid patient non-compliance. <p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0726/a.php" alt="Hit counter" /></p>

The Virtual Foot and Ankle Physical Examination

The COVID-19 pandemic has necessitated a rapid and drastic shift for clinicians and patients away from traditional in-person visits and toward internet-based virtual visits. The adoption of telehealth services is likely to persist in some capacity even as in-person visits resume, given the convenience and efficiency of telehealth consultations for patients and perhaps surgeons. A primary challenge of virtual visits, particularly in the field of orthopedic surgery, is the physical examination. However, for the foot and ankle, routine physical examination maneuvers can be completed virtually with little modification given proper patient instruction. We present a comprehensive virtual foot and ankle examination for telehealth visits, including instructions that can be provided to patients verbatim and a corresponding checklist for provider documentation. Level of Evidence: Level V, expert opinion.

QIM19-126: NCCN Member Institution Patient Education and Teaching for Biliary Stents and Drains

Background: Biliary obstruction often occurs with hepatobiliary cancers. Treatment consists of internal biliary stents or external biliary drains. Patient education regarding signs and symptoms of cholangitis, change of stents, or care of biliary drains is both critical and challenging. The Nursing Advisory Board of the Cholangiocarcinoma Foundation (CCF) found patient questions regarding stents and drains posted on the CCF website. Quality of life is impacted by treatment complications as well as lack of knowledge regarding living with stents or drains. Aim: To compare stent and biliary drain patient education practices of NCCN Member Institutions across the United States. Methods: A 40 item information survey was sent to the NCCN Member Institutions by email. Intended respondents were nursing or health professionals who provided patient instruction regarding biliary stents drains. The survey was sent to interventional radiology and endoscopy departments. It included questions regarding demographics of respondents, patient education and instructions, supplies provided, signs and symptoms to be reported, and follow-up appointments. Results: There were 26 survey responses. Of the 26 responses, 23 responses were complete. Patient education regarding stents or drains was predominantly completed by registered nurses (74%), or nurse practitioners (26%). The largest number of respondents practiced in interventional radiology (52%), endoscopy (13%), and other (30%), which included gastroenterology, or surgery. Verbal and written instructions were provided by 87% of NCCN centers. There was variation in survey responses regarding biliary drains. Survey responses regarding biliary stents were more cohesive. A schedule for stent change was provided by 75% of NCCN Member Institutions, although there was variation on length of time between stent exchanges. The majority of patients at these institutions receive education regarding signs and symptoms to report (95%). Conclusion: Discharge instructions to patients with external drains are inconsistent. Although there is some agreement among NCCN Member Institutions, the schedules for stent change vary. Patient education and instruction is predominantly provided by nurses and NPs. The importance of teaching signs and symptoms to report is evident in this sample. Standardized patient instructions post stents or external biliary drains may enable patients to care for drains and will help nurses and NPs reinforce consistent education.

Immediate post-transplant care and surgical complications

Care of the post-transplant kidney patient is complex and requires multidisciplinary team working. Careful attention is paid to haemodynamics, fluid balance, microbiology, drug prescription, and patient instruction. Delays in, or reduction of, graft function should be investigated and treated immediately to ensure long-term graft survival. Because complications do occur, they must be recognized early and dealt with promptly. The nature of the transplant operation and the need for immunosuppression mean that the complications differ from those of ordinary general surgical patients, and so require specialist medical, microbiological, or radiological input with a narrower time window for correction. This chapter covers the immediate postoperative care of the renal transplant recipient both as an inpatient and the early period as an outpatient, highlighting the potential complications and their management.

Nature and management of duplicate medication alerts

Objective: To investigate the nature of duplicate medication (DM) alerts, their management by community pharmacists, and potential characteristics of DM alerts that lead to interventions by pharmacists. Methods: Observational study in 53 community pharmacies. Each pharmacist registered the nature and management of 24 DM alerts on a structured form. Results: On average, the clinical decision support systems generated 20.4 DM alerts per 100 dispensed drugs. In half of the 1272 registered alerts, the pharmacists judged that there was no risk for concurrent use of both prescriptions. In 32% of the alerts, the DM alert was generated for an intentional combination. In 17% of the alerts, there was a risk for unintentional concurrent use. In 32% of the alerts the pharmacists decided that one or more actions were needed: the electronic patient record was updated in 15% of the alerts and in 19% of the alerts the pharmacists performed an external action—for example, informing the patient or modifying the prescription (including 5 therapeutic prescription modifications and 22 logistic prescription modifications). Alerts concerning first dispensing were more likely to be followed by an external action than alerts concerning refills (40% vs 14%, P &lt; .001). Discussion and Conclusion: In community pharmacy, prescription modifications based on DM alerts are rare, but DM alerts lead with some regularity to other actions—for example, patient instruction and update of the electronic patient record. As the current DM alerts are diverse and nonspecific in detecting situations where external action is considered relevant, other ways of alerting should therefore be considered.