Large Tertiary Care Teaching Hospital Research Articles

Epidemiology and clinical characteristics of patients with healthcare-acquired multidrug-resistant Gram-negative bacilli: a retrospective study from a tertiary care hospital

The numbers of infections caused by Gram-negative bacteria (GNB) that produce extended-spectrum beta-lactamases (ESBLs) and those that are carbapenem resistant, especially Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), are increasing, and these infections are becoming a global public health problem. The aim of this study was to assess the prevalence of infections caused by ESBL-producing and carbapenem-resistant Gram-negative bacilli in patients hospitalized at An-Najah National University Hospital in Nablus, Palestine, and to provide healthcare workers with valuable information on the treatment of these infections. A retrospective cross-sectional investigation was conducted at a large tertiary care teaching hospital. The study included patients admitted to the hospital between January and December 2021, from whom ESBL-producing and carbapenem-resistant Gram-negative bacilli were isolated. The patients' clinical and demographic information was obtained from the hospital information system. In addition, information regarding the bacterial isolates and antibiotic resistance was obtained from the hospital's microbiology laboratory. This study included a total of 188 patients—91 males (48.4%) and 97 females (51.6%). The general surgical ward accounted for the highest proportion of infections (30.9%), followed by the surgical ICU (12.2%). The most common infections were caused by ESBL-producing E. coli, which accounted for 62.8% of the cases. Among them, urinary tract infections caused by this microorganism were the most prevalent (44.7% of patients). Over 50% of the patients (54.2%) had a history of antibiotic use, and 77.8% had been hospitalized within the past three months. ESBL-producing E. coli was significantly isolated from blood cultures (p-value = 0.000), and CR-K. pneumoniae was significantly isolated from endotracheal isolates (p-value = 0.001). This study emphasizes the concerning frequency of healthcare-acquired infections caused by ESBL-producing and carbapenem-resistant GNB in a tertiary care hospital. The substantial prevalence of antibiotic resistance presents considerable obstacles to the successful administration of routinely employed antibiotics. The results highlight the immediate need for improved antimicrobial stewardship and the implementation of infection control strategies to reduce the effects of multidrug-resistant GNB on patient well-being and public health.

Streamlining the Process of Communicating and Reporting of Hospital Operations by Using Checklists as a Quality Improvement Tool: An Experience of Designing and Implementation at a Large Multispeciality Tertiary Care Teaching Hospital

Streamlining the Process of Communicating and Reporting of Hospital Operations by Using Checklists as a Quality Improvement Tool: An Experience of Designing and Implementation at a Large Multispeciality Tertiary Care Teaching Hospital

OCCURENCE OF ADVERSE PREGNANCY OUTCOMES AND ITS RELATION TO LIPID PROFILE IN EARLY PREGNANCY IN WOMEN ATTENDING IN TERTIARY CARE CENTRE

Background: Maternal dyslipidemia has been linked to adverse perinatal outcomes. Hypercholesterolemia and elevated triglycerides in early pregnancy have been associated with an increased risk for gestational hypertension and adverse perinatal outcomes. The present study aimed to know the occurrence of adverse pregnancy outcomes among dyslipidemic pregnant females in rst trimester and the relationship between maternal lipid prole in early pregnancy and birth outcomes. Material and methods: Serum lipid levels of total 124 pregnant females were taken in rst trimester in a large tertiary care teaching hospital in New Delhi and they were followed up for their pregnancy and perinatal outcomes. The outcomes were stratied by normal and elevated lipid levels. Results: 41.9% pregnant females were found to be dyslipidemic. The common morbidities were gestational Hypertension (10.5)% and gestational diabetes (16.1%). The overweight females (BMI, 25-30 kg/m2) in hyperlipidemia group (61.5%) were more than normal lipid group (36.1%). (p<0.01). Babies with birth weight between 3.5- 4 kg were all born to mothers having hyperlipidemia during rst trimester (N=8). (p <0.01). Babies with birth weight falling under large for gestation (LGA) category were signicantly more in hyperlipidemia group (15.4%) compared to normal lipid group (2.8 %) (p<0.05). Mean serum total cholesterol and triglyceride was signicantly higher in women >30 years compared to women less than 30 years. Conclusion: Risk of gestational hypertension, preeclampsia and gestational diabetes was higher in females with hyperlipidemia in rst trimester. Hyperlipidemia and gestational diabetes were responsible for large for gestation birth weights

Clinical Implications of a Moderate Positive Correlation Between the Braden Score and the AM-PAC Basic Mobility Score in the Acute Care Setting

Introduction: The Braden scale (Braden) is a scoring system used by bedside nursing staff to document a patient's risk of developing a pressure injury. This scale is completed immediately upon hospital admission and every 12 hours throughout the hospital course. The Activity Measure for Post-Acute Care inpatient basic mobility short form “6 clicks” (AM-PAC) is a scale used by physical therapists (PT) that provides a numerical value to help determine a patient's activity limitations and translates into a potential discharge destination from the acute care setting. The AM-PAC is scored on initial physical therapy evaluation and every physical therapy session during hospital course. The relationship between the 2 has yet to be hypothesized. Methods: A total of 212 patient medical charts met the inclusion criteria for this retrospective chart review study. Criteria incorporated patients with acute care admission to a large tertiary care teaching hospital between March 1, 2019, and March 31, 2021. All patients received at least 1 physical therapy visit during the course of their admission. The Braden admission score for this study is defined as the score documented on the same day and time as the first physical therapy evaluation during admission. Admission AM-PAC score was defined as the score recorded during physical therapy evaluation not admission to hospital. Discharge AM-PAC was defined as the final physical therapy note documented during the hospital admission (may not line up with acute hospital discharge date). Admission and discharge scores for both scoring systems were calculated for comparison. Results: The Spearman correlation for the Braden and AM-PAC was positive with an R value of 0.613 (P = .000) for admission and an R value of 0.555 (P = .000) for discharge, making it a statistically significant relationship with a moderate correlation. When the Braden score increased in value, the AM-PAC score increased in value at admission and discharge of physical therapy. In addition, as the values increased, the standard deviation decreased. Trends in discharge destination were recorded; in each of these relationships the discharge and admission Braden and AM-PAC continued to change together and a correlation for the numeric value was gathered. Discussion: Overall, when calculated for comparison between patient admission and discharge, the numerical results of the Braden and AM-PAC scores had a positive moderate relationship. The result of the present study suggests that the Braden score obtained on hospital admission may assist in determining discharge needs early in hospital admission. Additionally, this relationship may allow for reallocation of hospital resources to areas of greater mobility needs, and allow for monitoring of a decline in patient function. Conclusion: The relationship between the Braden and AM-PAC scores may assist in closing the knowledge gap between bedside nursing and PT in terms of patient mobility. The use of this data is a starting point for education and further research that may lead to further clinical implications. Through the early identification of patients ready and in need of physical therapy services, hospitals may be able to better allocate resources and improve patient outcomes.

Title Causative agents distribution of isolated from dermatomycoses in Eskişehir city hospital Sort Title Superficial fungal infections

Abstract Objective Dermatomycoses are superficial fungal infections of the skin, hair and nails. The fungi responsible for dermatomycoses include dermatophytes, yeasts and non-dermatophytic molds (NDM). Onychomycosis is the most common nail disease caused by dermatophytes, NDMs, and yeasts with a worldwide. This study was under taken to investigate the current distribution of aetiological agents of dermatomycoses. Materials and Methods In this study, we evaluated the microscopic examination and culture results of the samples taken from the patients who applied to our clinic for two year. Species were identification on the basis of combined clinical pictures, culture and microscopic morphology characters of together. Results During the study period, 592 samples were examined. The distribution of isolates was found to be 118 (47.2%) NDM, 66 (26.4%) dermatophytes and 66 (26.4%) yeasts, respectively. Tinea unguium was the most prevalent type of dermatophytoses. T. rubrum was most frequent aetiological agents of detected in patients. According to our study, 22% of non-dermatophyte hyaline molds are Fusarium spp. and 21% are Aspergillus spp. species. Conclusion Several studies have shown that both the prevalence and aetiology of dermatomycoses can change according to geographical location, climatic conditions, personal factors. The objective of our study was to analyse 2 years of epidemiological data regarding dermatological mycology testing performed in a large tertiary care teaching hospital in Eskişehir, This report represents the most comprehensive analysis of this type from Eskişehir, and it is hoped that its findings will be of interest to, and inform, researchers and clinicians focused on mycoses and international epidemiology. To the best of our knowledge, we provide the first analysis from Eskisehir of fungal detections from all external body site (skin, hair and nail).

Increasing Fusobacterium infections with Fusobacterium varium, an emerging pathogen.

Infections caused by Fusobacterium species are rare; however serious infections with complications or mortality may occur occasionally. We conducted a retrospective study to investigate the clinical features of patients with Fusobacterium infections and the differences between infections caused by the species F. necrophorum, F. nucleatum, and F. varium. Additionally, we attempted to identify risk factors for Fusobacterium-associated mortality. This study included all patients at a large tertiary care teaching hospital in South Korea with Fusobacterium infections from January 2006 to April 2021. Demographic, clinical, laboratory, and outcome data were analyzed. Multiple logistic regression analysis was performed to assess the risk factors for in-hospital mortality associated with F. nucleatum and F. varium infections. We identified 272 patients with Fusobacterium infections during the study period. The number of Fusobacterium cases has increased recently, with F. varium infections markedly increasing since 2016 and causing a significant proportion of infections. Patients with F. varium infections were older and had a higher proportion of nosocomial infections than the other groups. The F. nucleatum and F. varium groups showed higher in-hospital mortality than the F. necrophorum group. Through logistic regression analysis, APACHE II score and serum albumin level were considered risk factors for in-hospital mortality. APACHE II score was positively correlated with age, red cell distribution width, and serum blood urea nitrogen, and negatively correlated with serum albumin level. Infections caused by Fusobacterium species are increasing. F. varium causes a significant proportion of severe infections.

Comparison of memory between blind and sighted individuals

Background: One of the current challenges in sensory aids for blind pertains to the possible visual acuity and capacity which can be transmitted through various restoration approaches. Behavioral studies have shown that visual perception is not essential for an efficient development of working memory suggesting other sensory modalities that might compensate by providing necessary spatial information. Aims and Objectives: The aims of this study were as follows: (1) To study and compare verbal memory in blind and sighted individuals. (2) To study and compare spatial memory in blind and sighted individuals. Materials and Methods: Study group – consisted of total 21 adventitiously blind subjects (12 males and nine females) taken from blind school, in age group of 18–27 years. Control group – consisted of total 64 apparently healthy sighted subjects (37 males and 27 females) obtained from large tertiary care teaching hospital in Pune. Every subject to perform (a) verbal memory test and (b) spatial memory test. Data were recorded by taking help of any person who was blinded to study and results of the previous research done. All results were recorded in a pre-specified format. Data were tabulated. Results had been analyzed using unpaired test by SPSS version 16. Results: The sighted subjects performed the verbal memory test (C4 and C5) significantly better (P < 0.05) (more letters recalled) than the non-sighted subjects. The sighted subjects performed the spatial memory test significantly better (less time taken) than the non-sighted subjects. Conclusions: While verbal memory or the auditory memory was tested, it was found that 60% of the times, there was no difference in the outcome of the test between both the groups. However, remaining 40% of the times, non-sighted, or the study group were able to perform better. Results of the spatial memory test revealed that 80% of the times, sighted group performed significantly better than the non-sighted group.

RATIONALE OF ANTIBIOTIC PRESCRIPTION IN PATIENTS VISITING A TERTIARY CARE SOUTH INDIAN HOSPITAL

Objective: Antimicrobials are the class of drugs that are used irrationally in most cases leading to rise in instances of antimicrobial resistance altering the effect of such agents. Antimicrobial resistance has become a critical issue universally nerving the need to monitor the utilization pattern and rationality in prescribing of antibiotics. This helps in selection of most appropriate antibiotic for the specific patient and achieving the goals of the therapy. Methods: A prospective cross-sectional study with a sample size of 600 participants was conducted in department of general medicine of a tertiary care hospital. Inpatients prescribed with antibiotics were included in the study and their case sheets were reviewed to analyzing the prescribing pattern. The medication usage pattern was then assessed for rationality in prescribing was evaluated. The results obtained were statistically analyzed using SPSS Software. Results: It is noted that a more number of males participated and the greatest number of the patients were from the age group of 31-45. The diagnosis found in the majority of the patients was respiratory tract infection followed by others. On scrutinizing the prescriptions, it was noted that cephalosporins and penicillins were most often prescribed, and on an average single, antibiotic was frequently used with the preferred route of administration in most of the prescriptions being injection route. Though many of the antibiotics were prescribed empirically, it was observed that 59% of them were most appropriately dosed and maximum patients that are around 57% were cured from their illnesses. Conclusion: This study provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship programs. The culture and sensitivity testing suggested that the drug resistance was more for most commonly prescribed antibiotics in the hospital. Increased targeted prescribing based on sensitivity tests will bring down the high use of empiric broad-spectrum antibiotic use.

The bacterial colonization of healthcare workers' mobile phones in a large tertiary care teaching hospital in Saudi Arabia.

The use of mobile phones by healthcare workers is a risk factor for microorganism transmission in healthcare settings. Pathogenic bacteria such as methicillin-resistant Staphylococcus aureus and gram-negative bacteria like Escherichia coli that are known to cause nosocomial infection have been isolated from mobile phones. In this cross-sectional study, we assess the burden and related risk factors of the bacterial colonization of healthcare workers' mobile phones. We collected samples from the mobile phones of 130 healthcare workers' in a Saudi Arabian teaching hospital, using moistened cotton swabs. The isolated organisms were identified using an automated identification and susceptibility system. Multiple logistic regression analysis was used to test the data. Of 130 swabs collected, 45 (34.6%) grew one species and 48 (36.9%) grew two or more. Staphylococcus epidermidis was the most commonly isolated bacteria (52.3%), followed by Micrococcus and related species (25.4%), Staphylococcus hominis (13.8%), and Bacillus species (6.9%). Clinically significant microorganisms such as S. aureus and Pseudomonas sp. were identified in 2 (1.5%) samples, respectively. The odds of mobile phone colonization were 8.5 times higher (95% CI = 3.2-23.1) in the laboratory, neonatal intensive care unit, and medicine departments. Mobile phones owned for more than one year were more likely to be culture positive (OR = 2.9, 95% CI = 1.1-7.6). In our study, the prevalence of bacterial colonization among healthcare workers' mobile phones was high. Our findings suggest that high-risk groups for mobile phone colonization-such as laboratory, neonatal intensive care unit, and medicine department staff-should be a priority for preventative measures, to improve infection control.

Preoperative anxiety among patients scheduled for elective surgical procedures during the COVID-19 pandemic - A cross-sectional study in a tertiary care teaching hospital in India.

Preoperative anxiety among patients scheduled for elective surgical procedures during the COVID-19 pandemic - A cross-sectional study in a tertiary care teaching hospital in India.

To Study the Sensitivity and Specificity of Ankle Brachial Index in Diagnosis of Peripheral Arterial Disease in Diabetics With Coronary Artery Disease at a Large Tertiary Care Teaching Hospital

The aim of study was to determine the sensitivity and specificity of ankle brachial index in diagnosis of peripheral arterial disease in diabetics with coronary artery disease at a teaching hospital in North India. Materials and methods: All diabetic patients admitted with coronary artery disease who undergo coronary angiography irrespective of their presentation (stable angina, unstable angina, NSTEMI, STEMI) were included in the study. Systolic blood pressures of both arms at the brachial arteries and both lower limbs at the dorsalis pedis arteries were taken with the help of sphygmomanometer and a hand held doppler probe and recorded in the proforma. The higher of the two systolic pressures recorded at the ankle was divided by the highest of the systolic pressures recorded in the arms to get the ankle brachial index. The results of ABI were compared with peripheral angiography.

Mortality from Pulmonary Embolism by Clinical Severity

Aim: To report all-cause and PE related short term mortality by clinical severity of PE and to identify any missed opportunities for thrombolysis. Background: Mortality related to pulmonary embolism varies widely in the reported literature even for the same clinical severity category of PE. Method: Electronic medical records of all patients presenting to a large tertiary care teaching hospital in London, between October 1, 2018, and January 16, 2020, who had a discharge diagnosis of acute pulmonary embolism were reviewed retrospectively. Results: There was no PE related mortality in the low-risk PE group. There was one PE related death in the submassive PE group (1.47% mortality on day 14 and day 30). Massive PE was associated with a 29.4% PE related mortality short-term mortality.

One for Everyone: A Study of User Satisfaction Among Health-Care Providers Regarding Extended Use of N95 Masks During the COVID-19 Pandemic

This study was conducted to assess the feasibility of extended use of N95 masks in our hospital during the coronavirus disease 2019 (COVID-19) pandemic. We also studied the use pattern, user satisfaction, and issues faced during extended use of the mask. This cross-sectional study was conducted among health-care providers in a large tertiary care teaching hospital in northern India from April 1 to May 31, 2020. A list was prepared from the institute's register, and participants were chosen by random sampling. The data collected from the physical forms were transferred to excel sheets. A total of 1121 responses were received. The most common problem stated with reuse of N95 masks was loss of fit followed by damage to the slings, highlighted by 44.6% and 44.4% of the participants, respectively. A total of 476 (42.5%) participants responded that they would prefer "cup-shaped N95 mask with respirator". The median scores regarding the satisfaction with the quality of masks and their fit was also 4 each. It was concluded that the extended use of N95 masks was acceptable, with more than 96% of the participants using these masks.

Effect of Meropenem Restriction on Time Between Order and Administration in a Medical Intensive Care Unit

Background: In this study, we assessed whether meropenem restriction led to delays in administration for patients in a medical intensive care unit (MICU) at a large tertiary-care urban teaching hospital. Methods: The antimicrobial stewardship program (ASP) at Virginia Commonwealth University Health System (VCUHS) requires approval for restricted antimicrobial orders placed between 8 a.m. and 9 p.m. Between 8 a.m. and 5 p.m. (daytime), authorized approvers include ASP and infectious diseases (ID) physicians. From 5 p.m. to 9 p.m. (evening) orders are approved by ID fellows. Orders were entered as Stat, Now, and Routine. Between 9 p.m. and 8 a.m. (night), patients receive doses without approval. Meropenem restriction began in mid-January 2018. Pre- and postmeropenem restriction periods were defined as February–December 2017 and February–December 2018. Meropenem use data were compared for adult patients in the MICU. A multivariable Cox regression model was implemented to compare (1) time from order entry to approval; (2) time from order approval to patient administration; (3) total time from order entry to patient administration, adjusting for order priority, approver (ASP, ID consult, ID fellow, pharmacy); and (4) time of day of order placement (day, eve, night). The analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). Result: Time from order approval to patient administration was significantly decreased in the postrestriction period (HR, 1.840; P < .001) (Table 1). Stat orders were faster compared to routine orders for order entry to approval (HR, 1.735; P < .001), approval to administration (HR, 2.610; P < .001), and total time from order entry to administration (HR, 2.812; P < .001). No significant differences were found in time to approval by approving service. Time from order entry to approval was faster for nighttime orders than for daytime orders (HR, 1.399; P = .037). Conclusions: Our data indicate that the time from order entry to administration decreased following meropenem restriction in our MICU. More research is needed to identify the reason for this finding, but we postulate that this is due to an effect on drug administration prioritization within nursing workflow. These data will inform our local meropenem restriction efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

Medical interns\u2019 reflections on their training in use of personal protective equipment

BackgroundThe current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates’ experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety.MethodsThis study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns’ self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour.Results80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use.ConclusionsUndergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices.

Diagnostic Accuracy of High-Resolution Computed Tomography of Chest in Diagnosing Sputum Smear Positive and Sputum Smear Negative Pulmonary Tuberculosis.

IntroductionPulmonary tuberculosis (PTB) is caused by species of organisms in the Mycobacterium tuberculosis complex. It is a major public health problem worldwide and is endemic in Pakistan. Various clinical and biochemical markers exist for its diagnosis. Radiology has an important role in the diagnosis of PTB. Initially, a chest radiograph is warranted for PTB evaluation. High-resolution computed tomography (HRCT) also has high sensitivity and specificity for PTB diagnosis. Features of primary TB include consolidation, lymphadenopathy, pleural effusion and miliary nodules whereas post-primary TB include apical consolidation, nodules and cavitation. The aim of this study was to determine the diagnostic accuracy of HRCT chest in diagnosing sputum smear positive and smear negative PTB.MethodsA cross-sectional study was conducted at a large tertiary care teaching hospital. A retrospective review of medical records of patients who underwent HRCT chest and sputum acid-fast bacillus (AFB) direct smear and AFB culture for suspicion of PTB was undertaken. All HRCT chest examinations were performed on multislice computed tomography (CT) scanner. On HRCT, PTB was defined as the presence of consolidation, centrilobular nodules, branching nodules with tree in bud appearance with or without lymphadenopathy and pleural effusion. Diagnostic accuracy of HRCT including sensitivity, specificity, positive and negative predictive values was calculated using 2 x 2 table, taking findings of AFB culture as a gold standard.ResultsA total of 108 patients were included in this study with a mean age of 51.85 ± 16.86 years. Diagnostic accuracy of HRCT in diagnosing PTB was found to be 84.26% with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 89.09%, 79.25%, 81.67%, and 87.50%, respectively. In sputum smear positive patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 87.50%, 88.57%, 84.62%, 93.94%, and 73.33%, respectively. In sputum smear negative patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 81.67%, 90.00%, 77.50%, 66.67%, and 93.94%, respectively.ConclusionHRCT has high sensitivity in diagnosing sputum smear positive and sputum smear negative PTB. The specificity of HRCT in diagnosing sputum smear positive PTB was high, whereas it was slightly low in diagnosing sputum smear negative PTB. Overall diagnostic accuracy of HRCT was high in diagnosing PTB.

The Coronavirus Pandemic: Experience From a Rural West Virginia Tertiary Care Hospital

The coronavirus epidemic has taken the world by storm and has overwhelmed health systems in a number of first world countries. As a consequence, individual communities in the United States and the world have had to develop response plans to meet this extreme challenge. In these circumstances and in an effort to best prepare for the community's needs, it becomes necessary to critically analyze the specific and unique aspects of individual regions, their population characteristics and demographics, and the geography of the area. Once assessed, these data may be applied to formulating best practices for a given community and resource pool. The following manuscript describes how this challenge was met in a large tertiary care teaching hospital located in rural West Virginia.

Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship.

Purpose: The purpose of this study was to implement and evaluate a novel internship model that incorporates a practice tutor in physiotherapy clinical education during an acute care cardiorespiratory internship at a large acute tertiary care teaching hospital in Canada. Method: A prospective evaluation of this model was conducted by means of a mixed-methods approach using surveys and focus groups. The participants were students and clinical instructors (CIs) who were taking part in the internship. Results: Half of the CIs agreed that the practice tutor model gave them more time to manage their caseload and work with the student than did the traditional model, and 63% would recommend the model for future internships. In reviewing the focus group and open-ended data, we identified four themes: benefits, tensions, critical logistics, and unforeseen blind spots. There was a trend for patient attendance to increase with the practice tutor model compared with the previous year's internship session and with the 5 weeks immediately preceding the internship. Conclusions: On the basis of CIs' and students' self-reports, the piloted practice tutor model was perceived to facilitate students' clinical reasoning and collaborative learning skills. In addition, during the 5-week internship, the number of patients seen each day by the individual CIs and their students was not reduced, with a trend toward increased patient attendance. There was also a trend toward CIs having the same or more time to manage their caseload and work with the students compared with a non-practice tutor internship model. Recommendations to improve this model in future implementations are made.

Outcomes of Cataract Surgery Complicated by Retained Lens Fragments Requiring Pars Plana Vitrectomy.

ObjectiveTo analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees.MethodsRetrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20).Main Outcomes/MeasuresVisual acuity was recorded pre- and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression.ResultsThe average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p<0.01). Complications following PPV included hypotony (5 patients), corneal edema (4), elevated intraocular pressure (IOP) (3), and cystoid macular edema (3).Conclusions/RelevanceDespite patients with advanced pathology and trainee surgeons, rates of cataract surgery-associated RLF requiring PPV at a large tertiary care teaching hospital are similar to reported rates in the literature.

Predictors of survival in continuous ambulatory peritoneal dialysis patients: a five-year prospective study.

Our objective was to examine the influence of various demographic, clinical, and enrollment biochemical variables on the long-term survival of continuous ambulatory peritoneal dialysis (CAPD) patients. This was a prospective cohort study investigating the relationship between demographics and enrollment biochemical markers and mortality in CAPD patients in a CAPD unit in a large tertiary care teaching hospital. One hundred and sixty-nine patients in the CAPD program were enrolled between 1989 and 1994, and were followed up to 60 months. Independent predictors of mortality determined by Cox proportional hazards model included age, diabetes, serum albumin and creatinine. Enrollment level of serum albumin, and creatine can predict mortality in CAPD patients up to 60 months. Markers of visceral and somatic nutrition at enrollment are important predictors of mortality in CAPD patients up to five years.