Improving Compliance to Follow-Up Care After Primary Emergency Department Ophthalmic Consultation.

PURPOSE: To identify factors that affect the likelihood of follow-up after emergency department (ED) visit for ophthalmic complaints and to evaluate a protocol to improve compliance. DESIGN: Prospective interventional study with historical controls. METHODS: This study was conducted at Jamaica Hospital Medical Center in Jamaica, New York. The study population included 962 patients who presented to the ED and who required ophthalmology consultation. Participants in the control group were given only verbal follow-up instructions. Participants in the intervention group were given verbal instructions, written instructions, telephone calls, and, if not responding to calls, a mailed letter. The primary outcome was the overall follow-up rate. Secondary outcomes were follow-up rate by demographic subgroup. RESULTS: Patients in the intervention group were significantly more likely to follow up (68.8% vs 42.9%, P < .001). Nearly all subgroups exhibited significantly improved follow-up with the intervention, with the exception of patients 18 to 29 years of age, patients with diagnosis severity class III, patients with no insurance, patients with hospital financial aid, patients paying with workers' compensation, and patients with an unknown employment status. CONCLUSIONS: Before the intervention, most patients receiving ophthalmology consultation in the ED did not return for follow-up care. These patients tended to be young, unemployed, uninsured or use hospital financial aid, were in the control group, had good visual acuity, reported no change in vision, and had a condition that was not vision-threatening. Follow-up rates were improved in nearly all subgroups by providing written instructions, telephone calls, and mailed letters. Such instructions should be considered in similar populations.

Rabies Encephalitis and the Use of Optic Nerve Sheath Diameter to Detect Elevated Intracranial Pressure.

Rabies is a rare but rapidly progressive and almost universally fatal disease. A previously healthy 59-year-old male presented with rabies encephalitis. We measured his optic nerve sheath diameter (ONSD) daily in both eyes using ultrasonography to indirectly monitor for elevated intracranial pressure (ICP). We performed CT and MRI brain on days when his ONSD changed significantly. An increase in ONSD temporally correlated with radiologic findings of cerebral edema and acute subarachnoid hemorrhage (SAH). ONSD measurement is a fast, inexpensive, and widely-available imaging modality that may serve as a surrogate marker for elevated ICP. It may be especially useful in patients who are difficult to be transported to radiology due to the unstable nature of their disease.

Update on pharmacotherapy for ocular surface squamous neoplasia.

The most frequently encountered non-pigmented tumor of the ocular surface is ocular surface squamous neoplasia (OSSN). Over the past two decades, the pharmacological management of OSSN has grown, with topical 5-fluorouracil, mitomycin, and interferon alpha 2b all being successfully used to treat this disease. Other agents, such as anti-vascular endothelial growth factor (VEGF), retinoic acid, cidofovir and Aloe vera, have less frequently been used in the treatment of OSSN. This review will discuss these pharmacologic agents, summarizing available data and presenting the approach to the treatment of these tumors.

Social and Clinical Impact of Congenital Urological Malformations in a Developing Country: The Need for a Transdisciplinary Way of Treatment / Impacto social y clínico de las malformaciones urológicas congénitas en un país en desarrollo: La necesidad de un tratamiento transdisciplinario

Zoom Image Abstract Introduction The prognosis of congenital anomalies (CAs) can be improved if detected and treated accurately. Given the complexity of some anomalies, it is almost always necessary to approach them with an interdisciplinary team. Our objective was to contact patients with congenital urological anomalies (CUAs) and follow them up during their first years of life and evaluate their clinical status, as well as their social and health care limitations. Method Based on the Bogota Congenital Malformations Surveillance Program (BCMSP), we have contacted by phone all the patients with CUAs and evaluated their follow-up. We have included all the registered patients from 2006 until 2015. A standardized questionnaire was applied by a trained staff. The questions assessed on each call included: evaluation of the clinical status of the patient, the clinical treatments and evaluations performed by clinical and surgical subspecialties, health care limitations, and social barriers. The first call was made at the 2nd month, then every 3 months during the 1st year and every 6 months thereafter. Results A total of 277 patients were contacted, 97.3% of whom have an increased risk of mortality or significant disability. The malformation related mortality was of 38.1%. Only 38.7% of the patients were evaluated by a specialist, while 57.4% where still waiting to be seen by a specialist. Ninety eight percent of the limitations related to the health care system were the long waiting lists to be seen by a specialist. Conclusion Many of the pathologies that we have found belong to the group that has a significant reduction in mortality when treated accurately and promptly. However, we have a profound problem in our health care system, in that many of the patients have not been seen by a specialist, which results in a worse prognosis and recovery rate.

Introducción El pronóstico de las anomalías congénitas puede mejorarse si se detectan y tratan adecuadamente. Dada la complejidad de algunas anomalías, casi siempre es necesario abordarlas con un equipo interdisciplinario. Nuestro objetivo fue contactar a los pacientes con anomalías urológicas congénitas (CUA) con posterior seguimiento durante los primeros años de vida, se evaluó su estado clínico así como las limitaciones sociales y de atención médica. Método Basado en el Programa de Vigilancia de Malformaciones congénitas de Bogotá, contactamos por teléfono a todos los pacientes con CUA y evaluamos su seguimiento. Fueron incluidos todos los pacientes desde 2006 hasta 2015. Un cuestionario estandarizado fue aplicado por personal capacitado. Las preguntas evaluadas durante la llamada incluyeron: evaluación del estado clínico, tratamientos clínicos realizados y evaluaciones por subespecialidades clínicas y quirúrgicas, limitaciones de atención médica y barreras sociales. La primera llamada se realizó en el segundo mes y luego cada tres meses durante el primer año y luego cada 6 meses a partir de entonces. Resultados Se contactó a un total de 277 pacientes en los que el 97,3% tenía un riesgo de mortalidad o de discapacidad significativa. La mortalidad relacionada con la malformación fue del 38.1%. Solo el 38,7% de los pacientes fueron evaluados por un especialista, mientras que el 57,4% aún esperaban ser atendidos por un especialista. El noventa y ocho por ciento de las limitaciones relacionadas con el sistema de atención fueron las largas listas de espera para ser visto por un especialista. Conclusión Muchas de las patologías pertenecen al grupo que cuando son tratadas adecuadamente y prontamente tienen una reducción significativa en la mortalidad. Sin embargo, tenemos un problema profundo en nuestro sistema de atención médica donde muchos de los pacientes no han sido atendidos por un especialista, lo que resulta en un peor pronóstico y tasa de recuperación.

Suicide in the Indigenous Population of Latin America: A Systematic Review / Suicidio en la población indígena latinoamericana: revisión sistemática

Abstract Objective: Due to the high rates of suicide reported among many ethnic minorities, a systematic review is presented on suicide in indigenous populations of Latin America. Methods: Systematic review in PubMed, Scopus, PsycNET, SciELO and Scholar Google. Results: From an initial total of 1862 articles, 41were included for data extraction. They include 21 from Brazil, 13 from Colombia, 2 from Chile, 1 from Peru, and 4 articles grouped from different countries. Suicide is a public health issue in many communities. Lifestyle changes, industrialisation, environmental degradation, and alcohol have led the indigenous population experiencing what has been described as "cultural death."

Resumen Objetivo: Se han reportado altas tasas de suicidio en algunas minorías étnicas, entre ellas comunidades indígenas en Latinoamérica. Este fenómeno se considera un problema de salud pública. Realizamos una revisión sistemática para describirlo. Métodos: Se realizó una búsqueda sistemática en las bases de datos de PubMed, Scopus, PscycNET, SciELO y Google Scholar. Resultados: Se encontró un total inicial de 1.862 referencias; de estos artículos, se incluyeron 41 para extracción de datos según los criterios de inclusión, de los que 21 hacen referencia a Brasil,13 a Colombia, 2 a Chile,1a Perú y 4 artículos a diferentes países agrupados. Las comunidades indígenas están pasando por un fenómeno de «muerte cultural¼ en el que los cambios en las culturas, los estilos de vida, la industrialización, la invasión del medio ambiente y el consumo de alcohol se convierten en desencadenantes del suicidio.

Suicide in the Indigenous Population of Latin America: A Systematic Review.

OBJECTIVE: Due to the high rates of suicide reported among many ethnic minorities, a systematic review is presented on suicide in indigenous populations of Latin America. METHODS: Systematic review in PubMed, Scopus, PsycNET, Scielo and Scholar Google. RESULTS: From an initial total of 1862 articles, 41 were included for data extraction. They include 21 from Brazil, 13 from Colombia, 2 from Chile, 1 from Peru, and 4 articles grouped from different countries. Suicide is a public health issue in many communities. Lifestyle changes, industrialisation, environmental degradation, and alcohol have led the indigenous population experiencing what has been described as "cultural death."