ABSTRACT
Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; two of these patients underwent 2, and 1 patient had 3 separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23-0.85), specificity was 100% (95% CI: 0.60-1.00), positive predictive value was 100% (95% CI: 0.46-1.00), and negative predictive value was 67% (95% CI: 0.35-0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criteria for determining the need for surgical intervention.
Subject(s)
Invasive Fungal Infections/diagnosis , Mycological Typing Techniques/statistics & numerical data , Sinusitis/diagnosis , Adolescent , Adult , Aged , Debridement , Female , Humans , Invasive Fungal Infections/classification , Invasive Fungal Infections/microbiology , Male , Middle Aged , Mycological Typing Techniques/methods , Nose/microbiology , Pilot Projects , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Sinusitis/classification , Sinusitis/microbiology , Touch , Young AdultABSTRACT
Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; 2 of these patients underwent two and 1 patient had three separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23 to 0.85), specificity was 100% (95% CI: 0.60 to 1.00), positive predictive value was 100% (95% CI: 0.46 to 1.00), and negative predictive value was 67% (95% CI: 0.35 to 0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criterion for determining the need for surgical intervention.
Subject(s)
Invasive Fungal Infections/diagnosis , Mycological Typing Techniques/statistics & numerical data , Sinusitis/diagnosis , Adolescent , Adult , Debridement , Female , Humans , Invasive Fungal Infections/classification , Invasive Fungal Infections/microbiology , Male , Middle Aged , Mycological Typing Techniques/methods , Nose , Pilot Projects , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Sinusitis/classification , Sinusitis/microbiology , Touch , Young AdultABSTRACT
OBJECTIVES/HYPOTHESIS: Evaluate the effectiveness of an educational curriculum on general tracheostomy care principles and determine the effect of this educational curriculum on the level of provider comfort with tracheostomy care. STUDY DESIGN: Cross-sectional questionnaire in an academic medical center. MATERIALS AND METHODS: A 25-question multiple choice and true/false quiz was given to nonotolaryngology health care providers (nurses and physicians) who routinely provide tracheostomy care. This was followed by an education module, and the quiz was repeated. Participants were also asked to rate their level of comfort (0-100 point scale) managing a tracheostomy before and after the module. A 6-month follow-up assessment was also obtained. RESULTS: A total of 94 health care providers participated in the education module (50 physicians, 37 nurses, 7 fourth-year medical students). The average number of correct answers increased by 3.1 (P < 0.001). The level of confidence in tracheostomy care improved by 18.8 points (P < 0.001). At the 6-month assessment, there was still a significant improvement in the number of correct questions and level of confidence when compared to preeducation values (P < 0.02 for both). There was no significant change in the 6-month values when compared to the posteducation values. CONCLUSIONS: A standardized education module for tracheostomy care teaching resulted in significant increases in provider knowledge and confidence. Standardization of tracheostomy education and care is essential in academic hospital medical centers where multiple specialties may be performing tracheostomies and health care providers frequently change. LEVEL OF EVIDENCE: N/A.
