Point-of-care ultrasound in geriatrics: a national survey of VA medical centers.

BACKGROUND: Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care ("geriatric") clinics at Veterans Affairs Medical Centers (VAMCs). METHODS: We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics. RESULTS: All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics ("chiefs") at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers. CONCLUSIONS: POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future.

An Unusual Presentation of Spontaneous Rupture of Dermoid Cyst.

Intracranial dermoid cysts are exceptionally rare tumors. Interestingly, this condition has a low mortality rate but a high morbidity rate due to its numerous complications. We report a case of a 62-year-old man who presented with a headache and was found to have a ruptured dermoid cyst, complicated with the dissemination of lipid droplets within the subarachnoid space.

Assessing Teach-Back Utilization in a Downtown Medical Center.

BACKGROUND: The St. Vincent Charity Medical Center's Patient and Family Education Policy directs staff to provide patients with easy-to-understand written and verbal communication. This includes using plain language and Teach-Back. Teach-Back-or asking patients to explain in their own words what they have learned-is a best practice that health care professionals use to ensure patient understanding. The effective use of plain language is key to using Teach-Back successfully. From random audits, we could assess whether staff were documenting their use of Teach-Back. We had not, however, ascertained whether that documentation was a true account of the use of Teach-Back. Brief description of activity: We created a three-part project to (1) assess staff knowledge and use of Teach-Back, (2) assess and address barriers to use of Teach-Back, and 3) assess patients' recall of their providers using Teach-Back. IMPLEMENTATION: Internal medicine resident physicians (hereafter termed "residents") and nurses completed an anonymous, online survey regarding their experience with Teach-Back. After vetting, these responses were integrated into mandatory provider training. Focusing on health literacy and Teach-Back, the training addressed barriers, reinforced positive experiences, and tailored practice encounters to patients. We then randomly surveyed inpatients to assess their recall of their providers using Teach-Back. RESULTS: The majority (96.3%) of providers indicated that Teach-Back should be used frequently. Only 79.9%, however, reported using Teach-Back. Providers regarded Teach-Back as important and rated their confidence level as high. Providers also reported barriers to Teach-Back. Of the 135 patients surveyed, 46% recalled their providers using this method. LESSONS LEARNED: We note a gap between providers' self-reported use of Teach-Back and patients' recall of their providers using it. Providers may be overstating their utilization rate. The survey, further, assessed patients at random points in their hospital stays, to include those who had not yet received Teach-Back education. These factors could contribute to the observed discrepancy. Most notably, results confirmed our position that regular provider training helps address barriers and misconceptions about Teach-Back. [HLRP: Health Literacy Research and Practice. 2021;5(3):e226-e232.] Plain Language Summary: Our Health Literacy Institute was created in 2007 after receiving a grant to institutionalize health literacy across the continuum of patient care. Health literacy refers to a person's ability to obtain, understand, and process basic information, which empowers them to make appropriate health decisions.

Hypoxia and hyperbaric oxygen therapy: a review.

Hypoxia causes a cascade of activity from the level of the individual down to the regulation and function of the cell nucleus. Prolonged periods of low oxygen tension are a core feature of several disease states. Advances in the study of molecular biology have begun to bridge the gap between the cellular response to hypoxia and physiology. Hyperbaric oxygen therapy is a treatment for hypoxic- and inflammatory-driven conditions, in which patients are treated with 100% oxygen at pressures greater than atmospheric pressure. This review discusses hypoxia, the physiologic changes associated with hypoxia, the responses that occur in the cells during hypoxic conditions, and the role that hyperbaric oxygen therapy can play as part of the treatment for many patients suffering from diseases with underlying hypoxia.