Safety Unseen: Leveraging Design to Improve Inpatient Mental Health-Care Practices.

When a patient attacks a nurse, there is more than physical trauma that occurs. The consequences of the violence can manifest in anger, fear, anxiety, shame, blame, and post-traumatic stress disorder symptoms that can have negative effects on patient care and job satisfaction. In the past, design strategies in inpatient psychiatric centers upheld safety by erecting barriers between patients and staff, or over-using restraints and seclusion, strategies that communicated fear and distrust. Now, understanding of how people respond in a state of crisis is changing how care can be delivered in inpatient settings. Once seen as counterintuitive, eliminating physical barriers and opening connections between staff and patients are elevating safety by reducing the psychological walls that keep patients from feeling trusted and respected. By recognizing the human need to have choice and a sense of control in a world that feels out of proportion, health-care organizations can leverage design strategies that address aspects such as spatial density and zones of personal comfort, improving safety by elevating choice and dignity in a therapeutic healing environment.

Motor Vehicle-Associated Traumatic Ocular Injuries Secondary to External Rear-Facing Sideview Mirrors: A Report of 3 Patients.

IMPORTANCE: Rear-facing sideview mirrors are a potentially reducible source of ocular morbidity following motor vehicle crashes. OBJECTIVE: To report cases highlighting shattered glass from sideview mirrors as a potential cause of ocular trauma in motor vehicle crashes. DESIGN, SETTING, AND PARTICIPANTS: Case series of 3 patients who presented to Grady Memorial Hospital, a level 1 trauma center and tertiary hospital, between May 5, 2017, and July 10, 2017, with ocular trauma as a result of shattered glass from sideview mirrors during motor vehicle crashes. A review of the literature was also conducted. Data were analyzed between July 2017 and August 2017. INTERVENTIONS OR EXPOSURES: Operation for exploration and repair of open globe in all 3 cases. MAIN OUTCOMES AND MEASURES: Visual prognosis and ocular morbidity postoperatively. RESULTS: All patients were white men in the age range of 26 to 43 years. This was a retrospective review of 3 of 208 patients who presented to Grady Memorial Hospital after motor vehicle crashes from May 5, 2017, to July 10, 2017. From the time of presentation of the 3 reported patients from Grady Memorial Hospital, all 3 had 2 surgeries inclusive of the initial open globe repair. Patients with this mechanism of injury experienced ocular morbidity, with all 3 cases resulting in uveal prolapse and 2 of 3 resulting in retinal detachments. Among the 3 patients, visual acuities after the second surgery within the first year were hand motion, 20/100, and 20/150. CONCLUSIONS AND RELEVANCE: Sideview mirrors can be a cause of serious ocular injuries in motor vehicle crashes. These 3 reported cases, combined with cases previously reported, suggest that this mechanism of ocular injury does occur. Further studies seem warranted to investigate the frequency of these findings and whether any design modifications may help reduce the frequency.

Combined Intravitreal and Systemic Antibiotic Therapy in a Patient with Syphilitic Uveitis.

PURPOSE: To report the novel use of combined intravitreal and systemic antibiotic therapy in a patient with syphilitic panuveitis and discuss the management of ocular syphilis. METHODS: Case report Results: A 45-year old heterosexual male with human immunodeficiency virus (HIV) presented with 1 month of blurry vision in both eyes. Clinical examination revealed a bilateral panuveitis. The patient denied history of genital lesions or rash, but did complain of difficulty hearing bilaterally. Treponemal EIA was positive, the RPR titer greater than 1:512 dilution, and CSF VDRL 1:4. A diagnosis of neurosyphilis and ocular syphilis was made based on the clinical and laboratory findings. The patient was admitted for systemic intravenous antibiotic therapy, but was noted to have a penicillin allergy. Intravitreal ceftazidime was promptly administered bilaterally to achieve treponemacidal levels of antibiotic therapy. After penicillin desensitization protocol, the patient received 14 days of intravenous penicillin with clinical resolution. CONCLUSIONS: There are increasing reports of ocular syphilis in the United States and delay in diagnosis and management can lead to severe visual impairment and blindness. We report the first case of adjunct intravitreal antibiotic therapy in a penicillin allergic patient. As ocular syphilis is a form of bacterial endophthalmitis, combination intravitreal and systemic antibiotics may be considered.

Toric intraocular lens rotation to optimize refractive outcome despite appropriate intraoperative positioning.

UNLABELLED: We present 3 eyes of 2 patients who benefitted from toric intraocular lens (IOL) rotation despite appropriate intraoperative positioning. In each case, preoperative astigmatism measurements were obtained by manual keratometry, partial coherence interferometry, and corneal topography. In Case 1, a dramatic shift in corneal topography occurred after surgery, resulting in the need to rotate the toric IOL to maximize the refractive outcome. In Case 2 (both eyes), no significant change in topography occurred, but IOL rotation was required to maximize the refractive outcome despite appropriate IOL alignment based on preoperative measurements. Using an online toric IOL calculator, it was determined that rotation of the IOL would result in significantly improved astigmatic outcomes. At the final evaluation 2 months after IOL rotation, the residual manifest astigmatism was 0.50 diopter (D) in Case 1 and 0 D (right eye) and 0.75 D (left eye) in Case 2. Use of the toric IOL online calculator maximized the uncorrected visual and refractive outcomes. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.