Use of Nitrous Oxide for Minimal Sedation in Pediatric Outpatients: A Survey Analysis of Patient Experience and Parent-Guardian Satisfaction.

INTRODUCTION: The use of minimal and moderate sedation in the pediatric population allows for the successful completion of many procedures in both hospital and outpatient settings without the risks involved with general anesthesia. Sanford Children's outpatient sedation clinic had been using oral midazolam for minimal sedation but began using inhaled nitrous oxide in January 2019. The current study examines patient experience and parent/guardian satisfaction with use of inhaled nitrous oxide for minimal sedation. DESIGN/METHODS: A survey was designed to evaluate parent/guardian satisfaction with nitrous oxide for pediatric sedation in various outpatient procedures. Parents'/ guardians' understanding of the sedation and procedural logistics were surveyed as well as their satisfaction with the child's comfort, recovery time, and overall satisfaction were assessed. RESULTS: Thirty-seven surveys completed by parents/guardians of patients ages 1-16 years were collected. Average age of the patient was 6 years old, with 22 female and 15 male patients. Outpatient procedures for which the nitrous oxide sedation was used included 30 botulinum toxin injections, 5 VCUG, 1 vaccine administration, and 1 IV placement. Mean survey results were 9.6 (95 percent CI, 9.3-9.9) for satisfaction of recovery time, 8.5 (95 percent CI, 7.7-9.3) for control of discomfort, and 9.1 (95 percent CI, 8.5-9.7) for overall satisfaction. CONCLUSIONS: When evaluating nitrous oxide as an agent for minimal sedation in pediatric procedures, parents/guardians were most satisfied with the recovery time and least satisfied with its ability to control discomfort. Overall, we concluded that nitrous oxide is a moderately good agent for pediatric patients receiving minimal sedation.

When a Cyst is Not Just a Cyst.

In this article we report a series of cases with a cystic appearance clinically which were diagnosed as surprising entities histologically. The aim of presenting these cases is to demonstrate the importance of always sending clinically-appearing 'cysts' to pathology, because even the most experienced clinicians can be fooled by these lesions.

Student Initiative Improves HIV Screening Rate in Student-Run Free Clinic.

Background The Center for Disease Control provides recommendations for preventative services and screenings including recommendations for a one-time HIV screening of all adult patients between the ages of 13-64. But not all clinics are fully compliant with these recommendations. We identified a need for increased screening at two clinics in a rural setting. As a healthcare quality improvement initiative, we developed educational informatics to increase screening compliance. Methods This project assessed HIV screening rates before and after educational interventions at two clinics, the Coyote Clinic and the Avera Downtown Clinic. Three changes were implemented to increase the HIV screening rate and ultimately provide more effective high-quality health care. The three initiatives focused on patients, physicians, and student volunteers in order to provide a strong foundation of knowledge to all parties involved in a patient's care. Results Prior to any interventions, the baseline screening rate (screenings/100 persons) at the Avera Downtown Clinic was 0.84 while the screening rate at the Coyote Clinic was 0.00. After the proposed interventions, the screening rate of the Downtown Clinic improved to 3.97 and the screening rate at the Coyote Clinic improved to 29.4. Using a Fisher's Exact test, we found a statistically significant post-intervention increase in HIV screening at the Coyote Clinic after the intervention (p = 0.0002) but not at the Downtown Clinic (p = 0.0940.) Conclusion HIV screening rates improved after the implementation of interventional education initiatives tailored for patients, medical students, and physicians. Implementation of low-cost quality improvement measures such as the ones detailed herein may significantly improve long-term patient management, particularly in the context of screening tests.

A Case-Based Review of Systemic Amyloidosis and its Cutaneous Findings.

Systemic amyloidosis is a disorder in which misfolded proteins deposit extracellularly, causing diverse clinical presentations depending on which organ systems are involved and to what degree they are involved. Delay in diagnosis is common and leads to increased mortality. In this article we report a case of systemic amyloidosis with the aim of increasing awareness of this entity.