Communication of laboratory data and diagnostic test results to hospitalized patients: a study of preferences and recall

Muhammad W Athar,1 Christine Mativo,1 Regina Landis,2 Scott M Wright1 1Department of Medicine, Johns Hopkins University School of Medicine, 2Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA Objective: To assess patients’ preferences with respect to different methods of receiving test results while they were hospitalized and to determine whether the different modes of communication of the test results were associated with better recall. Methods: Five discrete test results were shared with adult inpatients on general medicine service (blood pressure, white blood cell count, hematocrit, creatinine, and chest X-ray). The information was delivered by a physician in one of three ways: 1) verbally, 2) explained with a print out of the results, or 3) described while showing results on a computer monitor (electronic). The same physician returned within 3 hours to assess recall and satisfaction with the way patients received their results. Results: All the patients (100%) receiving their results in written format were satisfied with the mode of communication as compared to electronic format (86%) or verbally (79%) (P=0.02). Fifty percent of patients in the computer format group could recall four or more test results at the follow-up, as compared to 43% in printed group and 24% who were informed of their results verbally (P=0.35). Conclusion: Patients most appreciated receiving test results in written form while in the hospital, and this delivery method was as good as any other method with respect to recall. Keywords: patient preference, patient satisfaction, patient-centered car

Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature.

Tuberculosis (TB) infection of the genitourinary tract (GU TB) is rare in renal transplant recipients, with only a few published case series. GU TB is difficult to diagnose with or without immunosuppression but must always be suspected in any patient with unexplained sterile pyuria. As GU TB is associated with graft rejection, prompt diagnosis and treatment are vital. Treatment is challenging, as rifampicin, the most effective drug used to treat tuberculosis, is a significant inducer of cytochrome P-450 3A metabolism, with the potential to cause significant reductions in the serum levels of calcineurin inhibitors. For this reason, rifabutin, a weaker cytochrome P-450 3A inducer, with similar efficacy against TB, is sometimes used as an alternative to rifampicin in transplant recipients. We present a renal transplant patient diagnosed with GU TB, treated with a regime containing rifabutin, who subsequently developed profound hyponatremia and leucopenia. Serum and urine biochemistry was consistent with a diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both SIADH and leucopenia resolved with rifabutin cessation. This is the first report of biochemically proven, idiosyncratic SIADH and leucopenia associated with the use of rifabutin in the treatment of GU TB in a renal transplant recipient