Topical Anesthetic Gel Interferes with Antibacterial Efficacy of Povidone-Iodine Both In Vitro and In Vivo

Purpose: To evaluate the effects of viscous lidocaine gel on the antimicrobial efficacy of povidone-iodine (PI) and their order of application in both in vitro and in vivo models. Methods: In vitro antibacterial effects were tested against Staphylococcus aureus (S. aureus) with disc diffusion methods for application of lidocaine alone, PI alone, PI before lidocaine, and lidocaine before PI. Zones of inhibition were measured after incubation at 37°C overnight. Mouse eyes were colonized with S. aureus for in vivo study to which PI and/or lidocaine were applied in various combinations. Eyes were then rinsed with saline, and the runoff fluid was collected, diluted, and plated on agar. Viable bacterial estimation was performed after incubation overnight at 37°C. Results: In vitro studies demonstrated a significantly smaller (PP\u3e0.05). In vivo studies showed that mouse eyes treated with lidocaine prior to PI had significantly more (PS. aureus growth compared to eyes that had PI applied prior to lidocaine. Conclusions: Both in vitro and in vivo studies demonstrated that lidocaine gel interfered with PI’s antiseptic properties when placed between the surface and PI. Our results are consistent with previous in vitro studies and provide greater evidence for applying PI before lidocaine gel if a viscous anesthetic agent is used

Comprehensive Analysis to Uncover Determinants of Patient Appointment Compliance in Ophthalmology at the Kresge Eye Institute

Introduction: Appointment compliance (AC) has a significant impact on physician-patient relationship and overall patient care. However, determinants of AC in Ophthalmology and its subspecialties remains elusive. Methods: We performed a five-year retrospective analysis across Kresge Eye Institute (KEI) and its affiliated Michigan locations. A total of 597,364 appointments across \u3e13 subspecialties were included. AC was the primary outcome of interest. Compliant (CO) and non-compliant (NC) groups were compared to the following variables: patient characteristics (gender, race, age, insurance), appointment rank (relative to patient history), scheduling location, month, and ophthalmic specialty, in regard to arrival and no-show. Results: Among all appointments, 59.77% were associated with a female patient and 79.16% of the total number of appointments were compliant. AC differed concerning specialty, with retina representing the highest compliance across all appointments. Among 200+ insurance providers, Medicare was most frequently used and represented the highest share of CO appointments. African Americans were the primary ethnicity served by KEI and had the highest number of NC appointments. Conclusion: Our study demonstrates the impact of patient demographics, appointment characteristics, and ophthalmic subspecialty on AC. A better understanding of these determinants could allow for an increased CO for Ophthalmology practices

Hemiplegic Shoulder Pain Syndrome: Frequency and Characteristics during Inpatient Stroke Rehabilitation

ABSTRACT. Dromerick AW, Edwards DF, Kumar A. Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation. Arch Phys Med Rehabil 2008;89:1589-93. Objective: To clarify the pathophysiology of hemiplegic shoulder pain by determining the frequency of abnormal shoulder physical diagnosis signs and the accuracy of self-report. Design: Prospective inception cohort. Setting: Academic inpatient stroke rehabilitation service. Participants: Consecutive admissions (Nϭ46) to stroke rehabilitation service. Interventions: Not applicable. Main Outcome Measures: The Neer test, Speed test, acromioclavicular shear test, Rowe test, and palpation for point tenderness. Results: Participants were enrolled at a mean time to evaluation of 18.9Ϯ14.1 days after stroke. Weakness of shoulder flexion, extension, or abduction was present in 94% of subjects, and neglect was found in 29%. Pain was present by self-report in 37%. The most common finding, which was found in nearly all persons with abnormalities in the study physical examination maneuvers, was bicipital tendon tenderness (54%), followed by supraspinatus tenderness (48%). The Neer sign was positive in 30%; 28% had the triad of bicipital tenderness, supraspinatus tenderness, and the Neer sign. Self-reported pain was a poor predictor of abnormalities elicited on the examination maneuvers, even in those without neglect. Conclusions: Our data implicate 2 vertical stabilizers of the humerus in early onset hemiplegic shoulder pain, the long head of the biceps and the supraspinatus. Our results also suggest that simple questioning of stroke rehabilitation inpatients about shoulder pain may not be adequate for clinical care or research purposes, even in the absence of neglect

Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial

Summary: Background: Evidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation. Methods: In this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149. Findings: Between March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: −1·6 (SD 1·2) in the 4 month group versus −1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI −0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group. Interpretation: Although there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation. Funding: Indian Council of Medical Research supported the study until Nov 14, 2015. Subsequently, Shuchita Gupta's salary was supported for 2 months by an institute fellowship from All India Institute Of Medical Sciences, and a grant by Wellcome Trust thereafter