Evaluation of Cytopathological Techniques for the Diagnosis of Canine Visceral Leishmaniosis with Lymph Node Samples.

The identification of the parasite in cytological smears of lymph node aspirates is a widely applied technique for the direct diagnosis of Leishmania spp. infection, especially in endemic areas. Although very specific, this method has limited sensitivity, and improving the technique would be highly desirable. This study aimed to evaluate the efficacy of conventional smear cytology (SC), liquid-based cytology (LBC), cell block (CB) stained with haematoxylin and eosin (HE) and immunocytochemistry (ICC), and formalin-fixed paraffin wax-embedded tissue immunohistochemistry (FFPE-IHC) compared with serology and polymerase chain reaction for the diagnosis of canine visceral leishmaniosis (CVL) in lymphoid tissue. The use of a preservative medium and centrifugation for cytological samples reduced the number of unsatisfactory artefacts/background. Moreover, LBC allowed excellent cellular preservation and the application of ancillary techniques, such as CB and ICC. SC was the most accurate morphological diagnostic method (45.0%). CB-ICC alone or associated with SC demonstrated significantly higher sensitivity (70.0% and 72.0%, respectively) when compared with SC alone (34.00%). CB-ICC was found to be more effective in the detection of infected animals with mild clinical signs, similar to FFPE-IHC. The specificity and positive predictive value were similar between all methods. Finally, the detection limit for CB-ICC and SC + CB-ICC was identical (18.46 amastigotes/mm2). Our study suggests that CB-ICC is a promising tool for improvement of the cytopathological diagnosis of CVL and may be applied in routine epidemiological screening.

Utilizing an electronic health record system to improve vaccination coverage in children.

BACKGROUND: Electronic Health Records (EHR) are widely believed to improve quality of care and effectiveness of service delivery. Use of EHR to improve childhood immunization rates has not been fully explored in an ambulatory setting. OBJECTIVE: To describe a pediatric practice's use of Electronic Health Records (EHR) in improving childhood immunization. METHODS: A multi-faceted EHR-based quality improvement initiative used electronic templates with pre-loaded immunization records, automatic diagnosis coding, and EHR alerts of missing or delayed vaccinations. An electronic patient tracking system was created to identify patients with missing vaccines. Barcode scanning technology was introduced to aid speed and accuracy of documentation of administered vaccines. Electronic reporting to a local health department immunization registry facilitated ordering of vaccines. RESULTS: Immunization completion rates captured in monthly patient reports showed a rise in the percentage of children receiving the recommended series of vaccination (65% to 76%) (p<0.000). Barcode technology reduced the time of immunization documentation (86 seconds to 26 seconds) (p<0.000). Use of barcode scanning showed increased accuracy of documentation of vaccine lot numbers (from 95% to 100%) (p<0.000). CONCLUSION: EHR-based quality improvement interventions were successfully implemented at a community health center. EHR systems have versatility in their ability to track patients in need of vaccines, identify patients who are delayed, facilitate ordering and coding of multiple vaccines and promote interdisciplinary communication among personnel involved in the vaccination process. EHR systems can be used to improve childhood vaccination rates.

The hospice concept of care: facing the 1990s.

Although hospice is a widely accepted form of care for the terminally ill, there is still a misconception that hospice represents a place, rather than a form of care. Hospice is designed to address three major problems of dying: pain, loneliness, and loss of control. It also emphasizes the role of the family in the caregiving process. The greatest need today in hospice is the increased involvement of the medical profession. Hospice must also expand to include not only cancer patients, but anyone who is dying, including AIDS patients. The future of hospice is bright, but it needs our commitment, our time, and our prayers.

Impact of computed tomography on the care of patients with suspected hydrocephalus.

To assess the impact of computed tomography (CT) on patient care, a cohort of patients with suspected hydrocephalus admitted before installation of CT was compared to a similar cohort admitted after installation of CT. The after CT cohort used significantly fewer pneumoencephalograms and radionuclide brain scans. The average cost of neurodiagnostic evaluation was 22% less after CT. However, speed of workup, therapy, institution of therapy, discharge plans, and discharge diagnoses were not different for the two cohorts. We conclude that CT has made the diagnostic evaluation of patients who otherwise would have required pneumoencephalography for suspected hydrocephalus less expensive and less hazardous.