No-Pass Zone: Multidisciplinary Approach to Responding to Patient Needs.

A nurse's need to juggle multiple priorities often leads to delays in responses to patient call lights, which may result in the patient's needs not being met quickly. Low patient satisfaction scores related to hospital staff responding to patient needs created urgency for this system to implement the No-Pass Zone, a multidisciplinary team approach to responding to call lights. A successful implementation of this intervention resulted in patients' needs being met more quickly as indicated by improved Hospital Consumer Assessment of Health Care Providers and Systems performance postimplementation.

Use of polymyxin as an endotoxin blocker in the prevention of diffuse lamellar keratitis in an animal model.

PURPOSE: To determine whether bacterial endotoxin, lipopolysaccharide (LPS), could induce diffuse lamellar keratitis (DLK) in an animal model and whether DLK could be prevented by endotoxin blockers such as polymyxin. METHODS: Laser in situ keratomileusis (LASIK) flaps were created in rabbit eyes. The stromal bed was treated with 20 microg of Burkholderia cepacia LPS or balanced salt solution (BSS). Development of DLK, histological degree of inflammation, and presence of LPS detected by anti-LPS antibody were evaluated after 48 hours. In a second experiment, all eyes received LPS and were randomly assigned to receive either polymyxin in the form of two drops of Polytrim (Allergan, Irvine, Calif) on the stromal bed or two drops of BSS. RESULTS: In the animal model study, LPS was significantly associated with the development of DLK (P<.05, n=30). Infiltration with polymorphonuclear cells and presence of DLK were found in LPS treated eyes but not in controls. In the second experiment, 4 (27%) of 15 eyes that received polymyxin in addition to LPS developed DLK compared to 18 (95%) of 19 eyes that received only LPS (P<.05, n=34). There was a trend towards higher flap displacement in polymyxin treated eyes but this was not significant (P=.07). CONCLUSIONS: Diffuse lamellar keratitis in a rabbit model can be caused by bacterial endotoxin (LPS). Endotoxin blockers, such as polymyxin, are effective in decreasing the incidence of endotoxin-induced DLK in a rabbit model.

Update on toxic anterior segment syndrome.

PURPOSE OF REVIEW: To review, summarize and update our present understanding of toxic anterior segment syndrome. RECENT FINDINGS: Toxic anterior segment syndrome has emerged within the last 2 years as a complication of increasing frequency following uneventful cataract surgery. Over 100 North American clinics reported toxic anterior segment syndrome cases to a specially constituted task force over a 4-month period in 2006. Toxic anterior segment syndrome is now recognized as a specific, noninfectious condition presenting as anterior segment inflammation that occurs within days of surgery and is responsive to topical steroids. Specific causes have been identified such as endotoxin contamination of balanced salt solutions and antibiotic ointment accessing the anterior chamber, although most cases appear to result from inadequate instrument sterilization and preparation. Outcomes are usually excellent, but delayed treatment and severe cases may result in glaucoma and persisting corneal edema requiring penetrating keratoplasty. SUMMARY: Toxic anterior segment syndrome has become a significant complication of cataract surgery. Rapidly increasing knowledge made possible by ophthalmic organizations and the prompt dissemination of research findings, however, appear to have provided the information necessary to help prevent and resolve this condition.