Management of Scleritis in Older Adults.

Scleritis, an inflammatory disease of the eye affecting scleral tissue, presents unique challenges in the older adult population. Unlike their younger counterparts, older individuals manifest a distinct spectrum of the disease with different underlying etiologies, co-morbidities, altered immune function, and an increased risk of systemic side effects from medication choices. Addressing these complexities necessitates a comprehensive and multidisciplinary approach. Treatment of choice will depend on any underlying cause but generally involves non-steroidal anti-inflammatory drugs, systemic or local corticosteroids, and potentially disease-modifying anti-rheumatic drugs. Utilization of these therapeutic agents in older adults warrants careful consideration because of their potential side-effect profiles. This article critically examines the specific concerns for the use of these drugs in older patients and reviews the existing literature on their use in this specific cohort.

Early unplanned return visits to a pediatric emergency department in Israel.

BACKGROUND: Early unplanned return visits (EURV) to the emergency department (ED) are stressful for children and caregivers. Dissatisfaction with the first ED visit could influence the decision to revisit the ED. The aim was to evaluate comprehensively parents' satisfaction with the first ED visit. METHODS: A prospective questionnaire-based study of parents of EURV patients was conducted in a pediatric ED. Participants were enrolled based on convenience sampling. The study instrument was the parental satisfaction questionnaire (PSQ). The 27 PSQ items evaluate four themes related to satisfaction: attitude and respect, information provided, continuity of care, and waiting times. Items are rated on a five-point Likert scale. RESULTS: During the 18-month study, 101 parents of EURV patients were surveyed and 98 agreed to participate. On the return visit, 63 EURV patients were discharged and 35 EURV patients were hospitalized. Eighty-seven (88.7%) caregivers scored an overall level of satisfaction with the first visit of 8-10 on a 10-point Likert scale. Median scores in 22 PSQ items were 4 (interquartile range [IQR] 4-5) or 4 (IQR 3-4). Median scores for "physicians attention and answering questions and concern" and "physicians clear and understood explanations" were 3 (IQR 3-4) and 2 (IQR 2-3), respectively. The PSQ scores were similar for patients who were discharged on the return visit and patients who were hospitalized. CONCLUSIONS: Parents were satisfied with the care provided at the first ED visit. There was a lower level of satisfaction with physician interaction.