Adequacy and Acceptability of the Self-Collected Anal Pap Smear in People Living With Human Immunodeficiency Virus in the Infectious Diseases Clinic.

Background Anal Pap smears are imperative to screening for human papillomavirus (HPV)-associated anal squamous cell cancers, particularly in patients living with human immunodeficiency virus (HIV) given a higher incidence of disease. Self-collection of specimens may be favored by patients and more feasible to collect, increasing screening. Methods This was a single-center observational cohort study at a single academic medical center Infectious Diseases clinic from October to December 2021. We aimed to improve compliance of anal Pap collection documentation of "self-collected" versus "physician-collected" as well as verify if self-collected specimens (SCS) were adequate for interpretation equivalent to physician-collected specimens (PCS). Additionally, we aimed to evaluate patient and provider satisfaction with self-collected anal Paps. Results Sixty anal Pap smears were available for evaluation. The rate of documentation of the collection method (self-collected vs. physician-collected) was 88% during the intervention. A total of 75% of patients opted for self-collection, and 35/45 (78%) of these samples were adequate for interpretation. There was no difference in the adequacy of specimen (the ability of a cytopathologist to interpret the specimen) between the SCS and PCS. Conclusion Limited prior data suggest self-collected anal Pap specimens are adequate for interpretation only slightly less often than PCS. In our small cohort, there was no statistically significant difference between collection methods. Satisfaction with self-collection of specimens was high for both patients and providers. Additional validation in more diverse/larger clinical settings may be helpful to support this practice.

A Cross-sectional Survey to Assess Awareness of Syndromic Surveillance by Clinicians Practicing Emergency Medicine: An Opportunity for Education and Collaboration.

INTRODUCTION: Syndromic surveillance (SyS) is an important public health tool using de-identified healthcare discharge data from emergency department (ED) and urgent care settings to rapidly identify new health threats and provide insight into current community well-being. While SyS is directly fed by clinical documentation such as chief complaint or discharge diagnosis, the degree to which clinicians are aware their documentation directly influences public health investigations is unknown. The primary objective of this study was to evaluate the degree to which clinicians practicing in Kansas EDs or urgent care settings were aware that certain de-identified aspects of their documentation are used in public health surveillance and to identify barriers to improved data representation. METHODS: We distributed an anonymous survey August-November 2021 to clinicians practicing at least part time in emergency or urgent care settings in Kansas. We then compared responses from emergency medicine (EM)-trained physicians to non-EM trained physicians. Descriptive statistics were used for analysis. RESULTS: A total of 189 respondents across 41 Kansas counties responded to the survey. Of those surveyed, 132 (83%) were unaware of SyS. Knowledge did not differ significantly by specialty, practice setting, urban region, age, nor by experience level. Respondents were unaware of which aspects of their documentation were visible to public health entities, or how quickly records were retrievable. When asked about improving documentation for SyS, lack of clinician awareness (71.5%) was perceived as a greater barrier than electronic health record platform usability or time available to document (61% and 59%, respectively). CONCLUSION: This survey suggests that most practitioners in EM have not heard of SyS and are unaware of the invaluable role certain aspects of their documentation play in public health. Critical information that would be captured and coded into a key syndrome is often missing, but clinicians are unaware of what types of information may be most useful in their documentation, and where to document that information. Lack of knowledge or awareness was identified by clinicians as the single greatest barrier to enhancing surveillance data quality. Increased awareness of this important tool may lead to enhanced utility for timely and impactful surveillance through improved data quality and collaboration between EM practitioners and public health.

Assessing Provider Utilization of COVID-19 Inflammatory Marker Trends in Hospitalized Patients and Implications in Optimizing Value-Based Care During a Pandemic.

Introduction: Numerous inflammatory markers may serve a role in prognostication of patients hospitalized with COVID-19 infection. Early in the pandemic, our health system created an admission order set which included daily d-dimer, c-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin. Given more available outcomes data, limiting standing order of labs that do not affect daily management could result in significant cost savings to the health system without adverse patient outcomes. The purpose of this study was to determine ordering and utilization patterns of inflammatory markers by physicians caring for patients hospitalized with COVID-19 infection. Methods: An anonymous 10-question survey was distributed to 125 physicians (Infectious Disease, Hospitalist, Pulmonary and Critical Care faculty). Responses were tallied and values greater than 50% were identified as the majority of the surveyed group. Results: Of the 125 physicians surveyed, 77 (62%) responded. A total of 57.1% (44/77) of physicians reported ordering daily inflammatory markers for 3 - 10 days from admission. Another 31.2% (24/77) ordered markers until clinical improvement or hospital discharge. D-dimer was used for care decisions by 83.1% (64/77) of respondents; 93.8% (60/64) of those reported utilizing it in determining anticoagulation dose. CRP was used by 61% (47/77) of physicians to help identify a secondary infection or determine steroid dose or duration. LDH and ferritin were not used for management decisions by the majority of physicians. Inflammatory markers were not used routinely after isolation precautions had been discontinued, even when ongoing care required mechanical ventilation. Conclusions: Of the markers studied, both d-dimer and CRP were considered useful by most respondents. LDH and ferritin were used less frequently and were not considered as useful in guiding medical decision making. Discontinuation of standing daily LDH and ferritin orders is believed to have potential to result in cost savings to the health care system with no adverse patient outcomes.

Spontaneous hyphema associated with ocular syphilis.

The purpose of this case series is to illustrate a novel presentation of ocular syphilis. Two cases of ocular syphilis presenting with spontaneous hyphema are described, demonstrating that spontaneous hyphema can be caused by ocular syphilis. This association has not previously been reported.