ObjectiveAll accredited cancer institutions are required to screen patients for psychosocial distress. This paper describes the development, implementation, and preliminary outcomes of the University of California San Diego Health Moores Cancer Center Wellbeing Screening Program.MethodEssential steps learned in a formal National Cancer Institute–funded training workshop entitled “Implementing Comprehensive Biopsychosocial Screening” were followed to ensure successful program implementation. These steps included identification of stakeholders; formation of a working committee; establishment of a vision, process, and implementation timeline; creation of a screening tool; development of patient educational material; tool integration into an electronic medical record system; staff training and pilot testing of tool administration; and education about tool results and appropriate follow-up actions. Screening data were collected and analyzed retrospectively for preliminary results and rapid cycle improvement of the wellbeing screening process.ResultsOver an 8-month implementation and assessment period, the screening tool was administered 5,610 times of 7,664 expected administrations (73.2%.) to 2,394 unique patients. Visits in which the questionnaire was administered averaged 39.6 ± 14.8 minutes, compared with 40.3 ± 15.2 minutes for visits in which the questionnaire was not administered (t = −1.76, df = 7,662, p = 0.079).Significance of resultsThis program provides a process and a tool for successful implementation of distress screening in cancer centers, in a meaningful way for patients and providers, while meeting accreditation standards. Further, meaningful data about patient distress and tool performance were able to be collected and utilized.
Over the past 20 years, scattered reports have emerged about a low virulence, gram negative bacillus, Sphingomonas paucimobilis, causing unpredictable clinical presentations of endophthalmitis. Previous reports have characterised the organism as being resistant to aggressive treatment and prone to recurrence up to several months later, with few warning signs of any residual infection. We report a case of a 75 year-old male who returned 10 days after a left eye cataract surgery with an atypical, indolent endophthalmitis. He was treated with broad-spectrum intravitreal antibiotics and vitrectomy, and despite initial improvement, the patient suffered a recurrence after 2 weeks, necessitating successive rounds of intravitreal antibiotics. While our patient was able to achieve an excellent final visual acuity of 6/9, there are several cases in the literature reporting similar cases with much worse visual outcomes. Further research is required to elucidate early warning signs that may indicate a recurrence of S. paucimobilis infection, and the underlying mechanism by which it is resistant to standard endophthalmitis therapy. Alongside this case, we review and summarise the literature on postoperative endophthalmitis involving this organism.
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