SummaryA high-functioning 82-year-old man presented with lower lumbar pain and pubic tenderness. On admission he was afebrile with a normal white count. A grossly elevated C reactive protein was noted. CT scan of the pelvis showed a fluid collection anterior to the pubic symphysis and to the right of the midline measuring 2.0 × 2.2 cm. Pseudomonas aeruginosa was cultured from the fluid collection. The patient had no history of intravenous drug use, pelvic surgeries, malignancies or trauma. We report what we believe is the first documented case of P aeruginosa infection of the pubic symphysis in an elderly patient that did not have any of the traditional risk factors associated with neither P aeruginosa septic arthritis nor infections of the pubic symphysis. Instead, we propose that phimosis with chronic infection of the foreskin and balanitis may have led to septic arthritis. BACKGROUND

While in general teachers in Belize have good HIV/AIDS-related knowledge, attitude, comfort, and instructional confidence, there are several subgroups of teachers who have lower comfort and instructional confidence scores. These subgroups can be targeted for HIV/AIDS training in order to increase their effectiveness as HIV/AIDS educators.

Background Physicians are often called to evaluate patients overnight with varying levels of clinical deterioration. Early warning scores predict critical clinical deterioration in patients; however, it is unknown whether they are able to reliably predict which patients will need to be seen overnight and whether these patients will require further resource use. Methods A prospective case cohort study of 522 patient nights in a single tertiary care hospital in Vancouver, British Columbia, Canada, was conducted to assess the ability of Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS) to predict patients who will need to be seen overnight by physicians and will require other healthcare resources. Prediction ability was assessed using area under the receiver operating characteristic curve and logistic regression models. Results The MEWS and NEWS both significantly predicted which patients needed to be seen overnight, and area under the receiver operating characteristic curves (95% confidence interval) for MEWS and NEWS were 0.72 (0.66–0.78) and 0.69 (0.63–0.76), respectively. Odds ratios (95% confidence interval) for MEWS and NEWS predicting need to be seen overnight were 1.52 (1.34–1.73) and 1.22 (1.14–1.31), respectively. Conclusions Both MEWS and NEWS have fair ability to predict patients who will need to be seen overnight. This may be useful for improving handover and resource allocation for overnight care.

BackgroundThe effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes.MethodsThis was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality.ResultsThe intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at the cluster level and an overall low number of clinical events.ConclusionsImplementation of a multi-faceted resident handoff intervention did not result in a significant improvement in patient safety although did improve number of patients handed off. Novel methods to improve handoff need to be explored.Trial registrationRegistered at ClinicalTrials.gov: NCT01796756.

We describe a 52-year-old woman presenting with acute onset of severe burning paraesthesia in the hands and feet associated with allodynia and antalgic gait. At the time of admission to hospital no motor weakness was present. A diagnosis of Guillain-Barré syndrome (GBS) was considered when neurophysiological studies were completed showing convincing evidence of demyelination on motor conduction studies and sural sparing on sensory nerve studies.1 We describe this case as a sensory variant of GBS. Clinical improvement followed treatment with a single course of intravenous immunoglobulin (IVIG). The patient made a complete clinical recovery within 6 months of onset and repeat neurophysiological studies showed marked improvement. We encourage clinicians to consider an atypical variant of GBS in patients presenting with acute sensory complaints.

The iHAND score had moderate ability to predict which patients required assessment overnight, while MEWS score and current gestalt approach correlated poorly, suggesting the iHAND score may help prioritisation of patients likely to be seen overnight for handover.

BackgroundDigital health interventions are increasingly used for patient care, yet little data is available on the phone access type and usage preferences amongst medical ward inpatients to inform the most appropriate digital interventions post-discharge.MethodsTo identify mobile phone ownership, internet access, and cellular use preferences among medical inpatients, we conducted a researcher-administered survey of patients admitted to five internal medicine units at Vancouver General Hospital (VGH) in January 2020. The survey was administered over 2 days separated by a 2-week period.ResultsA total of 81 inpatients completed the questionnaire. Survey found that 85.2% of survey respondents had mobile phone access where 63.0% owned their own mobile phone, and 22.2% had access to a mobile phone via a proxy (or an authorized third-party) such as a family member. All participants with mobile phone access had cellular plans (i.e., phone and text); however, a quarter of respondents did not have data plans with internet access. Survey showed that 71.1% of males owned a mobile phone compared to only 52.8% of females. All participants at a “high” risk of readmission had access to a mobile phone, either as phone-owners or proxy-dependent users.ConclusionAccess to mobile phones among medical ward inpatients, 85.2%, was comparable to smartphone penetration rates amongst Canadians in 2019, 85.1%. More patients had cellular than data plans (i.e., internet and applications). Understanding patient-specific access is key to informing potential uptake of digital health interventions aimed at using patients' mobile phones (mHealth) from an effectiveness and equity lens.

Background: Digital health interventions are increasingly used for patient care, yet little data is available on the phone access type and usage preferences of medical ward patients to inform the most appropriate digital interventions.Methods: To learn about mobile phone ownership, internet access, and cellular use preferences among medical patients, we conducted a researcher-administered survey of patients admitted to five internal medicine units at Vancouver General Hospital (VGH) in January 2020.Results: A total of 81 ward patients completed the questionnaire from the two survey dates. Of those, 63.0% owned their own mobile phone, an additional 22.2% had access to a mobile phone via a proxy (or an authorized third-party) such as a family member, and 14.8% did not own or have access to a mobile phone. All participants with mobile phone access had cellular plans (i.e., phone and text) ; however, a quarter of respondents did not have data plans with internet. 71.1% of men owned a mobile phone compared to only 52.8% of women. All participants at a ‘high’ risk of readmission had access to a mobile phone, either as phone-owners or proxy-dependent users.Conclusion: Access to mobile phones among medical ward patients was high, but incomplete. More patients had cellular than data plans (i.e., internet and applications). Understanding patient-specific access is key to informing potential uptake of digital health interventions aimed at using patients’ mobile phones (mHealth) from an effectiveness and equity lens.