INTRODUCTION Vaginal cuff infections are well-known complications of laparoscopic hysterectomies. An implicated etiology is bacterial vaginosis (BV), a condition where the vaginal microflora is predominated by anaerobic bacteria. Studies have demonstrated increased postoperative pelvic infection in patients with BV at time of hysterectomy. However, no guidelines exist at our institution to guide screening for BV for patients undergoing hysterectomy. Therefore, a prospective observational study was implemented at our academic institution to determine the incidence of BV in our pre-operative patients and to identify the association of a positive pre-operative BV screen with postoperative infection. METHODS Institutional review board approval was obtained. Patients undergoing minimally invasive benign hysterectomy were recruited, and they provided informed consent. An intraoperative wet mount and genital culture were collected, and, if positive for BV, the patient was treated postoperatively with metronidazole. RESULTS A sample size of 44 patients from October 2020 through March 2021 were enrolled. The incidence of BV was 25%. Patients who received metronidazole based on detection of BV had no incidence of postoperative pelvic infection. DISCUSSION This data supports the need for screening patients for BV prior to hysterectomy to reduce the potential for a surgical site infection and to consider the addition of metronidazole as a preoperative antibiotic. CONCLUSION The findings of our single-institution pilot study provide evidence for the need for more widespread research on this topic.
INTRODUCTION As healthcare evolves from fee-for-service to value-based care models, there is an increasing emphasis on quality over volume. In these models, pharmacists can play a vital role in ensuring patients meet quality measures for health system reimbursement. METHODS A retrospective, single-center cohort study was conducted at our university-based internal medical group practice. Patients who did not meet the quality measure for hemoglobin A1c (HbA1c) <9% in 2023 and/or those who had a HbA1c >9% from January to June 2024 were included in this study. The primary outcome was the percentage of patients meeting the quality measure of HbA1c <9% by December 31, 2024. Key secondary outcomes included the percent age of patients completing diabetic eye examinations and kidney health evaluations. RESULTS A total of 125 patients were included in this study, 31 in the pharmacist intervention group and 94 in the physician-only group. Baseline characteristics were balanced amongst both groups. For the primary outcome, 61.3% of patients in the pharmacist intervention group achieved a HbA1c of <9% compared to 69.1% in the physician-only group (P = 0.51). Patients followed by pharmacy were more likely to complete diabetic eye examinations and kid ney health evaluations. DISCUSSION These findings suggest that pharmacists play a key role in improving access to quality care in the Appalachian region while also supporting health system reimbursement. CONCLUSION Based on limited data, pharmacists are just as likely to meet health quality measures for diabetes as physicians with higher likelihood in some categories.
Subarachnoid hemorrhage (SAH) and subse- quent scarring can rarely precipitate syringo- myelia several years after the initial insult. We present a patient with a history of posterior circulation SAH six years prior who developed progressive lower limb weakness, numbness, low back pain, fecal retention, and sphincter dysfunction. Imaging revealed cervicothoracic syringomyelia associated with thoracic arach- noid scarring. Despite multiple surgical inter- ventions, the patient experienced persistent and progressive syringomyelia. This case demonstrates that posterior circulation SAH may warrant prolonged surveillance for arach- noiditis, which may not be readily evident on imaging. Furthermore, surgical management should be tailored to the underlying pathology, often necessitating multiple interventions to effectively manage symptom progression.
