Irrigating the conjunctiva with a povidone-iodine prepping solution prior to cataract surgery can help to prevent the incidence of endophthalmitis, according to South American researchers.

In a study published in the March/April issue of the Brazilian Archives of Ophthalmology, Paraguayan researchers point out that organisms sampled from the vitreous of a patient suffering from post-op endophthalmitis appear to be the same bacteria as those found on the patient's eyelids, conjunctiva or nose.

As a result, efforts to reduce the incidence of endophthalmitis in cataract surgery patients have focused on reducing the amount of bacteria on those areas. Povidone-iodine is typically used for the task because it is fast acting, effective against a wide variety of pathogens and affordable, the study notes.

To gauge the solution's efficacy, the researchers swabbed the inferior conjunctival fornix of 221 cataract surgery patients 3 times: Before prepping solution was applied; after applying 10% povidone-iodine prep to the eyelids, eyelashes and periocular area and flushing the conjuctiva with a 5% povidone-iodine solution; and after surgery was completed.

They reported a 60.7% reduction in bacterial growth on the conjuctiva after the povidone-iodine wash and no significant difference in colonization between samples taken immediately after the wash and after surgery. The findings lend support to the practice of routinely washing the conjunctiva with 5% povidone-iodine prior to cataract surgery in order to reduce endophthalmitis risks, they note.

Daniel Cook

Scheduling colonoscopies every 3 to 5 years for low-risk patients may appeal to physicians for medico-legal reasons. But that's not necessarily the most effective or cheapest way to help patients avoid colorectal cancer, according to researchers at the University of Michigan and the U.S. Veterans Affairs Health Services.

They used a computer model and epidemiological statistics to predict the overall effectiveness and cost-effectiveness of screening every 3 years for high-risk patients (the recommended interval) and every 3, 5 and 10 years for low-risk patients (with 10 years being the recommended interval).

Their study, published in the June issue of the journal Gastroenterology found that screening low-risk patients more frequently than every 10 years was not cost-effective considering the small number of cancers detected and deaths prevented, and put patients at an increased risk of harm.

One out of 5 colonoscopies conducted every year is strictly surveillance, according to the study. "We are over-using colonoscopy in low-risk patients and under-using colonoscopy in high-risk patients," says Sameer Dev Saini, MD, MS, of the University of Michigan. "We need to focus our efforts on high-risk patients, who have the most to gain."

Kent Steinriede

Distractions and diversions may be more effective than reassuring words when it comes to calming a pediatric patient's pre-procedure nerves, say researchers.

For a study published in the July issue of the journal Pain, researchers at Dalhousie University in Halifax, Nova Scotia, gauged the reactions of 100 children aged 5 to 10 years old (60 girls and 40 boys) as they were having blood drawn for tests, as well as the interaction and behavior of the parent accompanying them (86 mothers and 14 fathers).

The children were later asked to watch 12 short videos of actors playing parents and children during a venipuncture, and to rate the parent's fear or happiness during each scene.

"Children's distress during painful medical procedures is strongly influenced by adult behavior," the researchers write. For uncertain reasons, they say, parents' or healthcare providers' facial expressions, vocal tones and words spoken in an attempt to reassure a child causes them greater anxiety.

On the other hand, they note, "distraction is associated with increased child coping," and recommend adults talk about anything else except the medical procedure at hand to dispel fear.

David Bernard

From the silver screen to the surgical suite: 3-D imaging technology is being positioned as the next advance that will change the way your surgeons visualize their procedures. What do you think of the technology? Tell us in this week's online poll, then check back next week to see the results.

Last week's InstaPoll asked whether your facility had ever been named as a defendant in a medical malpractice suit. The results, based on 51 responses: