Advancements in technology have always had major impacts in medicine. The smartphone is one of the most ubiquitous and dynamic trends in communication, in which one's mobile phone can also be used ...for communicating via email, performing Internet searches, and using specific applications. The smartphone is one of the fastest growing sectors in the technology industry, and its impact in medicine has already been significant.
To provide a comprehensive and up-to-date summary of the role of the smartphone in medicine by highlighting the ways in which it can enhance continuing medical education, patient care, and communication. We also examine the evidence base for this technology.
We conducted a review of all published uses of the smartphone that could be applicable to the field of medicine and medical education with the exclusion of only surgical-related uses.
In the 60 studies that were identified, we found many uses for the smartphone in medicine; however, we also found that very few high-quality studies exist to help us understand how best to use this technology.
While the smartphone's role in medicine and education appears promising and exciting, more high-quality studies are needed to better understand the role it will have in this field. We recommend popular smartphone applications for physicians that are lacking in evidence and discuss future studies to support their use.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Delirium is an acute change in mental status affecting 10%-64% of hospitalized patients, and may be preventable in 30%-40% of cases. In October 2013, a task force for delirium prevention and early ...identification in medical-surgical units was formed at our hospital. We studied whether our standardized protocol prevented delirium among high-risk patients.
We studied 105,455 patient encounters between November 2013 and January 2018. Since November 2013, there has been ongoing education to decrease deliriogenic medications use. Since 2014, nurses screen all patients for presence or absence of delirium using the Confusion Assessment Method (CAM). Since 2015, nurses additionally screen all patients for risk of delirium. In 2015, a physician order set for delirium was created. Nonpharmacological measures are implemented for high-risk or CAM positive patients.
98.8% of patient encounters had CAM screening, and 99.6% had delirium risk screening. Since 2013, odds of opiate use decreased by 5.0% per year (P < .001), and odds of benzodiazepine use decreased by 8.0% per year (P < .001). There was no change in anticholinergic use. In the adjusted analysis, since 2015, odds of delirium decreased by 25.3% per year among high-risk patients (n = 21,465; P < .001). Among high-risk patients or those diagnosed with delirium (n = 22,121), estimated length of stay decreased by 0.13 days per year (P < .001), odds of inpatient mortality decreased by 16.0% per year (P = .011), and odds of discharge to a nursing home decreased by 17.1% per year (P < .001).
With high clinician engagement and simplified workflows, our delirium initiative has shown sustained results.
Author Affiliation: (1) Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA (2) Stanford, USA (3) Quantitative Sciences Unit, Division of ...Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA (4) Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA (a) nrohatgi@stanford.edu Article History: Registration Date: 12/02/2020 Received Date: 03/10/2020 Accepted Date: 12/01/2020 Online Date: 01/08/2021 Byline:
Author Affiliation: (1) Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA (2) Stanford, CA, USA (3) Quantitative Sciences Unit, Division ...of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA (4) Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA (a) nrohatgi@stanford.edu Article History: Registration Date: 12/02/2020 Received Date: 04/21/2020 Accepted Date: 12/01/2020 Online Date: 01/08/2021 Byline:
Background
It is unclear whether asthma and its allergic phenotype are risk factors for hospitalization or severe disease from SARS‐CoV‐2.
Methods
All patients over 28 days old testing positive for ...SARS‐CoV‐2 between March 1 and September 30, 2020, were retrospectively identified and characterized through electronic analysis at Stanford. A sub‐cohort was followed prospectively to evaluate long‐term COVID‐19 symptoms.
Results
168,190 patients underwent SARS‐CoV‐2 testing, and 6,976 (4.15%) tested positive. In a multivariate analysis, asthma was not an independent risk factor for hospitalization (OR 1.12 95% CI 0.86, 1.45, p = .40). Among SARS‐CoV‐2‐positive asthmatics, allergic asthma lowered the risk of hospitalization and had a protective effect compared with non‐allergic asthma (OR 0.52 0.28, 0.91, p = .026); there was no association between baseline medication use as characterized by GINA and hospitalization risk. Patients with severe COVID‐19 disease had lower eosinophil levels during hospitalization compared with patients with mild or asymptomatic disease, independent of asthma status (p = .0014). In a patient sub‐cohort followed longitudinally, asthmatics and non‐asthmatics had similar time to resolution of COVID‐19 symptoms, particularly lower respiratory symptoms.
Conclusions
Asthma is not a risk factor for more severe COVID‐19 disease. Allergic asthmatics were half as likely to be hospitalized with COVID‐19 compared with non‐allergic asthmatics. Lower levels of eosinophil counts (allergic biomarkers) were associated with a more severe COVID‐19 disease trajectory. Recovery was similar among asthmatics and non‐asthmatics with over 50% of patients reporting ongoing lower respiratory symptoms 3 months post‐infection.
Asthma is not a risk factor for more severe COVID‐19 disease. Allergic asthmatics are half as likely to be hospitalized compared with non‐allergic asthmatics and lower levels of eosinophil counts (allergic biomarkers) are associated with a more severe COVID‐19 disease trajectory. Recovery is similar among asthmatics and non‐asthmatics. Abbreviation: COVID, coronavirus disease 2019.
Surgical comanagement (SCM), in which surgeons and hospitalists share responsibility of care for surgical patients, has been increasingly utilized. In August 2012, we implemented SCM in Orthopedic ...and Neurosurgery services in which the same Internal Medicine hospitalists are dedicated year round to each of these surgical services to proactively prevent and manage medical conditions. In this article, we evaluate if SCM was associated with continued improvement in patient outcomes between 2012 and 2018 in Orthopedic and Neurosurgery services at our institution. We conducted regression analysis on 26,380 discharges to assess yearly change in our outcomes. Since 2012, the odds of patients with ≥1 medical complication decreased by 3.8% per year (P = .01), the estimated length of stay decreased by 0.3 days per year (P < .0001), and the odds of rapid response team calls decreased by 12.2% per year (P = .001). Estimated average direct cost savings were $3,424 per discharge.
» Acute kidney injury, defined as an increase in serum creatinine of 0.3 mg/dL or >50% of baseline or sustained oliguria with urine output of <0.5 mL/kg/hr for >6 hours, affects 2% to 15% of patients ...undergoing lower-extremity joint arthroplasty. Patients who develop acute kidney injury have an increased length of hospitalization and a greater cost of care, are less likely to be discharged home postoperatively, and have increased short-term and long-term mortality.
» Risk factors for acute kidney injury after lower-extremity joint arthroplasty include older age, male sex, obesity, diabetes, hypertension, congestive heart failure, and especially underlying chronic kidney disease.
» Consensus guidelines have not been updated to reflect recent research into the perioperative effects on angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs); most patients taking these medications chronically without systolic heart failure should omit the dose prior to the surgical procedure to reduce the risk of perioperative hypotension and acute kidney injury.
» In patients at an increased risk for acute kidney injury, efforts should be made when clinically appropriate to minimize exposure to potential nephrotoxins including nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, intravenous computed tomography (CT) contrast, and antibiotics with higher rates of nephrotoxicity such as vancomycin and aminoglycosides.
» The initial evaluation for patients developing acute kidney injury after lower-extremity joint arthroplasty should include ruling out urinary obstruction, clinical volume status assessment, determining whether intraoperative or postoperative hypotension has occurred, urinalysis, and urine electrolyte studies.
* Diabetes mellitus is prevalent among patients undergoing lower-extremity total joint arthroplasty, occurring in upwards of 20% of patients undergoing arthroplasty, and nondiabetic stress-induced ...hyperglycemia may be seen in >50% of patients undergoing arthroplasty.
* Poor glycemic control including elevated hemoglobin A1c (HbA1c) in patients with diabetes and elevated plasma glucose levels in patients without diabetes correlate with worse surgical and medical outcomes in patients undergoing total joint arthroplasty, but may have limited predictive value in individual patients.
* Available outcomes literature suggests that efforts to achieve HbA1c below 6.5% to 7.5% preoperatively may maximize access to total joint arthroplasty while limiting excess morbidity; this generally aligns with most medical guidelines’ recommendations with regard to long-term glycemic control in patients with diabetes.
* Most patients with type-2 diabetes undergoing total joint arthroplasty should be treated perioperatively with a weight-based basal-bolus insulin regimen instead of sliding-scale monotherapy targeting moderate (generally defined as <180 mg/dL in nonfasting patients) and not overly strict glycemic control. Oral hypoglycemic agents may convey specific risks in the perioperative period.
* Future prospective studies evaluating preoperative and perioperative glycemic control strategies for patients with and without diabetes are needed to assess whether clinically meaningful outcomes might be improved by implementing these strategies.
Abstract Dronedarone is an amiodarone-like antiarrhythmic with a modified structure. The addition of a methyl sulfonyl group theoretically reduces the toxicity of amiodarone, specifically, adverse ...thyroid and pulmonary effects. Although animal studies have implicated dronedarone as a cause of lung injury, to date controlled trials in humans have not demonstrated an association. A 68-year-old woman developed a dry cough and worsening respiratory distress after receiving dronedarone for 6 months. Discontinuation of dronedarone therapy and subsequent steroid therapy led to a dramatic improvement of symptoms. Dronedarone may be associated with interstitial lung disease. We believe that patients receiving dronedarone should have their diffusing capacity of lung for carbon monoxide and lung volumes monitored prior to initiation of therapy and frequently thereafter.
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