Secure smartphone application-based text messaging in emergency department, a system implementation and review of literature.

BACKGROUND: The utilization of smartphone-based technology and applications to streamline patient care provides an exciting opportunity for quality improvement research. As traditional communication methods such as paging have repeatedly been shown to be susceptible to errors and inefficiency that can delay patient care, smartphones continue to be investigated as means of improving inter-hospital communication and patient outcomes. METHODS AND MATERIALS: We conducted a systematic literature review in PubMed, MEDLINE using the keywords Health Insurance Portability and Accountability Act (HIPAA) Compliant Group Messaging (HCGM), text paging communication, secure hospital text message, HIPAA text message, and secure hospital communication. The search considered studies published until January 2018. Only English-language studies were included. We reviewed the reference lists of included articles for additional studies, as well. Abstracts, unpublished data, and duplicate articles were excluded. RESULTS: 569 studies were screened and assessed for eligibility with 35 meeting the inclusion criteria. 15 of these studies are data-driven with topics of investigation ranging from facilitation of communication (40%), security (33%), provider/patient satisfaction with communication (26%), diagnostic assistance (20%), demographics of use (13%), time spent in communication (13%), and finances (7%). Sample size per study varied from 30 to 10,000 encounters. CONCLUSIONS: The use of smartphones can positively impact patient care; however, these benefits must be balanced with the responsibility to protect patient privacy and confidentiality. In order to continue to support HCGM's expansion and integration into daily practice, further data-driven studies into HCGM-specific interventions must be pursued.

Emergency department approach to QTc prolongation.

QTc prolongation has been associated with increased risk of developing ventricular tachydysrhythmias, particularly Torsades de Pointes (TdP). QTc prolongation is influenced by many factors including congenital causes, heart rate, metabolic imbalances, and pharmacotherapy. Several commonly used medications in the emergency department (ED), such as antipsychotics and antiemetics, are known to prolong the QT interval. In addition, ED patients may present with conditions that may predispose them to QTc prolongation, such as drug overdose or hypokalemia, which can further complicate management. ED providers should not only be aware of which medications have these effects, but must also thoroughly investigate any pertinent patient history that may contribute to QTc prolongation. This review discusses commonly encountered medications that are associated with QTc prolongation, the mechanisms by which they prolong the QTc interval, and other factors that may influence ED medication administration and management.

Ethanol Drives Evolution of Hsp90-Dependent Robustness by Redundancy in Yeast Domestication.

Protein folding promotes and constrains adaptive evolution. We uncover this surprising duality in the role the protein-folding chaperone Hsp90 plays in mediating the interplay between proteome and the genome which acts to maintain the integrity of yeast metabolism in the face of proteotoxic stressors in anthropic niches. Of great industrial relevance, ethanol concentrations generated by fermentation in the making of beer and bread disrupt critical Hsp90-dependent nodes of metabolism and exert strong selective pressure for increased copy number of key genes encoding components of these nodes, yielding the classical genetic signatures of beer and bread domestication. This work establishes a mechanism of adaptive canalization in an ecology of major economic significance and highlights Hsp90-contingent variation as an important source of phantom heritability in complex traits.