Smartphone Technology: Impact on Interprofessional Working Relations between Doctors and Nurses.

BACKGROUND: For decades, the main communication technology in hospitals has been the paging system. In the era of digital communication, smartphones have been adopted by hospitals seeking to modernize processes and offer real-time, two-way communication to increase efficiency. OBJECTIVE: The aim of this study was to explore physicians' and nurses' perceptions of the impact of smartphones on communication and efficiency. METHODS: Mann-Whitney U-tests were used to compare differences in item scores between physicians and nurses on 17 questionnaire items relating to smartphone impact on interpersonal relationships and communication, efficiency and reliability. An open-ended question was used to elicit additional feedback. RESULTS: In total, 43 nurses and 27 physicians participated in the study. Nurses' ratings were significantly higher than physicians' on a number of questionnaire items, including the following: smartphones have a positive impact on efficiency (Mdn = 4.0 vs. 3.0, U = 321.0, p = 0.027, r = .33), smartphones increase my accessibility to physicians (Mdn = 5.0 vs. 3.0, U = 277.0, p = 0.009, r = 0.42) and smartphones reduce interruptions versus pagers (Mdn = 4.0 vs. 2.0, U = 224.0, p > 0.0001, r = 0.47). CONCLUSION: The findings suggest that smartphone technology may reduce the locus of control for physicians, potentially limiting their ability to prioritize patients' needs and manage workflow efficiently.

Legionnaires' Disease Cases at a Large Community Hospital-Common and Underdiagnosed.

Legionnaires' disease (LD) is a severe pneumonia with a mortality rate of about 10%. The illness remains largely underdiagnosed with outbreaks occurring with alarming incidence. In this study, we assessed the frequency of Legionnaires' disease among pneumonia cases treated at a large community hospital over a summer season. We invited all admitted patients diagnosed with pneumonia, able to provide a urine sample for an antigen test, presenting from May to October 2018, to enroll in our study; 35 patients were tested for the presence of Legionella. Out of 33 patients tested, 9 (28%) were positive for Legionella. Three sets of the 9 Legionella cases exhibited spatiotemporal clustering indicative of LD outbreaks. Only one of the 9 Legionella UAT-positive patients presented a sporadic case of LD. The number of pneumonia cases in our community confirmed to be LD was strikingly high (28%), compared to other survey studies that report between 3.7% and 14%. These results are consistent with previous knowledge that LD is underdiagnosed and support that routine testing should be considered for all possible LD cases, particularly in the summer months. Such testing is likely to prevent further cases of community acquired LD.

Routine chest x-rays in intensive care units: a systematic review and meta-analysis.

INTRODUCTION: Chest x-rays (CXRs) are the most frequent radiological tests performed in the intensive care unit (ICU). However, the utility of performing daily routine CXRs is unclear. METHODS: We searched Medline and Embase (1948 to March 2011) for randomized and quasi-randomized controlled trials (RCTs) and before-after observational studies comparing a strategy of routine CXRs to a more restrictive approach with CXRs performed to investigate clinical changes among critically ill adults or children. In duplicate, we extracted data on the CXR strategy, study quality and clinical outcomes (ICU and hospital mortality; duration of mechanical ventilation and ICU and hospital stay). RESULTS: Nine studies (39,358 CXRs; 9,611 patients) were included in the meta-analysis. Three trials (N = 870) of moderate to good quality provided information on the safety of a restrictive routine CXR strategy; only one trial systematically assessed for missed findings. Pooled data from trials showed no evidence of effect of a restrictive approach on ICU mortality (risk ratio [RR] 1.04, 95% confidence interval [CI] 0.84 to 1.28, P = 0.72; two trials, N = 776), hospital mortality (RR 0.98, 95% CI 0.68 to 1.41, P = 0.91; two trials, N = 259), ICU length of stay (weighted mean difference [WMD] -0.86 days, 95% CI -2.38 to 0.66 days, P = 0.27; three trials, N = 870), hospital length of stay (WMD -2.50 days, 95% CI -6.62 to 1.61 days, P = 0.23; two trials, N = 259), or duration of mechanical ventilation (WMD -0.30 days, 95% CI -1.48 to 0.89 days, P = 0.62; three trials, N = 705). Adding data from six observational studies, one of which systematically screened for missed findings, gave similar results. CONCLUSIONS: This meta-analysis did not detect any harm associated with a restrictive chest radiograph strategy. However, confidence intervals were wide and harm was not rigorously assessed. Therefore, the safety of abandoning routine CXRs in patients admitted to the ICU remains uncertain.

Intestinal toxemia botulism in 3 adults, Ontario, Canada, 2006-2008.

Five cases of intestinal toxemia botulism in adults were identified within an 18-month period in or near Toronto, Ontario, Canada. We describe findings for 3 of the 5 case-patients. Clinical samples contained Clostridium botulinum spores and botulinum neurotoxins (types A and B) for extended periods (range 41-61 days), indicative of intestinal toxemia botulism. Patients' clinical signs improved with supportive care and administration of botulinum antitoxin. Peanut butter from the residence of 1 case-patient yielded C. botulinum type A, which corresponded with type A spores found in the patient's feces. The food and clinical isolates from this case-patient could not be distinguished by pulsed-field gel electrophoresis. Two of the case-patients had Crohn disease and had undergone previous bowel surgery, which may have contributed to infection with C. botulinum. These cases reinforce the view that an underlying gastrointestinal condition is a risk factor for adult intestinal toxemia botulism.

Bowel loops and eyelid droops.

A patient presented with a small-bowel obstruction associated with signs and symptoms of botulism. Fecal cultures were positive for viable Clostridium botulinum. This case emphasizes the importance of a broad differential diagnosis and doing a complete examination to account for all signs and symptoms.

Abdominoplasty: a comparison of outpatient and inpatient procedures shows that it is a safe and effective procedure for outpatients in an office-based surgery clinic.

BACKGROUND: Abdominoplasty is one of the most commonly performed aesthetic procedures. In our practice, it has recently shifted toward outpatient care as the standard. In this study, the authors investigated the difference in short-term complications in outpatient and inpatient procedures in an office-based surgery clinic. METHODS: A total of 69 consecutive abdominoplasty patients from a plastic surgeon's office-based surgery clinic were reviewed retrospectively. Of these, there were 37 inpatients (mean age at time of operation, 41.2 years; range, 26 to 54 years) and 32 outpatients (mean age at time of operation, 37.5 years; range, 21 to 58 years). Each patient was reviewed for short-term complications, which included wound infection, wound dehiscence, seroma, and/or hematoma. Complications were correlated to inpatient and outpatient groups. RESULTS: Four inpatients (10.8 percent) and one outpatient (3.1 percent) had wound infections, whereas two inpatients (5.4 percent) and two outpatients (6.2 percent) had wound dehiscence/marginal necrosis (a small area of surgical wound opening). The most common perioperative complication was seroma formation, which was seen in seven inpatients (18.9 percent) and eight outpatients (25.0 percent). The overall complication rate in this study was 30.4 percent (29.7 percent in inpatients and 31.2 percent in outpatients). There was no correlation between short-term complications and inpatient/outpatient status. CONCLUSION: These results demonstrate that abdominoplasties can be safely and effectively performed in an outpatient surgery clinic.

Dissecting the architecture of a quantitative trait locus in yeast.

Most phenotypic diversity in natural populations is characterized by differences in degree rather than in kind. Identification of the actual genes underlying these quantitative traits has proved difficult. As a result, little is known about their genetic architecture. The failures are thought to be due to the different contributions of many underlying genes to the phenotype and the ability of different combinations of genes and environmental factors to produce similar phenotypes. This study combined genome-wide mapping and a new genetic technique named reciprocal-hemizygosity analysis to achieve the complete dissection of a quantitative trait locus (QTL) in Saccharomyces cerevisiae. A QTL architecture was uncovered that was more complex than expected. Functional linkages both in cis and in trans were found between three tightly linked quantitative trait genes that are neither necessary nor sufficient in isolation. This arrangement of alleles explains heterosis (hybrid vigour), the increased fitness of the heterozygote compared with homozygotes. It also demonstrates a deficiency in current approaches to QTL dissection with implications extending to traits in other organisms, including human genetic diseases.