Interactive Journal of Medical Research最新文献

Background: Delayed recognition of patient deterioration in a non-intensive care unit (ICU) setting contributes to serious adverse events. Continuous monitoring devices with alerting systems offer real-time data to support early detection, but their effectiveness depends on usability. While prior reviews focus on clinical outcomes, usability-defined by effectiveness, efficiency, and satisfaction-remains underexplored.

Objective: This study aims to scope the evidence related to the usability of continuous monitoring devices with deterioration alerting in noncritical adult care units.

Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of MEDLINE, Embase, Emcare, Web of Science, and IEEE Xplore was performed for studies published up to November 2024. Title and abstract screening, full-text review, and data extraction were independently conducted by 2 reviewers. Studies were included if they (1) evaluated the usability-defined as effectiveness, efficiency, or satisfaction-of continuous monitoring devices; (2) focused on adult patients in non-ICU hospital settings; (3) used primary data; (4) were published in English; and (5) described how clinicians received alerts.

Results: The search identified 1284 papers, with 35 included. Most studies focused on postoperative patients in surgical wards, mainly from the United States and the Netherlands. Only 2 studies used mixed methods, and 10 reported clinician characteristics. While effectiveness (71%) and efficiency (74%) were widely studied, satisfaction (46%) and usability barriers (29%) received less attention.

Conclusions: Continuous monitoring devices with deterioration alerts may reduce rapid response team calls and ICU transfers, save time, and maintain acceptable alarm frequencies with high user satisfaction. However, usability challenges persist, including technical issues, alarm fatigue, patient discomfort, and limited training or workflow integration. This review mapped current use, usability, and barriers, categorized key usability factors for improvement, and identified the need for further research on clinician perspectives and broader health care settings to enhance generalizability.

Unlabelled: Choroidal metastases (CM) represent a rare but clinically significant manifestation of systemic malignancy, most frequently from lung cancer., The choroid's vascular anatomy allows hematogenous tumor seeding. Although CM may be the first clinical sign of an underlying malignancy, evidence guiding its management in the modern immunotherapy era remains limited, as most published cases predate the widespread use of immune checkpoint-inhibitors., We describe a 33-year-old male patient presenting with ocular pain and visual disturbance, who was found to have an amelanotic choroidal lesion. Systemic workup revealed small pulmonary nodules and an iliac crest lesion. Sequential biopsies suggested that this was metastatic adenocarcinoma of unknown primary origin, but most likely of lung origin, without actionable mutations or PD-L1 (programmed death-ligand 1) expression. Management required multidisciplinary coordination and included carboplatin, paclitaxel, and pembrolizumab, followed by radiation to the orbit, iliac crest, and mediastinal sites of disease. Unfortunately, he experienced progression while on maintenance immunotherapy with new rib and brain lesions, for which he underwent treatment with platinum, pemetrexed, and bevacizumab with additional radiotherapy. Despite loss of vision in the affected eye, he achieved durable disease control and remains free of radiographic recurrent disease>4 years after diagnosis., This case illustrates that multimodality salvage strategies-integrating systemic therapy with aggressive local radiation-can provide unexpectedly prolonged survival even after immunotherapy failure. Importantly, current guidelines offer minimal direction on managing CM in this context, and prior case reports do not reflect present-day treatment realities. The key message for clinicians is that CM should not automatically be approached with palliative intent; carefully selected patients may benefit from an oligometastatic strategy that actively targets limited metastatic sites to prolong survival. Our findings underscore the need for ophthalmology, radiation oncology, and medical oncology collaboration when vision-threatening or occult metastatic lesions arise., For readers, the takeaway is that choroidal metastasis-particularly in the era of immunotherapy-warrants individualized, multidisciplinary evaluation rather than default palliation. Our case demonstrates that coordinated multimodality management can achieve long-term disease control, highlighting a treatment paradigm worth considering for selected patients and calling for updated guidelines that reflect modern therapeutic capabilities.

Background: Global population aging places an increasing burden on health care systems. This is driven by multimorbidity, frailty, and polypharmacy. Older adults, particularly those aged 65 years or older, use emergency departments (EDs) more frequently and experience poorer outcomes. In this population, decisions regarding admission to monitored acute care units-intensive care units, intermediate care units, and operating rooms-are frequent and complex. While ED and intensive care unit use are well documented, data on monitored acute care units as a whole remain limited. Evidence on admission trends, patient characteristics, and outcomes in older adults is scarce.

Objective: This study aimed to describe temporal trends in monitored acute care unit admissions, identify predictors of such admissions, and assess outcomes following these admissions.

Methods: We conducted a retrospective cohort study using routinely collected electronic health record data. We included patients aged 65 years or older who visited the EDs of the Geneva University Hospitals, Switzerland, between 2009 and 2019. The primary outcome was admission to a monitored acute care unit. The secondary outcomes were hospital length of stay, 7-day mortality, and 1-year mortality. Logistic regression models were used to identify factors associated with monitored acute care unit admission and to assess the association between age and mortality.

Results: During the 10-year period, 701,838 ED visits were recorded. Annual visits increased from 56,944 to 76,368 (+34.1%). The increase was greater among patients aged 65 years or older (+56.1%) than among younger patients (+26.5%). A total of 180,189 older patients presented to the ED. Of these, 887 (0.5%) died in the ED, 97,238 (54.0%) were discharged home, 63,025 (35.0%) were admitted to a ward, and 19,039 (10.6%) were admitted to a monitored acute care unit. Monitored acute care unit admissions increased from 1379 (10.3%) in 2009 to 2240 (11.1%) in 2019. This represented an absolute increase of 62.4% and a relative increase of 0.8%. Predictors of monitored acute care unit admission included younger age, male sex, ambulance arrival, higher triage level, being married or in a relationship, not residing in a nursing home, and French as the primary language. Among patients admitted to a monitored acute care unit, mortality was 5.8% (1105/19,039) at 7 days and 22.3% (4251/18,039) at 1 year. Older age was associated with higher 7-day mortality (adjusted odds ratio 1.55, 95% CI 1.14-2.10) and 1-year mortality (adjusted odds ratio 1.28, 95% CI 1.08-1.51).

Conclusions: Admissions to monitored acute care units among older patients increased over time. These findings indicate a growing demand for high-level care in this population. Hospitals should adapt infrastructure and resource allocation to address the needs of an aging population.

Background: First Nations people in Australia experience inequitable mental health outcomes and service access. Digital mental health (DMH) services, which refer to offering mental health services through digital platforms, are considered potential solutions to address such mental health service inequities and improve the mental health outcomes of First Nations Australians. However, evidence on the effectiveness of DMH services for First Nations people in Australia is yet to be synthesized.

Objective: This systematic scoping review aims to fill this gap and to identify the facilitators and barriers that influence the implementation of DMH services among First Nations people in Australia.

Methods: A systematic search was conducted across 6 academic databases to search for studies related to DMH services for First Nations people in Australia. Search terms relating to First Nations people, geographic terminologies of Australia, mental health, and DMH services were used. Studies were included if they assessed the effectiveness of DMH services or the determinants of the facilitators and barriers of implementing DMH interventions among First Nations people in Australia. Data were extracted based on study design, targeted services, and research findings, and were then synthesized using a thematic analysis framework.

Results: In total, 22 studies met the inclusion criteria. DMH services were used to support and treat First Nations Australians and conduct psychological assessments in these individuals. Evidence of effectiveness was stronger for nonsevere mental health conditions. The determinants of the facilitators and barriers of the implementation of DMH services included the following: (1) organizational and administrative factors; (2) cultural appropriateness; (3) accessibility; (4) integration of DMH services in the existing health system; (5) engagement between clients and service providers; (6) coverage of different conditions and clients; (7) acceptability to DMH services; (8) digital literacy; and (9) efficiency.

Conclusions: Evidence on the use of DMH services for First Nations Australians remains heterogeneous in terms of study design and outcome measurement. DMH services appear to be most effective for managing nonsevere mental health conditions. Successful implementation requires multilevel structural support, including policy and organizational commitment, enhanced digital infrastructure, workforce training and engagement, and the design of culturally responsive DMH models to improve uptake and equitable access to mental health care among First Nations Australians.

[This corrects the article DOI: 10.2196/67460.].