Kansas journal of medicine最新文献

Introduction: Provider time spent in the electronic health record (EHR) continues to increase, adding stress to an already demanding field. This study quantified the impact of a new EHR procedure documentation tool designed to reduce charting burden.

Methods: This retrospective cohort study was conducted at the University of Kansas Health System and involved ambulatory physicians from all hospitals who were granted access to a new procedural documentation tool. Data on time spent per chart and clicks per chart per office visit were gathered from the hospital's EHR system. The cohort also completed a survey regarding their self-perceived efficiency in the EHR and charting burden.

Results: The procedure documentation tool was used for 68% (25/37) of eligible procedures at one-month post-implementation. There was no significant difference in minutes per chart between the group that used the tool and the group that did not, although the group using the tool had lower charting time (median difference [MD] = 5.517; 95% CI, -0.283 to 13.317; p = 0.066). A similar trend was seen with clicks per chart, with an MD of 4 (95% CI, -3 to 11; p = 0.25).

Conclusions: While the difference was not significant, this study achieved its goal of quantifying the impact of a health information technology (HIT) project and indicates the need for further examination of how to quantify future projects. It lays the groundwork for future evaluation of similar tools and studies.

Introduction: Communication of breast biopsy results varies and does not always meet patient expectations. This study aimed to determine how patients previously diagnosed with breast cancer preferred to receive their biopsy results, including preferences for communication methods, the type of medical professional delivering the results, and wait time. Additionally, we evaluated how health literacy might affect these preferences.

Methods: English-speaking female patients who had previously been diagnosed with breast cancer were surveyed at a breast surgery clinic in Wichita, Kansas. The survey included the Brief Health Literacy Screen (BHLS), questions on how they received their biopsy results, and their preferences for receiving results. Participants were classified as having adequate or inadequate literacy based on their BHLS responses and a scoring system from previous research.

Results: The study included 101 participants. Overall, 64% preferred in-person communication, 40% preferred to hear from their primary care physician, 36% from their surgeon, and 56% wanted results within 24 hours. There was no statistically significant difference in preferences based on health literacy, including communication method (p = 0.44), type of medical professional (p = 0.56), and wait time (p = 0.38).

Conclusions: Most participants preferred to receive biopsy results indicating a breast cancer diagnosis in-person, regardless of their health literacy. While it may be sufficient to call a patient with benign biopsy results, it is recommended to offer an in-person discussion for cancer diagnoses, respecting the patient's preference.

Objective: To investigate the role that foot-strike hemolysis plays in sports-related anemia in marathon and ultramarathon runners.

Data sources: PubMed, Embase, Cochrane, Grey literature.

Study selection: Inclusion criteria consisted of human studies with runners completing a sanctioned race of marathon distance or greater, with outcomes measured by pre- and post-race hematological assessments.

Data extraction: Three independent reviewers systematically extracted data from selected studies. Data included age, sex, height, weight, best marathon time, and pre- and post-race outcomes for complete blood count, reticulocyte count, and iron studies. The evaluation of potential bias was conducted using the Methodological Index for Nonrandomized Studies (MINORS) criteria.

Data synthesis: The literature search yielded 334 studies, of which nine met the inclusion criteria, encompassing data from 267 runners. The majority (88%, 236 out of 267) were male, with a weighted mean age of 37 years (SD 8.2). The reticulocyte count demonstrated a 16% increase between pre- and post-race measurements, although still within normal limits, while haptoglobin levels were reduced by 21%. Hemoglobin, hematocrit, and RBC count values remained within accepted normal limits.

Conclusions: Changes in reticulocyte count and haptoglobin levels suggest transient foot-strike hemolysis; however, hemoglobin and hematocrit levels did not change notably. It is unclear whether these associations are influenced by differences in runner demographics, running experience, or race characteristics. Further studies should evaluate hemolytic changes while matching participants by demographic characteristics, level of running experience, and specific marathon course characteristics. Additionally, research should analyze whether intravascular hemolysis occurs at race distances shorter than 42.2 km.

Introduction: Few studies have examined the hospital course and patient outcomes among elderly trauma patients with COVID-19 and traumatic fall-related injuries. This study aimed to describe patient characteristics and hospital outcomes for older adults who sustained fall-related injuries and were concurrently infected with COVID-19.

Methods: A retrospective chart review was conducted for patients aged 65 years and older who were admitted to a single Level 1 trauma center with fall-related injuries between March 3, 2020 and March 3, 2021.

Results: Of the 807 patients who presented with fall-related injuries during the study period, 16% (n = 128) were tested for COVID-19, and 17% (n = 22) of those tested positive. After excluding one patient, 21 patients were included in the analysis. Common comorbidities among these patients included hypertension (86%, n = 18), dyslipidemia (57%, n = 12), and diabetes (43%, n = 9). Upon admission, 62% (n = 13) of patients exhibited respiratory symptoms such as cough, shortness of breath, and hypoxemia, while approximately 24% (n = 5) were asymptomatic for COVID-19 at presentation. Complications included unplanned intensive care unit or operating room visits (29%, n = 6). COVID-19-related complications included acute hypoxic respiratory failure (67%, n = 14) and pneumonia (43%, n = 9). In-hospital mortality was 19% (n = 4).

Conclusions: During the height of the COVID-19 pandemic, 17% of elderly patients admitted to a single Level 1 trauma center for fall-related injuries were concurrently infected with COVID-19. These patients experienced a high frequency of complications and in-hospital mortality. Therefore, COVID-19 should be recognized as a severe and potentially lethal comorbidity among older adults who sustain fall-related injuries.