BACKGROUND:Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous.OBJECTIVE:To evaluate the effect of a newly‐created electronic discharge summary.DESIGN AND PARTICIPANTS:Pre‐post evaluation of discharge summaries using a survey of outpatient physicians and a medical records review.MEASUREMENTS:Outpatient physicians' ratings of satisfaction with discharge summaries before and after implementation of an electronic discharge summary using a 5‐point Likert scale (1 = very dissatisfied; 5 = very satisfied). Additionally, 196 randomly selected discharge summaries before and after implementation were rated for timeliness and presence of 16 key content areas by 3 internists.RESULTS:Two hundred and twenty‐six of 416 (54%) and 256 of 397 (64%) outpatient physicians completed the baseline and postimplementation surveys. Satisfaction with quality and timeliness of discharge summaries improved with the use of the electronic discharge summary (mean quality rating 3.04 versus 3.64; P < 0.001, mean timeliness rating 2.59 versus 3.34; P < 0.001). A higher percentage of electronic discharge summaries were completed within 3 days of discharge as compared with dictated discharge summaries (44.8% versus 74.1%; P < 0.001). Several elements of the discharge summary were present more often with the electronic discharge summary, including discussion of follow‐up issues (52.0% versus 75.8%; P = 0.001), pending test results (13.9% versus 46.3%; P < 0.001), and information provided to the patient and/or family (85.1% versus 95.8%; P = 0.01).CONCLUSIONS:The use of an electronic discharge summary significantly improved the quality and timeliness of discharge summaries. Journal of Hospital Medicine 2009;4:219–225. © 2009 Society of Hospital Medicine.

Chronically instrumented dogs underwent 2- or 5-h regional reductions in coronary flow that were followed, respectively, by balanced reductions in myocardial contraction and O(2) consumption ("hibernation") and persistently reduced contraction despite normal myocardial O(2) consumption ("stunning"). Previously unidentified myofibrillar disruption developed during flow reduction in both experimental models and persisted throughout the duration of reperfusion (2-24 h). Aberrant perinuclear aggregates that resembled thick filaments and stained positively with a monoclonal myosin antibody were present in 34 +/- 3.8% (SE) and 68 +/- 5.9% of "hibernating" and "stunned" subendocardial myocytes in areas subjected to flow reduction and in 16 +/- 2.5% and 44 +/- 7.4% of subendocardial myocytes in remote areas of the same ventricles. Areas of myofibrillar disruption also showed glycogen accretion and unusual heterochromatin clumping adjacent to the inner nuclear envelope. The degrees of flow reduction employed were sufficient to reduce regional myofibrillar creatine kinase activity by 25-35%, but troponin I degradation was not evident. The observed changes may reflect an early, possibly reversible, phase of the myofibrillar loss characteristic of hypocontractile myocardium in patients undergoing revascularization.

Incorporating students longitudinally into primary care clinics is highly rated by students. The ECMH model led to improved continuity, improved perceptions of the learning climate, and higher patient centeredness. Preliminary data suggest that students add value and improve patient outcomes during longitudinal clinical experiences.

The purpose of this study was to determine the validity and reliability of a new method for measuring three-dimensional (3D) putting stroke kinematics using the TOMI device. A putting robot and a high-speed camera were used to simultaneously collect data for the validity evaluation. The TOMI device, when used in conjunction with standard 3D coordinate data processing techniques, was found to be a valid and reliable method for measuring face angle, stroke path, putter speed, and impact spot at the moment of ball contact. The validity of the TOMI(R) measurement system was quantified using the 95% limits of agreement method for each aforementioned variable. The practical significance of each validity score was assessed by incorporating the maximum estimated measurement error into the stroke of the putting robot for 10 consecutive putts. All putts were executed from a distance of 4 m on a straight and flat synthetic putting surface. Since all putts were holed successfully, the measurement error for each variable was deemed to be negligible for the purposes of measuring putting stroke kinematics. The influence of key kinematic errors, at impact, on the outcome of a putt was also determined.