BackgroundThoracic injuries are a leading cause of death in polytrauma patients. Early diagnosis and treatment are of paramount importance. Whole-body computed tomography (WBCT) has largely replaced traditional imaging techniques such as conventional radiographs and focused computed tomography (CT) as diagnostic tools in severely injured patients. It is still unclear whether WBCT has led to higher rates of diagnosis of thoracic injuries and thus to a change in outcomes.MethodsIn a retrospective study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®), we analysed data from 16,545 patients who underwent treatment in 59 hospitals between 2002 and 2012 (ISS ≥ 9). The 3 years preceding and the 3 years following the introduction of WBCT as a standard imaging modality for the investigation of severely injured patients were assessed for every hospital. Accordingly, patients were assigned to either the pre-WBCT or the WBCT group. We compared the numbers of thoracic injuries and the outcomes of patients before and after the routine use of WBCT.ResultsA total of 13,564 patients (pre-WBCT: n = 5005, WBCT: n = 8559) were included. Relevant thoracic injuries were detected in 47.8%. There were no major differences between the patient groups in injury severity (pre-WBCT: median ISS 21; WBCT: median ISS 22), injury patterns and demographics. After the introduction of WBCT, only minor changes were observed regarding the rates of most thoracic injuries. Clinically relevant injuries were pulmonary contusions (pre-WBCT: 18.5%; WBCT: 28.7%), injuries to the lung parenchyma (pre-WBCT: 12.6%; WBCT: 5.9%), multiple rib fractures (pre-WBCT: 10.6%; WBCT: 21.6%), and pneumothoraces (pre-WBCT: 17.3%; WBCT: 21.6%). The length of stay in the intensive care unit (pre-WBCT: 10.8 days; WBCT: 9.7 days) and in hospital (pre-WBCT: 26.2 days; WBCT: 23.3 days) decreased. There was no difference in overall mortality (pre-WBCT: 15.5%; WBCT: 15.6%).ConclusionsThe routine use of WBCT in the trauma room setting has led to changes in patient management that are not reflected in the rates of diagnosis of severe thoracic injuries (e.g. tension pneumothoraces, cardiac injuries, arterial injuries). By contrast, there was a relevant increase in the rates of diagnosis of minor thoracic injuries, which, however, did not result in an improvement in survival prognosis.
BACKGROUND In-patient management like ordering medical tests is time-consuming and burdens physicians on the ward with non-clinical tasks. We developed and implemented a smartphone-based mobile application (MA) that uses speech recognition for the ordering of radiological examinations. While we could show that the MA supported process was faster, its acceptance and usability remaines unknown. OBJECTIVE We examined the user experience (1), user acceptance (2) and the determinants of user acceptance (3) of a new mobile, speech recognition guided in-patient management MA. METHODS A comprehensive questionnaire based on the short version of the User Experience Questionnaire (UEQ-S) and the Unified Theory of Acceptance and use of Technology (UTAUT) was given to all physicians at the Department of Trauma and Plastic Surgery at the University Hospital of Wuerzburg , Germany. The user experience with the new MA was compared to the usual desktop application (DA) workflow embedded in the clinical information system (i.s.h.med, Cerner Health Services Deutschland GmbH, Berlin, Germany). The domains of user experience consisted of overall attractiveness, pragmatic quality, and hedonic quality. For the determinants of the acceptance model, we employed hierarchical regression analysis. RESULTS Twenty-one out of 30 physicians (mean age 34±8 years, 62% male) completed the questionnaire (response rate 70%). Compared to the conventional DA workflow, the new MA showed superior overall attractiveness (mean difference +2.15±1.33), pragmatic quality (mean difference +1.90±1.16), hedonic quality (mean difference 2.41±1.62; all p<.001). The user acceptance measured by the UTAUT (mean 4.49, SD 0.41; min. 1, max. 5) was also high. Performance expectancy (beta=0.57, p=.02) and effort expectancy (beta=0.36, p=.04) were identified as predictors of acceptance explaining 65.4% of its variance. CONCLUSIONS There is huge potential in reducing the physicians’ burden of administrative tasks by adopting innovative DHI like our speech recognition guided MA in daily ward routine. With this study, we could illustrate that physicians are more than willing to implement such innovative mobile health solutions.
AimsThe benefit of non‐invasive remote patient management (RPM) for patients with heart failure (HF) has been demonstrated. We evaluated the effect of left ventricular ejection fraction (LVEF) on treatment outcomes in the TIM‐HF2 (Telemedical Interventional Management in Heart Failure II; NCT01878630) randomized trial.Methods and resultsTIM‐HF2 was a prospective, randomized, multicentre trial investigating the effect of a structured RPM intervention versus usual care in patients who had been hospitalized for HF within 12 months before randomization. The primary endpoint was the percentage of days lost due to all‐cause death or unplanned cardiovascular hospitalization. Key secondary endpoints were all‐cause and cardiovascular mortality. Outcomes were assessed by LVEF in guideline‐defined subgroups of ≤40% (HF with reduced EF [HFrEF]), 41–49% (HF with mildly reduced EF [HFmrEF]), and ≥50% (HF with preserved EF [HFpEF]). Out of 1538 participants, 818 (53%) had HFrEF, 224 (15%) had HFmrEF, and 496 (32%) had HFpEF. Within each LVEF subgroup, the primary endpoint was lower in the treatment group, i.e. the incidence rate ratio [IRR] remained below 1.0. Comparing intervention and control group, the percentage of days lost was 5.4% versus 7.6% for HFrEF (IRR 0.72, 95% confidence interval [CI] 0.54–0.97), 3.3% versus 5.9% for HFmrEF (IRR 0.85, 95% CI 0.48–1.50) and 4.7% versus 5.4% for HFpEF (IRR 0.93, 95% CI 0.64–1.36). No interaction between LVEF and the randomized group became apparent. All‐cause and cardiovascular mortality were also reduced by RPM in each subgroup with hazard ratios <1.0 across the LVEF spectrum for both endpoints.ConclusionIn the clinical set‐up deployed in the TIM‐HF2 trial, RPM appeared effective irrespective of the LVEF‐based HF phenotype.
The administrative burden for physicians in the hospital can affect the quality of patient care. The Service Center Medical Informatics (SMI) of the University Hospital Würzburg developed and implemented the smartphone-based mobile application (MA) ukw.mobile1 that uses speech recognition for the point-of-care ordering of radiological examinations. The aim of this study was to examine the usability of the MA workflow for the point-of-care ordering of radiological examinations. All physicians at the Department of Trauma and Plastic Surgery at the University Hospital Würzburg, Germany, were asked to participate in a survey including the short version of the User Experience Questionnaire (UEQ-S) and the Unified Theory of Acceptance and Use of Technology (UTAUT). For the analysis of the different domains of user experience (overall attractiveness, pragmatic quality and hedonic quality), we used a two-sided dependent sample t-test. For the determinants of the acceptance model, we employed regression analysis. Twenty-one of 30 physicians (mean age 34 ± 8 years, 62% male) completed the questionnaire. Compared to the conventional desktop application (DA) workflow, the new MA workflow showed superior overall attractiveness (mean difference 2.15 ± 1.33), pragmatic quality (mean difference 1.90 ± 1.16), and hedonic quality (mean difference 2.41 ± 1.62; all p < .001). The user acceptance measured by the UTAUT (mean 4.49 ± 0.41; min. 1, max. 5) was also high. Performance expectancy (beta = 0.57, p = .02) and effort expectancy (beta = 0.36, p = .04) were identified as predictors of acceptance, the full predictive model explained 65.4% of its variance. Point-of-care mHealth solutions using innovative technology such as speech-recognition seem to address the users’ needs and to offer higher usability in comparison to conventional technology. Implementation of user-centered mHealth innovations might therefore help to facilitate physicians’ daily work.
Zusammenfassung Hintergrund Ärztliches Personal ist starkem beruflichem Disstress ausgesetzt. Im Vergleich zur Normalbevölkerung besteht eine erhöhte Prävalenz von disstressassoziierten Erkrankungen wie Depression, Burnout und Suchtverhalten. Fragestellung Können resilienzfördernde Interventionen ärztlichen Disstress reduzieren? Material und Methoden Systematische Literaturrecherche in den Datenbanken „The Cochrane Library“, „Medline“ (via „PubMed“) und „Embase“ im Zeitraum von 2011–2018. Vergleich von vier randomisiert kontrollierten Studien. Ergebnisse Resilienzfördernde Interventionen können ärztlichen Disstress reduzieren. Insbesondere Berufsanfänger/-innen und weibliches ärztliches Personal scheinen davon zu profitieren. Diskussion Da bereits Kurzinterventionen einen positiven Effekt zeigen, sollten resilienzfördernde Maßnahmen im beruflichen Alltag von Ärztinnen und Ärzten implementiert werden.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.