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Background Medication reconciliation has been shown to reduce medication-related errors in hospitalized patients, but the impact of pharmacy-led medication reconciliation in the intensive care unit (ICU) has not been extensively studied. Methods This was a retrospective chart review of patients with a pharmacy-led medication reconciliation on admission to an ICU between January 1st and March 31st, 2018. Pharmacy-led medication reconciliations were completed by pharmacists, pharmacy residents, and pharmacy students. The objective of this study was to describe medication discrepancies identified by pharmacy-led medication reconciliation and to evaluate the interventions following. Results A total of 288 patients were screened and 247 met inclusion criteria. There were 1148 medication discrepancies identified resulting in an average of 4.65 discrepancies per patient. Medication addition (54.25%) and medication deletion (45.75%) were most common. Within 24 hours of medication reconciliation, 214 interventions were made to active orders. No differences were observed between discrepancies identified and type of pharmacy staff completing the medication reconciliation. Conclusions This study identified a high rate of medication discrepancies on admission to the ICU. Furthermore, it describes the types of pharmacist interventions following pharmacy-led medication reconciliation. This process may be impactful to incorporate as a standard practice in ICUs and warrants further investigation into value, cost, and pharmacist workflow.

Objective: Assess whether participation in a well-established tele-education mentorship program, ECHO (Extension for Community Healthcare Outcomes) , improves preclinical providers’ self-efficacy, confidence, and knowledge in managing complex diabetes (DM) . Methods: Over 3 cycles of ECHO sessions from 2018-2021, we engaged 42 physician assistant students (PAS) in efforts to increase knowledge prior to clinical practice. Using didactics and case-based learning via videoconferencing, the ECHO model allowed participants to receive tele-mentoring from an endocrinologist, a diabetes educator, and rotating specialists. Over 14-16 bimonthly sessions, PAS (n=42) received an evidence-based curriculum on complex DM management. Pre and post course surveys measured self-efficacy (13 questions) , confidence in management (6) , factual knowledge (12) and prescribing practices (11) . Results: Twenty-three PAS completed at least 50% of sessions; 18 completed both evaluations. On a 7-point Likert scale, self-efficacy increased from 3.18 (slightly competent) pre-intervention to 4.78 (competent) post (p Conclusion: Our ECHO model is the first to evaluate healthcare trainees. PAS showed improved self-efficacy, knowledge, and confidence in DM management and increased comfort in prescribing. However, overall participation in live sessions was low. Further research is assessing incorporation of pre-recorded ECHO sessions into the PA curriculum. Disclosure M.Phelps: None. A.Aldous: None. N.M.Ehrhardt: Advisory Panel; Dexcom, Inc., Novo Nordisk, Research Support; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk. Funding Merck Foundation, Merck and Novo Nordisk

Participation in curricular change and teacher professional development can be challenging for honorary clinical teachers, who juggle teaching alongside busy clinical practice. Following redevelopm...

Objective: To review the clinical effects of nebulized heparin and N-acetylcysteine (NAC) in patients with smoke inhalation injury (IHI) and provide recommendations for use. Data Sources: A search of PubMed, MEDLINE, and Scopus databases was completed from database inception through April 15, 2020, using terms: heparin, acetylcysteine, smoke inhalation injury, and burn injury. Study Selection and Data Extraction: All studies pertaining to efficacy and safety of nebulized heparin and/or NAC for IHI in adult patients were evaluated. Reference lists were reviewed for additional publications. Nonhuman studies, non-English, and case report publications were excluded. Data Synthesis: Eight studies were included. Four demonstrated positive outcomes, 3 demonstrated no benefit or possible harm, and 1 assessed safety. Supporting trials treated patients within 48 hours of injury with 10 000 units of nebulized heparin with NAC for 7 days or until extubation. Two trials with negative findings treated patients within 72 hours, or unspecified, with 5000 units of nebulized heparin with NAC for 7 days, while the third used 25 000 units within 36 hours but was grossly underpowered for analysis. Clinical findings include reduced duration of mechanical ventilation and improved lung function with possible increase risk of pneumonia and no evidence of increased bleeding risk. Conclusions: Nebulized heparin may improve oxygenation and reduce duration of mechanical ventilation in IHI. If nebulized heparin is used, 10 000 units every 4 hours alternating with NAC and albuterol at 4-hour intervals is recommended. Sterile technique should be emphasized. Monitoring for bronchospasm or new-onset pneumonia should be considered.

Hunting of wildlife is one of the major threats to biodiversity. For effective conservation programmes in countries where hunting and shifting agriculture are the main sources of subsistence, forest management should aim to reduce hunting pressure and forest exploitation. The presence of researchers has been promoted as one of the main ways to mitigate anthropogenic pressures on wildlife populations. Our aim was to test whether local management and the establishment of a research station had a role in decreasing forest exploitation by local people living adjacent to a recently protected area in south-east Madagascar. We interviewed local people from nine villages at various distances from the recently established research station of Ampasy, in the northernmost portion of the Tsitongambarika Protected Area, to explore how people use the forest, with a particular focus on hunting. We also performed transect surveys to estimate snare and lemur encounter rates before local forest management began, at the establishment of the research station, and 1 year after. The impact of local communities on the forest seems to have decreased since the beginning of forest management, with a further decrease since the establishment of the research station. Participants from villages not involved in the local management were more reluctant to declare their illegal activities. We conclude that a combination of local management and related activities (e.g. installation of a research station) can assist in temporarily reducing forest exploitation by local communities; however, community needs and conservation plans should be integrated to maintain long-term benefits.

University policies prohibiting use of mobile devices by medical students during clinical placements are contradicted by regular use by physicians. Consequently, many students use their mobile devices, which can be beneficial for learning but may put patient privacy at risk. This study explores the reasons underlying students' decisions about using mobile devices in clinical settings. We used a mixed‐methods sequential explanatory design involving a questionnaire and focus groups. Qualitative data from the questionnaire and focus groups was analysed through thematic analysis. We found students were aware of the risks mobile devices posed to professionalism and medical practice. Despite prohibitions, many made individual decisions to use mobile devices because the benefits outweighed the risks. These students were influenced by an organised, strategic approach to learning and a motivation to comply with the beliefs and behaviours of their medical teams and conform to physicians' directives in order to participate in their community of practice. Many students appear to be transferring everyday use of mobile devices to clinical settings. There is a need to understand and promote aspects of learning that are enhanced by mobile devices in clinical settings, while articulating clear guidelines and boundaries compatible with the professional behaviour expected of students. [ABSTRACT FROM AUTHOR]

Background Mobile device use has become almost ubiquitous in daily life and therefore includes use by doctors in clinical settings. There has been little study as to the patterns of use and impact this has on doctors in the workplace and how negatively or positively it impacts at the point of care. Aim To explore how doctors use mobile devices in the clinical setting and understand drivers for use. Methods A mixed methods study was used with doctors in a paediatric and adult teaching hospital in 2013. A paper-based survey examined mobile device usage data by doctors in the clinical setting. Focus groups explored doctors' reasons for using or refraining from using mobile devices in the clinical setting, and their attitudes about others' use. Results The survey, completed by 109 doctors, showed that 91% owned a smartphone and 88% used their mobile devices frequently in the clinical setting. Trainees were more likely than consultants to use their mobile devices for learning and accessing information related to patient care, as well as for personal communication unrelated to work. Focus group data highlighted a range of factors that influenced doctors to use personal mobile devices in the clinical setting, including convenience for medical photography, and factors that limited use. Distraction in the clinical setting due to use of mobile devices was a key issue. Personal experience and confidence in using mobile devices affected their use, and was guided by role modelling and expectations within a medical team. Conclusion Doctors use mobile devices to enhance efficiency in the workplace. In the current environment, doctors are making their own decisions based on balancing the risks and benefits of using mobile devices in the clinical setting. There is a need for guidelines around acceptable and ethical use that is patient-centred and that respects patient privacy.

Mobile devices are ubiquitous worldwide, including in hospitals. 'Just in time' learning provided by these devices is important for students. We investigated current use of, and learning with, smartphones and other mobile devices by medical students in Parisian hospitals. A survey with quantitative and qualitative items previously used with students from an Australian medical school was translated to French and adapted. The voluntary survey was delivered online to Universite Paris Descartes students. A total 854 medical students from across the final 5 years of the program completed the survey. The mean age was 22 years and 90% identified as French, matching the demographic pattern of the student body. Of 976 devices used by these students, 43% were iPhones and 32% another smartphone. Students accessed the Internet regularly or often, more for medically relevant than unrelated information-49% versus 16.5%. Almost half of respondents reported never accessing social media during clinical placements. Students agreed they used mobile devices for improving learning, knowledge and skills, but less for timetabling and communication. Reactions of supervisors, patients and families were concerning. Only 3.3% of respondents did not use a mobile device in clinical settings. These findings have implications for Francophone and all health professional schools. [ABSTRACT FROM AUTHOR]

This study was conducted with medical students, physicians, patients and carers in a paediatric and an adult hospital to determine use of mobile devices for learning, and beliefs and attitudes about others' use. Awareness of ethical, patient privacy and data security concerns was explored. The research was conducted using a mixed-methods sequential explanatory design through survey and focus groups for students and physicians, and a separate survey for patients and carers. Each arm of the study was analysed individually, followed by integration of quantitative and qualitative data, which are the subject of this paper. Interpretation of the integrated student and physician quantitative data highlighted that both groups used mobile devices for information verification, organisation and communication, and these represented the best uses of mobile devices; the worst aspects of mobile devices involved Internet access difficulties. Interpretation of the integrated student and physician qualitative data highlighted that students and physicians made individual decisions about their use of mobile devices, despite some existing policies. Integration of all data from all arms of the study identified the benefits of using mobile devices and concerns about distraction. For many students and physicians, the benefits of using mobile devices for learning at the patient bedside outweigh the possible risks. As society grapples with norms governing appropriate use of mobile devices, many are devising their own rules to aid learning in clinical settings. [ABSTRACT FROM AUTHOR]

mHealth is transforming health care, yet few studies have evaluated patient and carer perceptions of the use of smartphones at the patient bedside. In this study, 70 patients and carers answered a short survey on health professionals' use of mobile devices. Half the participants were tolerant of doctors using such devices if it was work-related; others believed it was a distraction and not beneficial to patient care. Changes in practice and patient education may be needed to enable effective use of mobile devices in health.

Mobile device use has become almost ubiquitous in daily life and therefore includes use by doctors in clinical settings. There has been little study as to the patterns of use and impact this has on doctors in the workplace and how negatively or positively it impacts at the point of care.To explore how doctors use mobile devices in the clinical setting and understand drivers for use.A mixed methods study was used with doctors in a paediatric and adult teaching hospital in 2013. A paper-based survey examined mobile device usage data by doctors in the clinical setting. Focus groups explored doctors' reasons for using or refraining from using mobile devices in the clinical setting, and their attitudes about others' use.The survey, completed by 109 doctors, showed that 91% owned a smartphone and 88% used their mobile devices frequently in the clinical setting. Trainees were more likely than consultants to use their mobile devices for learning and accessing information related to patient care, as well as for personal communication unrelated to work. Focus group data highlighted a range of factors that influenced doctors to use personal mobile devices in the clinical setting, including convenience for medical photography, and factors that limited use. Distraction in the clinical setting due to use of mobile devices was a key issue. Personal experience and confidence in using mobile devices affected their use, and was guided by role modelling and expectations within a medical team.Doctors use mobile devices to enhance efficiency in the workplace. In the current environment, doctors are making their own decisions based on balancing the risks and benefits of using mobile devices in the clinical setting. There is a need for guidelines around acceptable and ethical use that is patient-centred and that respects patient privacy.

Objective: The present study aimed to assess the prevalence and predictors of anxiety and depression in Australian chronic hepatitis C (CHC) outpatients. Method: Hospital Anxiety and Depression Scale scores at referral and other patient data was analysed for 395 CHC outpatients attending the Royal Adelaide Hospital liver clinic from 2006 to 2010. Results: Results revealed probable prevalence rates of 41% for anxiety and 27% for depression. CHC patients had rates of anxiety and depression 1.2 and 2.4 times higher than community norms, respectively. Younger patients were found to experience increased anxiety, while married patients or those in a de facto relationship experienced decreased anxiety and depression. Conclusion: Regular psychiatric screening, and subsequent referral for mental health treatment, where necessary, is recommended for Australian CHC patients. Younger patients or those lacking social supports may be at increased risk. Research is needed to develop and evaluate psychological interventions.