Supravenous Hyperpigmentation in an HIV-Infected Patient.

A 47-year-old African American man was seen for routine follow-up for his human immunodeficiency virus (HIV). The patient's medical history included insomnia, gastroesophageal reflux disease, pulmonary embolism, right shoulder musculoskeletal pain, latent tuberculosis infection, sickle cell trait (hemoglobin S variant), and HIV of 24 years' duration.

Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle.

BACKGROUND: Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience. METHODS: This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. RESULTS: Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. CONCLUSIONS: The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.

Evaluation of a hands-free communication device in an acute care setting: a study of healthcare providers' perceptions of its performance.

Quality medical care hinges on healthcare providers being able to communicate effectively and efficiently. In this study, we examine if healthcare providers' perceptions of the performance of a wireless communication device are consistent with what it is claimed the technology can offer, namely, improved patient safety and quality of care. We used a mixed-methods design where we collected data from a single medical unit. During the qualitative component of the study, we conducted face-to-face interviews to explore healthcare team members' perceptions of the impact of a wireless communication device on their day-to-day patient care activities. Three major improvements were identified from the interview data: more direct and effective communication, improved work efficiency, and enhanced continuity of patient care. The quantitative component consisted of a questionnaire constructed from the major themes extracted from the interviews. Many of the healthcare team members reported that the wireless communication device improved their communication and allowed them to complete their work more efficiently. In addition, the questionnaire findings suggest that both improved communication and work efficiency are correlated with perceptions of improved quality of patient care. Based on the results of this study, this wireless communication device does live up to its aims of enhancing communication, staff efficiency, and improving perceived patient safety.

The efficacy of computer-enabled discharge communication interventions: a systematic review.

CONTEXT: Traditional manual/dictated discharge summaries are inaccurate, inconsistent and untimely. Computer-enabled discharge communications may improve information transfer by providing a standardised document that immediately links acute and community healthcare providers. OBJECTIVE: To conduct a systematic review evaluating the efficacy of computer-enabled discharge communication compared with traditional communication for patients discharged from acute care hospitals. DATA SOURCES: MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials and MEDLINE In-Process. Keywords from three themes were combined: discharge communication, electronic/online/web-based and controlled interventional studies. STUDY SELECTION: Study types included: clinical trials, quasiexperimental studies with concurrent controls and controlled before--after studies. Interventions included: (1) automatic population of a discharge document by computer database(s); (2) transmission of discharge information via computer technology; or (3) computer technology providing a 'platform' for dynamic discharge communication. Controls included: no intervention or traditional manual/dictated discharge summaries. Primary outcomes included: mortality, readmission and adverse events/near misses. Secondary outcomes included: timeliness, accuracy, quality/completeness and physician/patient satisfaction. DATA EXTRACTION: Description of interventions and study outcomes were extracted by two independent reviewers. RESULTS: 12 unique studies were identified: eight randomised controlled trials and four quasi-experimental studies. Pooling/meta-analysis was not possible, given the heterogeneity of measures and outcomes reported. The primary outcomes of mortality and readmission were inconsistently reported. There was no significant difference in mortality, and one study reported reduced long-term readmission. Intervention groups experienced reductions in perceived medical errors/adverse events, and improvements in timeliness and physician/patient satisfaction. CONCLUSIONS: Computer-enabled discharge communications appear beneficial with respect to a number of important secondary outcomes. Primary outcomes of mortality and readmission are less commonly reported in this literature and require further study.

Drug-induced rash with eosinophilia and systemic symptoms syndrome with bupropion administration.

BACKGROUND: Sustained-release bupropion is commonly used for the symptomatic relief of depressive illness and as an adjuvant in smoking cessation therapy. OBJECTIVE: To report a case of bupropion-induced drug rash with eosinophilia and systemic symptoms syndrome, including acute hepatitis, obstructive lung disease, and myositis. METHODS: After the patient discontinued use of bupropion, serologic tests, muscle biopsies, pulmonary function tests, a chest x-ray examination, venous Doppler ultrasounds, and an electrocardiogram were performed. RESULTS: On discontinuation of bupropion and prolonged systemic corticosteroid therapy, there was complete resolution of symptoms. CONCLUSIONS: To our knowledge, this is the first reported case of drug rash with eosinophilia and systemic symptoms syndrome induced by bupropion therapy. We report this case to notify clinicians of the potential serious multisystem complications that can occur with sustained-release bupropion therapy.