Journal of general internal medicine
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Selective antimuscarinics may offer a favorable safety profile over non-selective antimuscarinics for the management of overactive bladder (OAB) in patients with dementia. ⋯ Use of non-selective antimuscarinics was associated with a 50% increase in mortality risk among older adults with dementia and OAB. Given the safety concerns regarding non-selective antimuscarinic agents, there is a significant need to optimize their use in the management of OAB for older patients with dementia.
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The COVID-19 outbreak is putting tremendous strain on the US healthcare system, with a direct impact on medical professionals, hospital systems, and physical resources. While comprehensive public health and regulatory efforts are essential to overcome this crisis, it is important to recognize this moment as an opportunity to provide more intelligent and more efficient care in spite of increasing patient volumes and fewer resources. Specifically, we must limit unnecessary and wasteful medical practices and improve the delivery of those services which enhance the quality of patient care. In doing so, we will increase availability of the critical resources required for the provision of high-quality care to those in greatest need both now and in the future.
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The use of personal protective equipment (PPE) has skyrocketed, as providers don masks, glasses, and gowns to protect their eyes, noses, and mouths from COVID-19. Yet these same facial features express human individuality, and are crucial to nonverbal communication. Isolated ICU patients may develop "post intensive-care syndrome," which mimics PTSD with sometimes debilitating consequences. ⋯ Front-line providers reported more comfort with patient interactions while wearing PPE Portraits: "It makes it feel less like a disaster zone [for the patient]." A brief pilot showed signs of significant adoption: a participating physician requested PPE Portraits at their clinic, shift nurses had taken PPE Portraits with them to inpatient services, and masked medical assistant team-members requested PPE Portraits to wear over scrubs. We believe PPE Portraits may support patient care and health, and even potentially healthcare team function and provider wellness. While we await data on these effects, we hope hospitals can use our findings to speed their own implementation testing.
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Social media, particularly podcasts, has become an influential modality within informal medical education. As podcasts continue to become more prevalent among learners of all types, clinical educators of the future must be able to help navigate this new pedagogy. Preliminary data demonstrates that medical students, residents, post-training physicians, and advanced practitioners all utilize podcasts for their own benefit. New data is discussed in the setting of the current literature on podcasting and important questions remain to determine how this new form of learning can and will be integrated into formal and informal medical curriculum.