Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Changes in the clinical learning environment under resident duty hours restrictions have introduced a number of challenges on today's wards. Additionally, the current group of medical trainees is largely represented by the Millennial Generation, a generation characterized by an affinity for technology, interaction, and group-based learning. Special attention must be paid to take into account the learning needs of a generation that has only ever known life with duty hours. ⋯ Hospitalists serving as teaching attendings should consider these possible strategies as ways to enhance teaching in the post-duty hours era. These techniques appeal to the preferences of today's learners in an environment often limited by time constraints. Hospitalists are well positioned to champion innovative approaches to teaching in a dynamic and evolving clinical learning environment.
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Randomized Controlled Trial
Bacterial contamination of healthcare workers' uniforms: a randomized controlled trial of antimicrobial scrubs.
Healthcare workers' (HCWs) uniforms become contaminated with bacteria during normal use, and this may contribute to hospital-acquired infections. Antimicrobial uniforms are currently marketed as a means of reducing this contamination. ⋯ We found no evidence that either antimicrobial scrub product decreased bacterial contamination of HCWs' uniforms or skin after an 8-hour workday.
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Iatrogenic pneumothorax has become an increasingly recognized complication of routine outpatient procedures, such as transthoracic needle biopsies of the lung and transbronchial lung biopsies. Patients with clinically significant pneumothorax are typically managed with evacuation via a percutaneously placed catheter or chest tube. Tube thoracotomy and chest tube management have traditionally been performed by cardiothoracic surgeons; however, with the increasing number of interventional radiologists and interventional pulmonologists, more chest tubes are being placed by specialists who do not admit and manage patients in the hospital setting. ⋯ Hospitalists caring for such patients are often expected to manage the chest tube. General internal medicine training and the existing medical literature provide few guidelines to assist with this issue. We present a discussion of the current published literature and our management algorithms for hospitalists caring for patients admitted with iatrogenic pneumothorax.
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Multicenter Study
Educational impact of using smartphones for clinical communication on general medicine: more global, less local.
Medical trainees increasingly use smartphones in their clinical work. Similar to other information technology implementations, smartphone use can result in unintended consequences. This study aimed to examine the impact of smartphone use for clinical communication on medical trainees' educational experiences. ⋯ We summarized the impact of a rapidly emerging information technology-smartphones-on the educational experience of medical trainees. Smartphone use increase connectedness and allow trainees to be more globally available for patient care but creates interruptions that cause trainees to be less present in their local interactions with staff during teaching sessions. Educators should be aware of these findings and need to develop curriculum to address the negative impacts of smartphone use in the clinical training environment.
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Because relative value unit (RVU)-based costs vary across hospitals, it is difficult to use them to compare hospital utilization. ⋯ Standardized costs are a novel method for comparing utilization across hospitals and reduce variation observed with RVU-based costs. They have the potential to help hospitals understand how they use resources compared to their peers and will facilitate research comparing the effectiveness of higher and lower utilization.