FP essentials最新文献_第6页

Technology in Medicine: Optimizing Electronic Health Records. 医学技术：优化电子健康记录。

FP essentials Pub Date : 2024-02-01

Derek J Baughman

{"title":"Technology in Medicine: Optimizing Electronic Health Records.","authors":"Derek J Baughman","doi":"","DOIUrl":"","url":null,"abstract":"Electronic health record (EHR) systems have transformed the medical industry. Despite their known benefits, their implementation has resulted in new digital administrative tasks and responsibilities for physicians. This increase in administrative burden has been shown to contribute to physician burnout. Most sources of EHR-related burnout can be categorized into three groups: poor usability, excessive time spent in the EHR, and inefficient workflows. Evidence-based interventions for EHR-related burnout focus on training and education, which improve efficiency in EHR use and may reduce burnout. Optimization of the EHR interface, including personalization and use of targeted workflows, can help address physician frustrations and improve productivity. In the United States, the federal government regulates EHR system development and sets usability requirements. These requirements are critical because visualization and operational design of the user interface have been shown to directly affect patient care and safety. Negative effects of EHR implementation generally are related to increased administrative burden. Positive effects include greater clinician productivity and administrative cost savings. EHR adoption has consistently been associated with positive financial and clinical outcomes. Federal laws continue to be implemented to improve EHR usability, interoperability, and standards for data access and security.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"537 ","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Technology in Medicine: Telemedicine. 医学技术：远程医疗。

FP essentials Pub Date : 2024-02-01

Derek J Baughman, Paul A Botros, Abdul Waheed

{"title":"Technology in Medicine: Telemedicine.","authors":"Derek J Baughman, Paul A Botros, Abdul Waheed","doi":"","DOIUrl":"","url":null,"abstract":"Telemedicine is defined as the provision of clinical services via telephone or video and is a type of telehealth. Telehealth is defined as the use of electronic information and telecommunications technologies for the delivery of health care, health education, and health information. During the COVID-19 pandemic, telemedicine availability and use of telehealth care significantly increased. The integral role of telemedicine during this time prompted the unprecedented integration of telehealth as a quasi-standard of care. Recent studies have shown telemedicine can achieve comparable or superior quality performance compared with in-office visits for a range of clinical areas in large primary care populations. Implementation of telemedicine at the practice level depends on use of strong clinical workflows across the medical team. Effective telemedicine visits rely on adaptation to a digital environment and patient cooperation for virtual physical examinations. There are subtle differences in coding for billing telemedicine visits (mainly for audio-only visits), and many add-on codes for preventive care are eligible for telehealth. Concerns exist about the ethical implications of virtual care, especially regarding privacy and access. The future success of telehealth will depend on a balance of patient autonomy and health outcomes in the context of health equity.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"537 ","pages":"14-20"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Technology in Medicine: Remote Patient Monitoring. 医学技术：远程病人监护。

FP essentials Pub Date : 2024-02-01

Derek J Baughman, Paul A Botros, Abdul Waheed

引用次数: 0

Technology in Medicine: Foreword. 医学技术：前言。

FP essentials Pub Date : 2024-02-01

Ryan D Kauffman

引用次数: 0

Technology in Medicine: Improving Clinical Documentation. 医学技术：改进临床文档。

FP essentials Pub Date : 2024-02-01

Derek J Baughman, Paul A Botros, Abdul Waheed

{"title":"Technology in Medicine: Improving Clinical Documentation.","authors":"Derek J Baughman, Paul A Botros, Abdul Waheed","doi":"","DOIUrl":"","url":null,"abstract":"The association between electronic health record (EHR) documentation and physician burnout is well-known. A combination of insufficient time to complete tasks, clinical documentation burden, and electronic inbox overload comprises the definition of documentation-related burnout. Burnout mitigation strategies related to clinical documentation include use of targeted EHR training for documentation, use of medical scribes, and institutional documentation redesign. Mitigation strategies related to electronic inbox overload include assigning designated administrative time for inbox management, tailoring of message content to decrease length, and a team-based approach to clinical workflows. Best practices for improving the efficiency of clinical documentation in the EHR include use of automation tools (eg, macros, templates), physician note optimization, and use of team-based documentation. Clinical documentation aids such as medical scribes, speech recognition software, and artificial intelligence (AI)-based software are popular and often considered a necessary resource in health care. For most practices, decisions regarding which aid to use will likely be determined by cost. Speech recognition software is the lowest cost option. AI-based software and medical scribes are more costly.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"537 ","pages":"26-38"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Disease: Atrial Fibrillation and Atrial Flutter. 心血管疾病：心房颤动和心房扑动。

FP essentials Pub Date : 2024-01-01

Robert L Gauer, Joel M Guess

{"title":"Cardiovascular Disease: Atrial Fibrillation and Atrial Flutter.","authors":"Robert L Gauer, Joel M Guess","doi":"","DOIUrl":"","url":null,"abstract":"Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, with lifetime rates of 21% to 33%. There are numerous risk factors, including older age, hypertension, coronary disease, obstructive sleep apnea, diabetes, and others. Patients engaging in lifelong high-endurance exercise also have increased risk. Some organizations recommend screening; others do not. However, many patients identify AF themselves using mobile cardiac monitoring devices, some of which accurately detect the arrhythmia. Patients with AF with hemodynamic instability are treated with immediate synchronized cardioversion. Treatment options for stable patients include scheduled cardioversion, rhythm control with pharmacotherapy, catheter ablation, and rate control with pharmacotherapy. Catheter ablation is increasingly used as first-line therapy, with up to 80% of patients remaining AF-free after one or two ablation treatments, an outcome superior to that with pharmacotherapy. Patients with AF should receive anticoagulation based on the CHA2DS2-VASc (Congestive heart failure, Hypertension, Age 75 years or older [doubled], Diabetes, prior Stroke or transient ischemic attack or thromboembolism [doubled], Vascular disease, Age 65 to 74 years, Sex category) score, and also before and immediately after ablation or cardioversion. It is uncertain whether long-term anticoagulation is needed after successful ablation. Atrial flutter (AFL) is the second most common sustained supraventricular arrhythmia. Patients with AFL are at risk of developing AF, and many recommendations for managing AFL are similar to those for AF. The preferred management for AFL is catheter ablation, with success rates exceeding 90%.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"536 ","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139471457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Disease: Other Common Arrhythmias. 心血管疾病：其他常见心律失常。

FP essentials Pub Date : 2024-01-01

Joel M Guess, Robert L Gauer

{"title":"Cardiovascular Disease: Other Common Arrhythmias.","authors":"Joel M Guess, Robert L Gauer","doi":"","DOIUrl":"","url":null,"abstract":"Premature atrial contractions (PACs) occur in nearly all individuals. Although typically asymptomatic, they can cause palpitations. PACs previously were considered benign, but there is increasing recognition that frequent PACs are associated with developing atrial fibrillation. After potentially reversible causes (eg, electrolyte abnormalities, hyperthyroidism) are eliminated, symptomatic PACs can be treated with beta blockers; some patients are candidates for ablation. Premature ventricular contractions (PVCs) also are common, occurring in more than two-thirds of the population. They typically are asymptomatic, but some patients experience palpitations and dizziness. Persistent PVCs are associated with underlying heart disease; an echocardiogram can help detect this disease. Reversible causes (eg, electrolyte abnormalities, hyperthyroidism, stimulant drug use) should be excluded. Patients with PVCs and left ventricular dysfunction are candidates for ablation. Others may be treated with beta blockers, nondihydropyridine calcium channel blockers, or antiarrhythmics. Supraventricular tachycardia also is common. Hemodynamically unstable patients are treated with cardioversion. Stable symptomatic patients can be considered for catheter ablation or medical antiarrhythmics. Finally, sinus node dysfunction, previously called sick sinus syndrome, causes a variety of rhythm disturbances, including bradycardia, sinus arrest, bradycardia-tachycardia syndrome, and others. Unstable patients are treated with atropine to increase heart rate. Stable patients should discontinue bradycardia-causing drugs, if possible. Some may require a pacemaker.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"536 ","pages":"22-28"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139471841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Disease: Inflammatory and Infectious Heart Conditions. 心血管疾病：炎症和感染性心脏疾病。

FP essentials Pub Date : 2024-01-01

Robert L Gauer, Joel M Guess

{"title":"Cardiovascular Disease: Inflammatory and Infectious Heart Conditions.","authors":"Robert L Gauer, Joel M Guess","doi":"","DOIUrl":"","url":null,"abstract":"Acute pericarditis, the most common inflammatory heart condition, typically is caused by viral infections. Patients have sharp chest pain that improves when leaning forward. Electrocardiogram typically shows widespread ST-segment elevation; echocardiogram may show pericardial effusion; and levels of inflammatory markers may be elevated. Colchicine plus nonsteroidal anti-inflammatory drugs are first-line treatment. Patients with fever, elevated inflammatory marker levels, or pericardial effusion should be hospitalized. Myocarditis also commonly is caused by viruses, although some cases are due to autoimmune or other conditions. Symptoms include chest pain, dyspnea, and fever. Although endomyocardial biopsy is the definitive diagnostic test, most cases are diagnosed based on clinical symptoms, electrocardiogram, echocardiogram, and cardiac markers, plus excluding other conditions. Patients with heart failure should receive guideline-recommended therapy, plus treatment of underlying conditions (eg, autoimmune conditions). Infective endocarditis is caused by infection of cardiac valves, chambers, or intracardiac devices. There are many causative organisms, but Staphylococcus aureus is most common. Fever is the most frequent symptom, although some patients have systemic emboli or heart failure. The modified Duke criteria can aid in diagnosis, which is confirmed by positive blood cultures. Antibiotics are started immediately after obtaining blood cultures, modified based on culture results, and continued for 4 to 6 weeks after first negative culture.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"536 ","pages":"29-45"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139471489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Disease: Anticoagulation Therapy for Atrial Fibrillation. 心血管疾病：心房颤动的抗凝疗法。

FP essentials Pub Date : 2024-01-01

William Criswell, Robert L Gauer

{"title":"Cardiovascular Disease: Anticoagulation Therapy for Atrial Fibrillation.","authors":"William Criswell, Robert L Gauer","doi":"","DOIUrl":"","url":null,"abstract":"Patients with atrial fibrillation (AF) should receive anticoagulation with warfarin or direct oral anticoagulants (DOACs) if the CHA2DS2-VASc (Congestive heart failure, Hypertension, Age 75 years or older [doubled], Diabetes, prior Stroke or transient ischemic attack or thromboembolism [doubled], Vascular disease, Age 65 to 74 years, Sex category) score is at least 2 in men or 3 in women. Antiplatelet therapy is not recommended. DOACs typically are the first-line therapy. Anticoagulation requires special consideration in some patient groups (eg, patients with bleeding problems should be considered for left atrial appendage occlusion devices, rather than anticoagulation). Atrial high-rate episodes detected on electronic devices confer higher AF risk; however, there currently are no clearly defined thresholds to determine who benefits from anticoagulation. Patients with AF with valvular heart disease should receive anticoagulation based on CHA2DS2-VASc score; those with mechanical heart valves or moderate to severe stenosis of a native mitral valve should receive warfarin, not DOACs. Chronic kidney disease requires dose reduction. Patients with AF taking antiplatelet therapy for acute coronary syndrome or percutaneous coronary intervention require special consideration because of the bleeding risk. The risk-benefit profile favors anticoagulation in older adults. Patients undergoing surgical procedures with high bleeding risk often need temporary anticoagulant discontinuation. Patients receiving anticoagulation who develop life-threatening bleeding should receive reversal therapy.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"536 ","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139471374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Disease: Foreword. 心血管疾病：前言。

FP essentials Pub Date : 2024-01-01

Barry D Weiss

引用次数: 0