A traumatic enterorenal fistula.

Enterorenal fistulas can arise from various spontaneous and traumatic etiologies. While nephrectomy is frequently the treatment of choice, renal sparing techniques have been described. We report a case of an enterorenal fistula as a complication of penetrating trauma.

The Treatment of Genitoperineal Hidradenitis Suppurativa: A Review of the Literature.

Hidradenitis suppurativa is a chronic inflammatory condition affecting the axilla, genitals, perineum, and perianal regions. The pathophysiology of hidradenitis suppurativa is complex and requires a multidisciplinary approach to treatment involving medical and surgical management when indicated. We describe our multidisciplinary protocol for treatment, which includes rheumatology-monitored immunotherapy, medical management, wide surgical resection, wound care, and reconstruction.

Pro: endoscopic realignment for pelvic fracture urethral injuries.

Patients with pelvic fracture urethral distraction injuries may benefit from early endoscopic realignment. Realignment is associated with a low risk of immediate complications and has a high success rate for achieving catheter placement. Review of over thirty studies assessing for subsequent urethral stenosis, including at least a dozen that directly compare realignment to suprapubic diversion along, conclude that there is a benefit averaging at least 35% in favor of realignment.

Concurrent Testicular and Bladder Cancer in a 57-year-old Man.

We present a rare finding of concurrent right testis non-seminomatous mixed germ cell tumor and muscle invasive urothelial carcinoma of the bladder in a 57-year-old homeless man. The socioeconomic factors and the disease presentation caused a treatment dilemma in terms of the appropriate type of neoadjuvant chemotherapy. The patient ultimately underwent upfront surgery with retroperitoneal lymph node dissection and radical cystoprostatectomy followed by adjuvant cisplatin-based chemotherapy.

An update on urotrauma.

Purpose Of Review: The subject of genitourinary trauma was recently reviewed as an American Urologic Association guideline as well as recently updated as a European Association of Urology guideline. These guidelines, while complete and authoritative, deserve review, amplification and clarification. Also, notably absent from the guidelines is a section on the management of renovascular injuries, which will be reviewed here.

Associations between healthcare quality and use of electronic health record functions in ambulatory care.

Objectives: Contemporary electronic health records (EHRs) offer a wide variety of features, creating opportunities to influence healthcare quality in different ways. This study was designed to assess the relationship between physician use of individual EHR functions and healthcare quality.

Materials And Methods: Sixty-five providers eligible for "meaningful use" were included.

Smartphone Data in Rheumatoid Arthritis - What Do Rheumatologists Want?

Objective: To create a relevant and clinically informative visualization of passively collected patient mobility data from smartphones of rheumatoid arthritis (RA) patients for rheumatologists.

Methods: (1) Pilot analysis of smartphone mobility data in RA; (2) Assessment of rheumatologists' needs for patient data through semi-structured interviews; and (3) Evaluation of the visual format of the RA data using scenario-based usability methods.

Results: We created a color-scale mobility index superimposed on a calendar to summarize the passive mobility measures from the smartphone that the rheumatologists confirmed would be clinically relevant.

Fertility Preservation Preferences and Perspectives Among Adult Male Survivors of Pediatric Cancer and Their Parents.

In this study, we set out to determine the preferences, concerns, and attitudes toward fertility preservation of adult male survivors of pediatric cancer and their parents. We conducted 3 focus groups with a total of 15 male survivors of pediatric cancer (age at diagnosis: mean=14, range: 10-20; age at study: mean=35, range: 25-47) and 2 groups with a total of 7 parents of survivors. Grounded theory methodology was used for the identification and analysis of recurrent themes expressed by survivors and their parents in the course of focus group discussions.

How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use.

Background: Studies of the effects of electronic health records (EHRs) have had mixed findings, which may be attributable to unmeasured confounders such as individual variability in use of EHR features.

Objective: To capture physician-level variations in use of EHR features, associations with other predictors, and usage intensity over time.

Methods: Retrospective cohort study of primary care providers eligible for meaningful use at a network of federally qualified health centers, using commercial EHR data from January 2010 through June 2013, a period during which the organization was preparing for and in the early stages of meaningful use.

Implementation of a computerized patient handoff application.

For hospitalized patients, handoffs between providers affect continuity of care and increase the risk of medical errors. Most commercial electronic health record (EHR) systems lack dedicated tools to support patient handoff activities. We developed a collaborative application supporting patient handoff that is fully integrated with our commercial EHR.

Erectile function in men with failed hypospadias repair.

Objectives: While efforts have been made to study erectile function in patients with urethral stricture, very few prior investigations have specifically assessed erectile function in men with failed hypospadias surgery. We set forth to assess the baseline erectile function of men with hypospadias failure presenting for urethroplasty as adults.

Methods: Retrospective data was analyzed on 163 adult patients with prior failed hypospadias repair who presented for urethroplasty from 2002-2007 at two sites in the United States and Italy.

Admission rates and costs associated with emergency presentation of urolithiasis: analysis of the Nationwide Emergency Department Sample 2006-2009.

Background And Purpose: We sought to examine a large nationwide (United States) sample of emergency department (ED) visits to determine data related to utilization and costs of care for urolithiasis in this setting.

Methods: Nationwide Emergency Department Sample was analyzed from 2006 to 2009. All patients presenting to the ED with a diagnosis of upper tract urolithiasis were analyzed.

Nationwide emergency department visits for priapism in the United States.

Introduction: The epidemiology of priapism is not well characterized. A small number of studies based on inpatient data or small population samples have estimated the incidence to range from 0.34 to 1.

A geographic analysis of male urethral stricture aetiology and location.

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The incidence of specific aetiologies of urethral stricture disease has been reported from a variety of series throughout the world. Most reported urethral stricture series are from single institutions or from a specific region of the world. We provide a multi-centred series to compare aetiologic incidence between differing regional populations.

Commentary: time to sign off on signout.

The physician signout note is a widely used clinical document that supports patient safety and care continuity during patient handoff in the hospital. Despite its centrality to patient care, the signout note is not considered an official document, and it is, therefore, not generally standardized or taught to medical trainees, nor is it usually integrated into electronic health records (EHRs). This commentary outlines several of the potential advantages to establishing the physician signout note as an official part of the medical record, such as the facilitation of information flow between signout notes and other parts of the patient chart and the possibility of integrating decision support tools into this important aspect of the clinical workflow.

An analysis of team checklists in physician signout notes.

Teams of physicians in the hospital collaboratively maintain checklists in informal "signout" documents to help organize, manage, and hand off critical patient-based tasks. We created an application within our commercial EHR that supports basic management of these checklists at two urban, academic medical centers. We collected and analyzed over 400,000 checklist tasks created in the application.

Content overlap in nurse and physician handoff artifacts and the potential role of electronic health records: a systematic review.

Purpose: The aims of this systematic review were: (1) to analyze the content overlap between nurse and physician hospital-based handoff documentation for the purpose of developing a list of interdisciplinary handoff information for use in the future development of shared and tailored computer-based handoff tools, and (2) to evaluate the utility of the Continuity of Care Document (CCD) standard as a framework for organizing hospital-based handoff information for use in electronic health records (EHRs).

Methods: We searched PubMed for studies published through July 2010 containing the indexed terms: handoff(s), hand-off, handover(s), shift-report, shift report, signout, and sign-out. Original, hospital-based studies of acute care nursing or physician handoff were included.

Awareness of the Care Team in Electronic Health Records.

OBJECTIVE: To support collaboration and clinician-targeted decision support, electronic health records (EHRs) must contain accurate information about patients' care providers. The objective of this study was to evaluate two approaches for care provider identification employed within a commercial EHR at a large academic medical center. METHODS: We performed a retrospective review of EHR data for 121 patients in two cardiology wards during a four-week period.

Quantifying clinical narrative redundancy in an electronic health record.

Objective: Although electronic notes have advantages compared to handwritten notes, they take longer to write and promote information redundancy in electronic health records (EHRs). We sought to quantify redundancy in clinical documentation by studying collections of physician notes in an EHR.

Design And Methods: We implemented a retrospective design to gather all electronic admission, progress, resident signout and discharge summary notes written during 100 randomly selected patient admissions within a 6 month period.

What "to-do" with physician task lists: clinical task model development and electronic health record design implications.

Clinical task, or "to-do" lists are a common element in the physician document known as signout. Such lists are used to capture and track patient care plan items, supporting daily workflow and collaborative patient management continuity across care transitions. While physician task lists have been shown to be important to patient safety, the tasks themselves have not been systematically examined for their subject matter, structure, or components.

A competency-based curriculum to acculturate biomedical informatics students to the practice of medicine.

Biomedical informatics students who choose to study clinical information systems may not have significant clinical experience. A course was designed to "acculturate" these students to the practice of medicine through case-based presentations that span three competency areas: biomedicine, clinical workflow and practice, and applications in clinical informatics.

Assessing data relevance for automated generation of a clinical summary.

Clinicians perform many tasks in their daily work requiring summarization of clinical data. However, as technology makes more data available, the challenges of data overload become ever more significant. As interoperable data exchange between hospitals becomes more common, there is an increased need for tools to summarize information.

Signout: a collaborative document with implications for the future of clinical information systems.

Signout is an unofficial clinical document used traditionally to facilitate patient handoff. Qualitative studies have suggested its importance in clinical care. We used a novel technique to quantify the use of signout by analyzing clinical information system logfiles.

Effect of corneal drying on optical coherence tomography.

Purpose: To determine the effect of corneal drying on the outcome of optical coherence tomography (OCT).

Design: Cohort study.

Participants: Seventeen normal participants (mean age, 39+/-12 years).

Are antibodies to the capsular polysaccharide of Neisseria meningitidis group B and Escherichia coli K1 associated with immunopathology?

As polysialic acid (PSA), the capsule of Group B meningococcus (GBM) and Escherichia coli K1, is a component of mammalian glycopeptides, there is concern that vaccines against PSA could induce immunopathology. Purified PSA is not immunogenic; however, as a component of bacteria or bound to proteins, it induces protective antibodies. In this review, we did not unearth data indicating an association of IgG anti-PSA with immunopathology in experimental animals or humans.