The birth of the virtual clinic: welcome to the Mediverse.

The COVID-19 pandemic triggered a global pivot to virtual care (VC) technologies. While there has been considerable academic work exploring the "how" of VC, few studies have explored the impact of this pivot, its unintended consequences, and its governing rationales. This study addresses this gap in relation to care, professional identity and the evolving requirements for health professions education.

Using Texting for Clinical Communication in Surgery: A Survey of Academic Staff Surgeons.

Background: Text messaging has become ubiquitous and is being increasingly used within the health care system. The purpose of this study was to understand texting practices for clinical communication among staff surgeons at a large academic institution.

Methods: Staff surgeons in 4 subspecialties (vascular, plastics, urology, and general surgery) were surveyed electronically.

Do Combined Pharmacist and Prescriber Efforts on Medication Reconciliation Reduce Postdischarge Patient Emergency Department Visits and Hospital Readmissions?

Background: Although medication reconciliation (Med Rec) has demonstrated a reduction in potential adverse drug events, its effect on hospital readmissions remains inconclusive.

Objective: To evaluate the impact of an interprofessional Med Rec bundle from admission to discharge on patient emergency department visits and hospital readmissions (hospital visits).

Methods: The design was a retrospective, cohort study.

A Review on the Quality of Colonoscopy Reporting.

Colonoscopy reports are important communication tools for providers and patients with potential to serve as information sources for research, quality, performance, and resource management. Despite decades of work, studies continue to indicate that colonoscopy reports are often incomplete. Although electronic medical records (EMRs) and databases can address this problem, costs, workflow, and interoperability (difficulty exchanging information between systems) continue to limit adoption and implementation of endoscopy EMRs in Canada and elsewhere.

Discrepancy between gastroenterologists' and general surgeons' perspectives on repeat endoscopy in colorectal cancer.

Background: A myriad of localization options are available to endoscopists for colorectal cancer (CRC); however, little is known about the use of such techniques and their relation to repeat endoscopy before CRC surgery. We examined the localization practices of gastroenterologists and compared their perceptions toward repeat endoscopy to those of general surgeons.

Methods: We distributed a survey to practising gastroenterologists through a provincial repository.

Smartphones and Patient Care: Exploring the Use of Text-Based Messaging for Patient-Related Communication.

Background Text messaging (texting) has become a routine medium of communication in society. However, its use among clinicians has not been fully characterized. We explored general surgery residents' practices and views on texting for patient-related communication.

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

Background: Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.

Objectives: To describe the effects of different communication interventions and their problems.

It's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare.

Background: Institutions have tried to replace the use of numeric pagers for clinical communication by implementing health information technology (HIT) solutions. However, failing to account for the sociotechnical aspects of HIT or the interplay of technology with existing clinical workflow, culture, and social interactions may create other unintended consequences.

Objective: To evaluate a Web-based messaging system that allows asynchronous communication between health providers and identify the unintended consequences associated with implementing such technology.

Report on the expert forum on using information technology to facilitate uptake and impact of colorectal cancer screening guidelines.

The present report summarizes the proceedings of the pan-Canadian Expert Forum on Using Information Technology to Facilitate Uptake and Impact of Colorectal Cancer Screening Guidelines, which was held in Montreal, Quebec, November 18 to 19, 2011. The meeting assembled a multidisciplinary group of family physicians, gastroenterologists, nurses, patients, foundation representatives, screening program administrators and researchers to discuss the development of a mechanism or strategy that would permit the collection of comparable data by all colorectal cancer (CRC) screening programs, which would not only support the needs of each program but also provide a national perspective. The overarching theme of the meeting was 'designing a national approach to computerized electronic data collection and dissemination for CRC screening that would improve knowledge transfer across the continuum of preventive health care'.

Order sets in health care: a systematic review of their effects.

Objectives: Order sets are widely used in hospitals to enter diagnosis and treatment orders. To determine the effectiveness of order sets in improving guideline adherence, treatment outcomes, processes of care, efficiency, and cost, we conducted a systematic review of the literature.

Methods: A comprehensive literature search was performed in various databases for studies published between January 1, 1990, and April 18, 2009.

Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics.

Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings.

Improving hospital care and collaborative communications for the 21st century: key recommendations for general internal medicine.

Background: Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to look at alternative communication technologies to address some of these inefficiencies and to improve interprofessional collaboration.

Objective: To develop recommendations that assist health care organizations in improving communication and collaboration in order to develop effective methods for evaluation.

An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study.

Background: Communication between clinicians is critical to providing quality patient care but is often hampered by limitations of current systems. Smartphones such as BlackBerrys may improve communication, but studies of these technologies have been limited to date.

Objective: Our objectives were to describe how smartphones were adopted for clinical communication within general internal medical wards and determine their impact on team effectiveness and communication.

Real-time automated paging and decision support for critical laboratory abnormalities.

Background: For patients with critical laboratory abnormalities, timely clinical alerts with decision support could improve management and reduce adverse events.

Methods: The authors developed a real-time clinical alerting system for critical laboratory abnormalities. The system sent alerts to physicians as text messages to a smartphone or alphanumeric pager.

The impact of telemedicine on greenhouse gas emissions at an academic health science center in Canada.

Objective: This study estimates the reduction in greenhouse gas (GHG) emissions resulting from 840 telemedicine consultations completed in a 6-month time period. Our model considers GHG emissions for both vehicle and videoconferencing unit energy use. Cost avoidance factors are also discussed.

Patient perceptions of remote monitoring for nocturnal home hemodialysis.

Adoption of nocturnal home hemodialysis (NHHD) has been slow, due in part to patient-perceived barriers, such as anxiety and lack of self-efficacy. This study investigates patient perception of remote monitoring in addressing these barriers. Perceptions of remote patient monitoring (RPM) were studied through a quantitative survey and qualitative interviews.

The use of smartphones for clinical communication on internal medicine wards.

Background: Communication between clinicians is hampered by the frequent difficulty in reaching the most responsible physician for a patient as well as the use of outdated methods such as numeric paging. The aim of this study was to evaluate the use of smartphones to improve communication on internal medicine wards.

Method: At the Toronto General Hospital, residents were provided with smartphones.

Effectiveness of asynchronous tele-endoscopy.

Background: Asynchronous tele-endoscopy can improve access and quality of patient care. This is the first published evaluation of the diagnostic accuracy of highly compressed digital video in GI endoscopy.

Objective: To determine whether asynchronous tele-endoscopy using highly compressed video can accurately document and diagnose lesions in the upper GI tract.

Human factors perspectives on a systemic approach to ensuring a safer medication delivery process.

The current, prevailing approach to addressing medication delivery safety issues has been to apply solutions at the point of failure with direct, local remediation. These include computerized physician order entry to address transcription and prescribing problems, tall man lettering for label clarity and smart pump systems to address programming use errors. We discuss the lack of a systemic, holistic approach to addressing medication delivery issues that has led to fragmented solutions that do not address the problem as intended and introduce new, unintended patient safety issues.

The user-centered approach in the development of a complex hospital-at-home intervention.

We discuss the development of a comprehensive remote patient monitoring system that facilitates the self-care of patients undergoing nocturnal home hemodialysis (NHHD), a complex hospital-at-home therapy. The use of a continuous, iterative approach with user involvement for the validation of assumptions can avoid situations where the system serves a patient poorly. An ethnographic analysis was used to determine specific design principles, which were reviewed with the patients prior to development of the system.

Patient-perceived barriers to the adoption of nocturnal home hemodialysis.

Background And Objectives: Nocturnal home hemodialysis (NHHD) has been shown to improve clinical outcomes, although adoption has been limited. Given the known benefits, an understanding of the barriers to adoption is needed.

Design, Setting, Participants, & Measurements: Patient-perceived barriers were studied through a cross-sectional survey of prevalent hemodialysis patients using validated instruments, study-specific questions, and ethnographic interviews.

Demonstrating the BlackBerry as a clinical communication tool: a pilot study conducted through the Centre for Innovation in Complex Care.

Canadians are living longer with chronic medical conditions, which have led to an increasing complexity and volume of care for hospitalized patients. Effective in-patient care depends on the effective coordination of care through rapid and efficient communication between various care providers. A delay in coordinating this care has downstream effects on other parts of the system, ultimately contributing to increased emergency department wait times.

Accidental ingestion of 35% hydrogen peroxide.

Hydrogen peroxide is a commonly used oxidizing agent with a variety of uses depending on its concentration. Ingestion of hydrogen peroxide is not an uncommon source of poisoning, and results in morbidity through three main mechanisms: direct caustic injury, oxygen gas formation and lipid peroxidation. A case of a 39-year-old man who inadvertently ingested 250 mL of unlabelled 35% hydrogen peroxide intended for natural health use is presented.