The role of the smartphone in the transition from medical student to foundation trainee: a qualitative interview and focus group study

Background The transition from medical student to junior doctor is one of the most challenging in medicine, affecting both doctor and patient health. Opportunities to support this transition have arisen from advances in mobile technology and increased smartphone ownership. Methods This qualitative study consisted of six in-depth interviews and two focus groups with Foundation Year 1 Trainees (intern doctors) and final year medical students within the same NHS Trust. A convenience sample of 14 participants was recruited using chain sampling. Interviews and focus groups were recorded, transcribed verbatim, analysed in accordance with thematic analysis and presented below in keeping with the standards for reporting qualitative research. Results Participants represented both high and low intensity users. They used their smartphones to support their prescribing practices, especially antimicrobials through the MicroGuide™ app. Instant messaging, via WhatsApp, contributed to the existing bleep system, allowing coordination of both work and learning opportunities across place and time. Clinical photographs were recognised as being against regulations but there had still been occasions of use despite this. Concerns about public and colleague perceptions were important to both students and doctors, with participants describing various tactics employed to successfully integrate phone use into their practices. Conclusion This study suggests that both final year medical students and foundation trainees use smartphones in everyday practice. Medical schools and healthcare institutions should seek to integrate such use into core curricula/training to enable safe and effective use and further ease the transition to foundation training. We recommend juniors are reminded of the potential risks to patient confidentiality associated with smartphone use

Ovarian malignancy unmasked by venous gangrene in a patient on warfarin therapy: a case report

Venous gangrene complicating deep vein thrombosis in the context of anticoagulation use in patients with gynecologic malignancy is rarely reported. We report an unusual presentation of venous gangrene of the lower limbs associated with warfarin therapy in a 53-year-old woman from the Cook Islands with an occult ovarian cancer.A 53-year-old woman of Cook Islands origin presented with exertional dyspnea, rapid atrial fibrillation, bilateral lower limb edema, and painful digital ischemia of her hallux. She was on warfarin therapy for atrial fibrillation and had a stable therapeutic international normalized ratio. Bilateral proximal lower limb deep vein thrombosis and digital gangrene subsequently developed in the setting of a supratherapeutic international normalized ratio and platelet count depletion. Her warfarin was reversed and heparin therapy was commenced with resulting correction of her thrombocytopenia.We would like to attract the attention of the reader to the potential hazard of the use of warfarin in patients with malignancy. In our case, we also demonstrated a predictive value of supratherapeutic international normalized ratio and platelet count depletion that could herald massive thrombosis and gangrene in a patient who was previously stable on warfarin therapy. Early recognition and prompt reversal of warfarin in these circumstances is essential to correct the unbalanced prothrombotic process that leads to extensive thrombosis and gangrene. The outlook of such cases remains dismal and results in extensive morbidity and mortality

Going digital: A narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice

Objective. The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes

Patterns of competition and insolation along a canopy disturbance severity gradient: implications for the Quercus bottleneck

Regeneration failure of Quercus has been widely reported throughout the Central Hardwood Forest of the eastern United States across all but the most xeric site types. Quercus seedlings are often abundant in upland hardwood stands, but typically fail to recruit to larger size classes (i.e. the Quercus bottleneck). The goal of my study was to investigate the competition with small-sized Quercus stems to elucidate what variables may cause resistance or facilitation of Quercus recruitment. I established a 2 ha plot in the Sipsey Wilderness, AL that was subdivided into 5 x 5 m quadrats to encompass the entire extent of damage caused by an EF1 tornado in 2011. The study area encompassed a range of damage (light, moderate, severe), starting from the center of the tornado tract and ending in an undamaged area (control). The canopy disturbance provided a range of light conditions in the understory (0.5–91.0% full sunlight). In each quadrat, the height of all small-sized Quercus stems (≥ 0.5 m in height to >5 cm DBH) were measured and recorded. The nearest neighbor was identified by species and measured for height and distance from the focal Quercus stem. Photosynthetically active radiation was quantified at 1.4 m above the forest floor. Quercus’ competition was largely interspecific and the majority of competitors were shade-tolerant species such as Acer saccharum and Ostrya virginiana. Competitive indices of Quercus’ primary competitors were significantly different (p 0.01) effect on the competitive ability of species. Spatial patterns of Quercus stems, their nearest neighbor, and percent full sunlight were analyzed at 5 x 5 m, 10 x 10 m, and 20 x 20 m. Analysis at a fine-scale resolution revealed spatial patterns which would otherwise not be apparent at coarser scales. Creative and flexible silvicultural techniques may need to be implemented at finer scales to optimize the recruitment of Quercus spp. (Published By University of Alabama Libraries