Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds

INTRODUCTION

Clinical questions often arise at daily hospital bedside rounds. Yet, little information exists on how the search for answers may be facilitated. The aim of this prospective study was, therefore, to evaluate the overall utility, including the feasibility and usefulness of incorporating searches of UpToDate, a popular online information resource, into rounds.

METHODS

Doctors searched UpToDate for any unresolved clinical questions during rounds for patients in general medicine and respiratory wards, and in the medical intensive care unit of a tertiary teaching hospital. The nature of the questions and the results of the searches were recorded. Searches were deemed feasible if they were completed during the rounds and useful if they provided a satisfactory answer.

RESULTS

A total of 157 UpToDate searches were performed during the study period. Questions were raised by all ranks of clinicians from junior doctors to consultants. The searches were feasible and performed immediately during rounds 44% of the time. Each search took a median of three minutes (first quartile: two minutes, third quartile: five minutes). UpToDate provided a useful and satisfactory answer 75% of the time, a partial answer 17% of the time and no answer 9% of the time. It led to a change in investigations, diagnosis or management 37% of the time, confirmed what was originally known or planned 38% of the time and had no effect 25% of the time.

CONCLUSION

Incorporating UpToDate searches into daily bedside rounds was feasible and useful in clinical decision-making.

Effect of LiBF4 Salt Concentration on the Properties of Plasticized MG49-TiO2 Based Nanocomposite Polymer Electrolyte

A nanocomposite polymer electrolyte (NCPE) comprising of 49% poly(methyl methacrylate) grafted natural rubber (MG49) as polymer host, titanium dioxide (TiO2) as a ceramic filler, lithium tetrafluoroborate (LiBF4) as dopant salt, and ethylene carbonate (EC) as plasticizer was prepared by solution casting technique. The ceramic filler, TiO2, was synthesized in situ by a sol-gel process. The ionic conductivity, chemical interaction, structure, and surface morphology of nanocomposite polymer electrolyte have been investigated as a function of wt% LiBF4. The interaction between lithium ions and oxygen atoms occurred at carbonyl and ether groups. The crystalline phase of polymer host slightly decreases with the addition of salt. TGA and DTG analysis suggested that the thermal stability of the electrolyte decreases with the salt content. The ionic conductivity of the electrolyte was found to increase with the increase of salt concentration and then decreased after an optimum value. The highest conductivity achieved was  S cm−1 at 25 wt% of LiBF4.

Ethnicity, obstructive sleep apnoea and ischaemic heart disease

We studied the relationship between different ethnic groups, obstructive sleep apnoea (OSA) and ischaemic heart disease. Four hundred and thirty-two inpatients from the medical wards were interviewed. Limited overnight sleep studies were done in 129 of those who had habitual snoring, daytime sleepiness based on an Epworth sleepiness scale of 8 or more, or a large neck size of 40 cm or more. There were 315 Chinese (72.9%), 67 Malays (15.5%), 43 Indians (10%) and 3 from other races (1.4%). The prevalence of OSA was 19.7%, 30% and 12% among the Chinese, Malays and Indians, respectively. The prevalence ratio for OSA was 1.52 in Malays using Chinese patients as the baseline (P = 0.07). The median neck circumference was 37 cm in both racial groups. The median body mass index was 22.7 kg/m2 in Chinese compared to 23.6 kg/m2 in Malays. The median apnoea-hypopnoea index was 22.7, 19.0 and 26.9 events/hour among the Chinese, Malays and Indians, respectively. OSA was independently associated with the prevalence of IHD (adjusted prevalence ratio 1.68; 95% CI: 1.15, 2.46; P = 0.009). The prevalence of ischaemic heart disease (IHD) was 31%, 24% and 28% in Chinese, Malays and Indians, respectively. The prevalence ratio for IHD in Malays compared to Chinese was 0.77. After adjusting for OSA, there was an even greater reduction in the risk of IHD (adjusted prevalence ratio 0.70). This suggests that OSA is a confounder in the relationship between race and ischaemic heart disease.