Prevalence and patterns of mobile device usage among physicians in clinical practice: A systematic review

Mobile devices and corresponding applications (apps) offer a unique potential for clinical work improvement. Healthcare employees already use them for a variety of clinical purposes. Even though their use might affect patients' health and data security, they have rarely found their way into organizational knowledge management strategies. We present the current state of research regarding the prevalence, patterns, and trends of smartphone and tablet usage among physicians in clinical practice. Five electronic databases were searched for quantitative studies. The extracted data were systematically analyzed and visualized in boxplots. The results show an increasing prevalence of smartphones and medical apps in clinical practice, especially among junior physicians. Current applications can be subdivided into four categories: Communication and Organization, Documentation and Monitoring, Diagnostic and Therapeutic Decision Support, and Education. Among them, there is a large number of applications with a direct impact on physicians' clinical actions and therefore on patients' health and data security. In consequence, healthcare organizations should systematically integrate mobile devices and apps into their knowledge management strategies, including a modern IT infrastructure and training courses. Further studies are necessary to identify organizational and external factors that support an efficient mobile device usage during clinical practice.

Smartphone Use and Security Challenges in Hospitals: A Survey among Resident Physicians in Germany

Although mobile devices support physicians in a variety of ways in everyday clinical practice, the use of (personal) mobile devices poses potential risks for information security, data protection, and patient safety in hospitals. We used a cross-sectional survey-based study design to assess the current state of smartphone use among resident physicians in hospitals and to investigate the relationships between working conditions, current smartphone usage patterns, and security-related behavior. In total, data from 343 participating physicians could be analyzed. A large majority (98.3%) used their smartphones during clinical practice. Of the respondents who used a smartphone during clinical practice, only 4.5% were provided with a smartphone by their employer. Approximately three-quarters of the respondents who used their smartphones for professional communication never/almost never used dedicated GDPR-compliant messenger services. Using a hierarchical regression model, we found a significant effect of the organizational resources Social Support (Supervisor) and Information Security-related Communication on security-related behavior during the selection of medical apps (App Selection). Smartphones are an important part of digital support for physicians in everyday clinical practice. To minimize the risks of use, technical and organizational measures should be taken by the hospital management, resulting, for example, in a Bring-Your-Own-Device (BYOD) initiative.

Late results of complementary specific immunostimulation in metastatic prostate carcinoma

Calculation of the 5-year actuarial survival reveals a clear superiority of a combination of estrogenic hormone therapy with specific immunostimulation as compared to hormone therapy alone. The aim of this investigation was to show that specific immunostimulation complementary to estrogenic hormone therapy can substantially improve the results of the latter. Because of the appreciable side effects of estrogens, we have abandoned them as basic therapy. Today, we combine specific immunotherapy with RH-LH analogs and androgen receptor blockers and hope to attain further improvement of the actuarial survival in metastatic prostate carcinoma.

[Value of intravesical ultrasound tomography and computer tomography in the evaluation of the depth of infiltration of bladder tumors]

In 83% of cases the tumour could be correctly staged by intravesical sonography. Computed tomography gave a correct staging in 80%. By a combination of both methods the depths of tumour infiltration could be established exactly in 90%. Both methods are supplementary since the lower stages are better assessable by intravesical ultrasonic tomography whereas in the advanced stages computer tomography combined with pneumocystography permits a more exact evaluation of the depth of tumour infiltration.

[Specific immunotherapy of prostate carcinoma]

For the first time since the introduction of female sex hormone treatment of carcinoma of the prostate, an entirely new therapeutic approach was tried, i.e., specific immune therapy in the form of chessboard vaccination. With this method, and continuation of hormone therapy, inactivated cancerous cells were injected with neuraminidase intracutaneously into the thigh. Should hormone therapy prove ineffective, a long-term therapeutic effect can be achieved in approximately half of the patients by giving three vaccinations containing 44,400,000 cells. The effectiveness of specific immunotherapy in the form of chessboard vaccinations could be established on the basis of a significant drop in serum phosphatases and carcinoembryonic antigen under therapy, the scintigraphic evidence of remission of osteometastases and not least of all a statistically significant increase in the survival rate during treatment of unconfined metastasizing prostate carcinomas. Even in early stages specific immunotherapy constitutes a new alternative therapeutic method, particularly in the treatment of hormone-independent prostate carcinomas and in cases of estrogen intolerance.

[Experience with argon laser in urological diseases (author's transl)]

The application of the Argon laser in urology has proved to be effective in resecting recurrent, exophytic urothelial tumors of the bladder up to the size of a raspberry. In cases of wide spread bladder tumors we only perform a radiation of the resected area as local recurrence prophylaxis following transurethral resection. The urethroscopic Argon laser irradiation makes laser urethrotomy and evaporisation of urethral strictures possible. Furthermore, a curative and conservative treatment of urethral tumors is possible in combination with chemotherapy. The same applies for the penis carcinoma. Urethral ruptures are also successfully treated by urethroscopic laser recanalization. A determination of the ureteral submucosal course, which may allow a prognosis about the probable maturation, is possible in cases of cystoureteral reflux with the help of laser diaphanoscopy.

[Behavior of phosphatases and carcino-embryonal antigens in serum following specific immunotherapy of metastasizing prostatic cancers]

The efficacy of specific immunotherapy was examined in patients suffering from metastatic prostatic cancer. For this purpose determination of prostatic acid phosphatase and carcino-embryonic antigen in serum was performed using conventional enzymatic and radioimmunological techniques before and after therapy. The results were as following: 1. A significant decrease of the above mentioned parameters was demonstrable after therapy. 2. The determination of prostatic acid phosphatase was helpful for immediate control of therapy, the determination of carcino-embryonic antigen was more helpful in follow-up studies. 3. Contrary to disappointing relevance of radioimmunological determined prostatic phosphatase in early prostatic cancer this parameter seemed to be more suitable in follow-up studies than conventional determined phosphatase.

[Cell cultures as vitality test for preservation of kidneys by deep freezing (author's transl)]

Cytologic examinations of kidneys, which were frozen for preservation in a nitrogen atmosphere below 3 ata, show a considerable damage of the cells. This does not only occur by significant reduction in the amount of isolated cells, but also in the loss of the ability to form cell colonies. DNA measurements show, however, that after 3--4 days the DNA amounts in surviving cells are intact. In one of the cultures we even found DNA values, which stand for a DNA synthesis. Experiments with mechanical perfusion alone show that this procedure results in a severe damage of the cells, only about one-third of these cells being able to form colonies.