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https://www.readbyqxmd.com/read/27910035/self-care-as-a-professional-imperative-physician-burnout-depression-and-suicide
#1
Catherine M Kuhn, Ellen M Flanagan
PURPOSE: Burnout has been identified in approximately half of all practicing physicians, including anesthesiologists. In this narrative review, the relationship between burnout, depression, and suicide is explored, with particular attention to the anesthesiologist. Throughout this review, we highlight our professional imperative regarding this epidemic. SOURCE: The authors searched the existing English language literature via PubMed from 1986 until present using the search terms physician burnout, depression, and suicide, with particular attention to studies regarding anesthesiologists and strategies to address these problems...
December 1, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/27908334/antimicrobial-stewardship-in-the-management-of-sepsis
#2
REVIEW
Michael S Pulia, Robert Redwood, Brian Sharp
Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record-based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27906921/rheumatologists-fail-to-advise-people-with-ra-to-get-immunised-which-matters-if-you-are-under-65-an-audit-in-a-new-zealand-rheumatology-service
#3
Brendan Ng, Lynn McBain, Rebecca Grainger
AIM: To assess if yearly-influenza and five-yearly pneumococcal vaccines are recommended to people with rheumatoid arthritis (RA) in a New Zealand rheumatology service in accordance with guidelines and determine patient immunisation status for these respiratory pathogens. METHODS: Retrospective review of electronic health records of all outpatients with RA attending a regional rheumatology centre in New Zealand over a one-month period immediately after the release of the 2015 influenza vaccination...
December 2, 2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27906530/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment-systems-and-quality-reporting-programs-organ-procurement-organization-reporting-and-communication-transplant-outcome-measures-and-documentation-requirements-electronic
#4
(no author information available yet)
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system...
November 14, 2016: Federal Register
https://www.readbyqxmd.com/read/27905815/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm-incentive-under-the-physician-fee-schedule-and-criteria-for-physician-focused-payment-models-final-rule-with-comment-period
#5
(no author information available yet)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs)...
November 4, 2016: Federal Register
https://www.readbyqxmd.com/read/27903774/-they-shouldn-t-be-coming-to-the-ed-should-they-a-descriptive-service-evaluation-of-why-patients-with-palliative-care-needs-present-to-the-emergency-department
#6
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
November 30, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27903614/association-between-inpatient-sleep-loss-and-hyperglycemia-of-hospitalization
#7
Regina H DePietro, Kristen L Knutson, Lisa Spampinato, Samantha L Anderson, David O Meltzer, Eve Van Cauter, Vineet M Arora
OBJECTIVE: To determine whether inpatient sleep duration and efficiency are associated with a greater risk of hyperglycemia in hospitalized patients with and without diabetes. RESEARCH DESIGN AND METHODS: In this retrospective analysis of a prospective cohort study, medical inpatients ≥50 years of age were interviewed, and their charts were reviewed to obtain demographic data and diagnosis. Using World Health Organization criteria, patients were categorized as having normal blood glucose, impaired fasting blood glucose, or hyperglycemia based on morning glucose from the electronic health record...
November 30, 2016: Diabetes Care
https://www.readbyqxmd.com/read/27903489/finding-important-terms-for-patients-in-their-electronic-health-records-a-learning-to-rank-approach-using-expert-annotations
#8
Jinying Chen, Jiaping Zheng, Hong Yu
BACKGROUND: Many health organizations allow patients to access their own electronic health record (EHR) notes through online patient portals as a way to enhance patient-centered care. However, EHR notes are typically long and contain abundant medical jargon that can be difficult for patients to understand. In addition, many medical terms in patients' notes are not directly related to their health care needs. One way to help patients better comprehend their own notes is to reduce information overload and help them focus on medical terms that matter most to them...
November 30, 2016: JMIR Medical Informatics
https://www.readbyqxmd.com/read/27902588/short-term-hypertension-management-in-community-is-associated-with-long-term-risk-of-stroke-and-total-death-in-china-a-community-controlled-trial
#9
Zengwu Wang, Guang Hao, Xin Wang, Wen Wang, Weiwei Chen, Manlu Zhu
BACKGROUND: It is not fully clear whether the effect of short-term management in community can reduce the long-term risk of stroke OBJECTIVES:: To evaluate whether short-term hypertension management is associated with long-term incidence of stroke and total death in community health centers in China. DESIGN: Community controlled trail. PARTICIPANTS: Six community health centers (4 active, 2 control) in China, patients with hypertension. CONTROL ARM: Patients were treated with normally therapy method...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27902553/perspectives-and-uses-of-the-electronic-health-record-among-us-pediatricians-a-national-survey
#10
Julie W Doberne, Travis Redd, Daniel Lattin, Thomas R Yackel, Carl O Eriksson, Vishnu Mohan, Jeffrey A Gold, Joan S Ash, Michael F Chiang
Little is known about how existing electronic health records (EHRs) influence the practice of pediatric medicine. A total of 808 pediatricians participated in a survey about workflows using the EHR. The EHR was the most commonly used source of initial patient information. Seventy-two percent reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR. Pediatricians acquire information about new patients from EHRs more often than any other source...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902552/factors-associated-with-electronic-health-record-use-among-nurse-practitioners-in-the-united-states
#11
Emily B Jones
Widespread use of electronic health records (EHRs) among all provider types is foundational to delivery system transformation. Three in 4 nurse practitioners used EHRs in 2012 (76.0%), and 60.3% of nonusers planned to adopt within 18 months. Practice setting, younger age, and colocation with physicians were associated with EHR use. In hospitals and in settings without on-site physicians, EHR use lagged in rural areas. Implementation assistance should be targeted to nonadopters, particularly those who never or infrequently work alongside physicians and those in rural hospitals...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902551/do-years-of-experience-with-electronic-health-records-matter-for-productivity-in-community-health-centers
#12
Bianca K Frogner, Xiaoli Wu, Leighton Ku, Patricia Pittman, Leah E Masselink
This study investigated how years of experience with an electronic health record (EHR) related to productivity in community health centers (CHCs). Using data from the 2012 Uniform Data System, we regressed average annual medical visits, weighted for service intensity, as a function of full-time equivalent medical staff controlling for CHC size and location. Physician productivity significantly improved. Although the productivity of all other staff types was not significantly different by years of EHR experience, the trends showed lower productivity among nurses and other medical staff in CHCs with fewer years of EHR experience versus more years of experience...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902550/-salt-in-the-wound-safety-net-clinician-perspectives-on-performance-feedback-derived-from-ehr-data
#13
Arwen E Bunce, Rachel Gold, James V Davis, MaryBeth Mercer, Victoria Jaworski, Celine Hollombe, Christine Nelson
Electronic health record (EHR) data can be extracted for calculating performance feedback, but users' perceptions of such feedback impact its effectiveness. Through qualitative analyses, we identified perspectives on barriers and facilitators to the perceived legitimacy of EHR-based performance feedback, in 11 community health centers (CHCs). Providers said such measures rarely accounted for CHC patients' complex lives or for providers' decisions as informed by this complexity, which diminished the measures' perceived validity...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902548/leveraging-electronic-health-record-implementation-to-facilitate-clinical-and-operational-quality-improvement-in-an-ambulatory-surgical-clinic
#14
Joseph L Bobadilla, Cathy S Roe, Patricia Estes, Jennifer Lackey, Carol L Steltenkamp
The implementation of electronic health records is a challenging, complex process requiring significant resources. The temptation is to convert a paper process into electronic format. This strategy fosters a familiar product to the users but is fraught with pitfalls. We chose to utilize the opportunity of the implementation of an enterprise-wide ambulatory electronic health record to foster an overreaching clinical and operational improvement project in a multispecialty surgical ambulatory clinic practice. We interrogated every aspect of the practice: clinic design, scheduling, physical space, staffing, and clinical and operational workflows...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902547/ambulatory-electronic-health-records-must-be-more-interoperable-to-support-optimal-practice
#15
Alan E Zuckerman
No abstract text is available yet for this article.
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27902546/toward-electronic-health-record-optimization-learning-from-the-user-experience
#16
Jeffrey M Weinfeld, Ranit Mishori
No abstract text is available yet for this article.
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27901174/metrics-for-electronic-nursing-record-based-narratives-cross-sectional-analysis
#17
Kidong Kim, Suyeon Jeong, Kyogu Lee, Hyeoun-Ae Park, Yul Ha Min, Joo Yun Lee, Yekyung Kim, Sooyoung Yoo, Gippeum Doh, Soyeon Ahn
OBJECTIVES: We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. METHODS: We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system...
November 30, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27899338/high-touch-and-high-tech-ht2-proposal-transforming-patient-engagement-throughout-the-continuum-of-care-by-engaging-patients-with-portal-technology-at-the-bedside
#18
Ann Scheck McAlearney, Cynthia J Sieck, Jennifer L Hefner, Alison M Aldrich, Daniel M Walker, Milisa K Rizer, Susan D Moffatt-Bruce, Timothy R Huerta
BACKGROUND: For patients with complex care needs, engagement in disease management activities is critical. Chronic illnesses touch almost every person in the United States. The costs are real, personal, and pervasive. In response, patients often seek tools to help them manage their health. Patient portals, personal health records tethered to an electronic health record, show promise as tools that patients value and that can improve health. Although patient portals currently focus on the outpatient experience, the Ohio State University Wexner Medical Center (OSUWMC) has deployed a portal designed specifically for the inpatient experience that is connected to the ambulatory patient portal available after discharge...
November 29, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27899076/the-kaiser-permanente-northern-california-research-program-on-genes-environment-and-health-rpgeh-pregnancy-cohort-study-design-methodology-and-baseline-characteristics
#19
M M Hedderson, A Ferrara, L A Avalos, S K Van den Eeden, E P Gunderson, D K Li, A Altschuler, S Woo, S Rowell, V Choudhary, F Xu, T Flanagan, C Schaefer, L A Croen
BACKGROUND: Exposures during the prenatal period may have lasting effects on maternal and child health outcomes. To better understand the effects of the in utero environment on children's short- and long-term health, large representative pregnancy cohorts with comprehensive information on a broad range of environmental influences (including biological and behavioral) and the ability to link to prenatal, child and maternal health outcomes are needed. The Research Program on Genes, Environment and Health (RPGEH) pregnancy cohort at Kaiser Permanente Northern California (KPNC) was established to create a resource for conducting research to better understand factors influencing women's and children's health...
November 29, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27899012/disease-outcomes-and-care-fragmentation-among-patients-with-systemic-lupus-erythematosus
#20
Theresa L Walunas, Kathryn L Jackson, Anh H Chung, Karen A Mancera-Cuevas, Daniel L Erickson, Rosalind Ramsey-Goldman, Abel Kho
OBJECTIVE: To examine the impact of care fragmentation across multiple healthcare institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). METHODS: Using the Chicago HealthLNK Data Repository (HDR), an assembly of electronic health records from six institutions, we identified patients with SLE, using ICD-9 codes, whose care was delivered at more than one organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicate SLE-induced damage...
November 29, 2016: Arthritis Care & Research
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