Comparison of Routine Health Screening Rates Between Two EMR Systems

An EMR, electronic medical record, system refers to the software widely adopted by medical practitioners to reduce the use of hard-copy files, and improve the documentation, storage, and retrieval of patient information. Some EMR systems can generate automatic alerts reminding providers when patients are due for certain preventive services or meet the criteria for various screening measures. Epic, one of the leading EMR systems in use today, contains this additional feature. The screening recommendations built into Epic are derived from a committee of USPSTF, U.S. Preventive Services Task Force, medical experts whose focus is to improve patient health across the nation. In September of 2021, the University of Tennessee-Family Medicine Jackson clinic switched from using the Centricity EMR to Epic EMR. The primary goal of this study was to measure whether there is any quantifiable improvement in USPSTF screening rates after implementing the Epic EMR, which contains the notifications to prevent lapses in patient care. For each EMR, 100 patients were selected at random including those greater than 44 years of age and less than 65 years of age. This study involved checking whether patients were up-to-date on thirteen potential USPSTF screening measures and recording the data in the SPSS statistical software program. Chi-square analysis comparing the data across both Centricity and Epic, revealed no statistical significance between screening rates. However, when accounting for sex (male vs. female) across both EMRs, women in the study had 16% more drug screening, 3% more tobacco screening, and 18% more statin use in comparison to men. Furthermore, statistical significance was found when comparing race (black vs. white). For example, black patients had 10% more syphilis screening and 33% more STD screening, whereas white patients had 28% more lung cancer screening across both EMR systems. Although reassuring to find no statistical significance when comparing screening rates across both EMRs, conclusions to explain the results for specific screening measures pertaining to race and sex cannot be drawn based on the data at this time. Future research analyzing external variables such as patient compliance, provider biases, and population risk, may be useful in providing further insight to explain the statistical significance of this data

State of the Art: An Update on Adult Burn Resuscitation

Treatment of patients with severe burn injuries is complex, relying on attentive fluid resuscitation, successful management of concomitant injuries, prompt wound assessment and closure, early rehabilitation, and compassionate psychosocial care. The goal of fluid resuscitation is to maintain organ perfusion at the lowest possible physiologic cost. This requires careful, hourly titration of the infusion rate to meet individual patient needs, and no more; the risks of over-resuscitation, such as compartment syndromes, are numerous and life-threatening. Recognizing runaway resuscitations and understanding how to employ adjuncts to crystalloid resuscitation are paramount to preventing morbidity and mortality. This article provides an update on fluid resuscitation techniques in burn patients, to include choosing the initial fluid infusion rate, using alternate endpoints of resuscitation, and responding to the difficult resuscitation

Coronal Heating as Determined by the Solar Flare Frequency Distribution Obtained by Aggregating Case Studies

Flare frequency distributions represent a key approach to addressing one of the largest problems in solar and stellar physics: determining the mechanism that counter-intuitively heats coronae to temperatures that are orders of magnitude hotter than the corresponding photospheres. It is widely accepted that the magnetic field is responsible for the heating, but there are two competing mechanisms that could explain it: nanoflares or Alfv\'en waves. To date, neither can be directly observed. Nanoflares are, by definition, extremely small, but their aggregate energy release could represent a substantial heating mechanism, presuming they are sufficiently abundant. One way to test this presumption is via the flare frequency distribution, which describes how often flares of various energies occur. If the slope of the power law fitting the flare frequency distribution is above a critical threshold, $\alpha=2$ as established in prior literature, then there should be a sufficient abundance of nanoflares to explain coronal heating. We performed $>$600 case studies of solar flares, made possible by an unprecedented number of data analysts via three semesters of an undergraduate physics laboratory course. This allowed us to include two crucial, but nontrivial, analysis methods: pre-flare baseline subtraction and computation of the flare energy, which requires determining flare start and stop times. We aggregated the results of these analyses into a statistical study to determine that $\alpha = 1.63 \pm 0.03$. This is below the critical threshold, suggesting that Alfv\'en waves are an important driver of coronal heating.Comment: 1,002 authors, 14 pages, 4 figures, 3 tables, published by The Astrophysical Journal on 2023-05-09, volume 948, page 7