Identifying and addressing barriers to implementing core electronic health record use metrics for ambulatory care: Virtual consensus conference proceedings

Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive electronic health record (EHR) improvements and decrease EHR burden. Differences exist between research and vendor definitions of metrics. PROCESS:  We convened three stakeholder groups (health system informatics leaders, EHR vendor representatives, and researchers) in a virtual workshop series to achieve consensus on barriers, solutions, and next steps to implementing the core EHR use metrics in ambulatory care. CONCLUSION:  Actionable solutions identified to address core categories of EHR metric implementation challenges include: (1) maintaining broad stakeholder engagement, (2) reaching agreement on standardized measure definitions across vendors, (3) integrating clinician perspectives, and (4) addressing cognitive and EHR burden. Building upon the momentum of this workshop\u27s outputs offers promise for overcoming barriers to implementing EHR use metrics

Patterns of rod and cone dysfunction in Bardet-Biedl syndrome

We studied visual function in 16 patients with the Bardet-Biedl syndrome. Visual acuity, kinetic perimetry, and electroretinography results indicated a severe loss of central and peripheral vision and rod and cone function by the second or third decade of life. Light- and dark-adapted static perimetry in patients 10 to 15 years of age with early involvement showed a parallel and marked loss of rod and cone sensitivity across the visual field. Patients with more advanced disease and no measurable peripheral visual field showed different patterns of central visual dysfunction: an island of only cone function centered in a bull's-eye lesion; patches of rod function surrounding geographic atrophy; or a central island of excellent rod sensitivity but severely impaired cones. In the two least-affected patients, a 13-year-old boy and the asymptomatic 45-year-old sibling of a patient, there were more rod than cone abnormalities as determined by electroretinography and static perimetry

Are They Aligned? An Analysis of Social Media-Based Nurse Well-Being Concerns and Well-Being Programs

# Background Nurse burnout and distress pose patient safety risks due to impaired nurse attention, increased likelihood of medical error, and increased nurse turnover leading to a reduction in the number of nurses available to deliver care. Some healthcare facilities have launched well-being programs in response to increasing rates of burnout. Many of these programs are based on survey data which may be incomplete, resulting in programs that are not as comprehensive as they should be. We sought to identify nurse concerns related to burnout and well-being through analysis of social media data. We aligned these concerns with well-being program leader perceptions of factors contributing to burnout and well-being program initiatives. # Methods We conducted a qualitative study composed of two parts: social media analysis and semistructured interviews with well-being leaders. The social media analysis focused on 120 nurse comments on Reddit that were retrieved based on a keyword search using the terms "burnout," "stress," and "wellbeing." The interviews were conducted with nine well-being leaders from seven different healthcare systems. Well-being program leaders were asked about factors contributing to burnout and lack of well-being, initiatives to address these factors, and metrics used to evaluate their programs. The social media comments and interview data were reviewed by two experts to identify topics, themes, and subthemes grounded in wellness models. # Results Of the 120 social media comments analyzed, the most frequent topic was Lack of Meaningful Recognition, Compensation, and Influence (n=46 of 120, 38.3%), followed by Work Environment (n=43, 35.8%) and Uninformed or Misinformed Public (n=31, 25.8%). Several themes emerged and the most prevalent was Constrained Professional Agency with the most prevalent subtheme of health system or macrosystem policies or regulations that limit nurses' ability to respond effectively to patient care needs. Of the seven healthcare systems interviewed, the most common topics that emerged from asking about the factors contributing to the lack of nurse well-being were the Work Environment (n=6 of 7, 85.7%), followed by Lack of Meaningful Recognition, Compensation, and Influence (n=4, 57.1%), and Inadequate or Inaccessible Well-Being Resources (n=3, 42.9%). Several novel initiatives were identified, and most healthcare systems relied on surveys as their key metric. # Conclusions The social media analysis revealed nurse concerns that may not be identified as factors contributing to lack of well-being by well-being program leaders. There is an opportunity to optimize our understanding of nurse concerns around well-being through social media, and an opportunity to better align nurse concerns with the focus of well-being programs

Rod or cone dysfunction: uniocular presentations

Two patients presented with unusual uniocular electroretinographic (ERG) phenomena. One patient showed the ERG characteristics of stationary night blindness in one eye only and the other patient presented with ERG evidence of uniocular cone dysfunction. In both patients, however, further electrophysiological and psychophysical studies and serial testing provided evidence for dysfunction of both receptor systems and relatively subtle involvement of the fellow eyes