Joy in Medicine

https://openworks.mdanderson.org/hrc_burnout_presentations/1011/thumbnail.jp

In Search of Joy in Practice

There is tremendous hunger among physicians and other health professionals to serve the needs of patients, without ignoring their own needs for work-life balance and career satisfaction. Professional satisfaction is a powerful driver of the Triple Aim, and as a result, it should be a critical concern of health system leaders and practicing physicians alike. Over half of all U.S. physicians exhibit some sign of burnout, increasing the likelihood of mistakes, patient dissatisfaction, and physician intent to leave practice. Improvements in clinical workflow, teamwork and communication are among the most potent anecdotes to burnout. This session will describe practice transformation approaches that can help physicians and staff re-engineer their practice to foster sound medical decision making, minimize error, increase provider quality time with patients yet go home earlier, and create an atmosphere that patients, staff, and physicians can enjoyhttps://openworks.mdanderson.org/hrc_burnout_presentations/1012/thumbnail.jp

Polyenamines from aromatic diacetylenic diketones and diamines

The synthesis and characterization of several polyenamine ketones are discussed wherein conjugated diacetylenic diketones and aromatic diamines are used as a route to the formation of high molecular weight polyenamine ketones which exhibit good mechanical properties and can be cast into creasible films. Typical polymerization conditions involved the reaction of stoichiometric amounts of 1,4- or 1,3-PPPO and a diamine at 60 to 130 C in m-cresol at (w/w) solids content of 8 to 26% for a specified period of time under a nitrogen atmosphere. Novel polyenamine ketones were prepared with inherent viscosities as high as 1.99 dl/g and tough, clear amber films with tensile strengths of 12,400 psi and tensile moduli of 397,000 psi were cast from solutions of the polymers in chloroform. In most cases, the elemental analyses for the polyenamine ketones agree within + or - 0.3% of the theoretical values

56+ Gb/s serial transmission using duo-binary signaling

In this paper we present duobinary signaling as an alternative for signaling schemes like PAM4 and Ensemble NRZ that are currently being considered as ways to achieve data rates of 56 Gb/s over copper. At the system level, the design includes a custom transceiver ASIC. The transmitter is capable of equalizing 56 Gb/s non-return to zero (NRZ) signals into a duobinary response at the output of the channel. The receiver includes dedicated hardware to decode the duobinary signal. This transceiver is used to demonstrate error-free transmission for different PCB channel lengths including a state-of-the-art Megtron 6 backplane demonstrator

Characterizing the patterns of electronic health record-integrated secure messaging use: Cross-sectional study

BACKGROUND: Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. OBJECTIVE: This study aims to characterize the use of an electronic health record-integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. METHODS: We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). RESULTS: A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages). CONCLUSIONS: Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors

84 Gbit/s SiGe BiCMOS duobinary serial data link including Serialiser/Deserialiser (SERDES) and 5-tap FFE

The increasing demand for bandwidth fuels the development towards high data rate electrical serial links. These links generally suffer from considerable frequency-dependent loss, introducing the need for equalisation at 10 Gbit/s and higher. Modulation schemes with improved spectral efficiency, with respect to non-retrun to zero (NRZ), combined with feed-forward equalisation (FFE), allow increasing the chip-to-chip data rate with the drawback of a more complex, e.g. multi-level, receiver (Rx). The use of duobinary modulation (DB) is presented to realise a high-speed serial link. The increase in complexity of a DB Rx is limited, whereas the required channel bandwidth compared with NRZ is reduced. Furthermore, the need for equalisation when compared with PAM4 is reduced as the required roll-off that is needed to create a duobinary modulated signal from an NRZ stream can incorporate the frequency-dependent loss of the link

Provider Monitoring and Pay-for-Performance When Multiple Providers Affect Outcomes: An Application to Renal Dialysis

To characterize the influence of dialysis facilities and nephrologists on resource use and patient outcomes in the dialysis population and to illustrate how such information can be used to inform payment system design. Data Sources . Medicare claims for all hemodialysis patients for whom Medicare was the primary payer in 2004, combined with the Medicare Enrollment Database and the CMS Medical Evidence Form (CMS Form 2728), which is completed at onset of renal replacement therapy. Study Design . Resource use (mainly drugs and laboratory tests) per dialysis session and two clinical outcomes (achieving targets for anemia management and dose of dialysis) were modeled at the patient level with random effects for nephrologist and dialysis facility, controlling for patient characteristics. Results . For each measure, both the physician and the facility had significant effects. However, facilities were more influential than physicians, as measured by the standard deviation of the random effects. Conclusions . The success of tools such as P4P and provider profiling relies upon the identification of providers most able to enhance efficiency and quality. This paper demonstrates a method for determining the extent to which variation in health care costs and quality of care can be attributed to physicians and institutional providers. Because variation in quality and cost attributable to facilities is consistently larger than that attributable to physicians, if provider profiling or financial incentives are targeted to only one type of provider, the facility appears to be the appropriate locus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73964/1/j.1475-6773.2009.00990.x.pd