Can scribes boost FPs\u27 efficiency and job satisfaction

Purpose: Research in other medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians\u27 practice experience and increases productivity. To date, literature on the implementation of scribes in primary care is limited. To determine the feasibility and benefits of implementing scribes in family medicine, we undertook a pilot mixed- method quality improvement (QI) study. Methods: In 2014, we incorporated 4 part-time scribes into an academic family medicine practice consisting of 7 physicians. We then measured, via survey and time-tracking data, the impact the scribes had on physician office hours and productivity, time spent on documentation, perceptions of work-life balance, and physician and patient satisfaction. Results: Six of the 7 faculty physicians participated. This study demonstrated that the use of scribes in a busy academic primary care practice substantially reduced the amount of time that family physicians spent on charting, improved work-life balance, and had good patient acceptance. Specifically, the physicians spent an average of 5.1 fewer hours/week (hrs/wk) on documentation, while various measures of productivity revealed increases ranging from 9.2% to 28.8%. Perhaps most important of all, when the results of the pilot study were annualized, they were projected to generate $168,600 per year--more than twice the$79,500 annual cost of 2 full-time equivalent scribes. Surveys assessing work-life balance demonstrated improvement in the physicians\u27 perception of the administrative burden/paperwork related to practice and a decrease in their perception of the extent to which work encroached on their personal lives. In addition, survey data from 313 patients at the time of their ambulatory visit with a scribe present revealed a high level of comfort. Likewise, surveys completed by physicians after 55 clinical sessions (ie, blocks of consecutive, uninterrupted patient appointments; there are usually 2 sessions per day) revealed good to excellent ratings more than 90% of the time. Conclusion: In an outpatient family medicine clinic, the use of scribes substantially improved physicians\u27 efficiency, job satisfaction, and productivity without negatively impacting the patient experience

Bostonia

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Promising insights into the health related quality of life for children with severe obesity

Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity. Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile. Results 136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05). Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life

Promising insights into the health related quality of life for children with severe obesity

Abstract Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity. Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile. Results 136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05). Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life

Building the layers of a manufacturing taxonomy: how 3D printing is creating a new landscape of production eco-systems and competitive dynamics

Recent innovations in 3D printing technologies and processes have influenced how products are designed, built and delivered. However, there is a significant gap in our knowledge of how 3D printing is impacting on manufacturing eco-systems and competitive dynamics in different industries and contexts. Basing our analysis on systematic review of organisations, we develop a taxonomy capable of explaining the many areas the technology can impact. We based our taxonomy on Pavitt’s identification of industry types, but extended this with Castellacci’s more recent service-manufacturing sectors which includes external sources and more open business models (Castellacci, 2008; Pavitt, 1984). We populate the model with cases and industry exemplars showing the wide extent of the applications of 3D printing within the different sectors, the novel disruption happening in existing market structures, and the implications for both firms and their customers. In addition to offering a comprehensive framework for plotting and comparing the impact of 3D printing, we emphasise the role of users in co-creation and personalisation and how this varies according to the level of use of 3D printing at different stages between end products and various types of manufacturing rstrategies. While 3D printing has been touted as disruptive, we suggest that a new taxonomy offers an additional understanding to appreciate the ways firms can operate in a 3D printing context

Complete unilateral section of the pyramidal tract at the medullary level in Macaca mulatta

A short movie was shown to illustrate the motor deficits in hand usage which result in the adult monkey after complete unilateral section of the medullary pyramid at the level of the trapezoid body. The animal (68-70) was one of 8 in which unilateral or bilateral pyramidal section was undertaken for the primary purpose of studying the effects of pyramidal tract section on movements elicited by electrical stimulation of the rolandic region of the cerebral cortex. The results obtained in these 8 animals formed the subject of the J. Hughlings Jackson Memorial Lecture given at the Montreal Neurological Institute on May 11, 1971

Complete unilateral section of the pyramidal tract at the medullary level in Macaca mulatta

A short movie was shown to illustrate the motor deficits in hand usage which result in the adult monkey after complete unilateral section of the medullary pyramid at the level of the trapezoid body. The animal (68-70) was one of 8 in which unilateral or bilateral pyramidal section was undertaken for the primary purpose of studying the effects of pyramidal tract section on movements elicited by electrical stimulation of the rolandic region of the cerebral cortex. The results obtained in these 8 animals formed the subject of the J. Hughlings Jackson Memorial Lecture given at the Montreal Neurological Institute on May 11, 1971