Assessing Loneliness and Other Types of Emotional Distress among Practicing Physicians

Introduction. Loneliness has been linked to clinician burnout and other types of emotional distress. Research assessing the prevalence of loneliness among physicians is growing. Little is known, however, about how loneliness relates to other types of emotional distress among practicing physicians. The objectives of the study were to determine the prevalence of loneliness, and to explore the relationship between loneliness, burnout, depressive symptoms, and suicidal ideation among active member physicians of the Medical Society of Sedgwick County (MSSC). Methods. The study involved a convenience sample of 197 practicing physicians who were active members of the MSSC. The 3-item University of California, Los Angeles Loneliness Scale, the Abbreviated Maslach Burnout Inventory, and 2-item Primary Care Evaluation of Mental Disorders Patient Health Questionnaire were used to measure prevalence of loneliness, manifestations of burnout, and symptoms of depression, respectively. Results. Using an email survey, 442 practicing physicians received an invitation to participate; 197 (44%) completed the survey. The prevalence of loneliness was 43%. Loneliness prevalence was associated positively with age (p = 0.017) and more likely in those who reported manifestations of burnout (p < 0.01) or screened positive for depression (p < 0.01). Depression (OR = 2.24; 95% CI, 0.97-5.19) and emotional exhaustion (OR = 1.05; 95% CI, 0.39-2.84) were significantly associated with loneliness, including when adjusted for participants’ sex, age, and duty hours. Conclusion. Loneliness is prevalent among active member physicians of the Medical Society of Sedgwick County. Given that loneliness is associated with burnout and other emotional distress, there is an important need to understand its implications better

Nicotine Dependence from Electronic Cigarettes Use and Depressive Symptoms Among Adolescents

Introduction. The use of electronic cigarettes (e-cigarettes) has been increasing among adolescents in the United States population since they were first introduced to the US market in 2007. With depression as a major risk factor for suicide in adolescents, this study examined nicotine dependence from the use of e-cigarettes and depressive symptoms among adolescents. Methods. The authors conducted a retrospective patient chart review at a pediatric clinic in the Midwestern United States, from May 2021 to September 2021. As a standard practice, the clinic uses the adapted Penn State Nicotine Dependency Index to evaluate its patients’ nicotine dependence from the use of e-cigarettes and the PHQ-9 modified for teens to screen for depressive symptoms of its patients. Data on 69 patients were included in the study. The authors used standard descriptive statistics and an adjusted odds ratio (aOR) to analyze the data on the 69 adolescents.  Results. The mean age of the adolescents was 17.6 (SD = 2.3), 46.4% (n = 32) were female, and 53.6% (n = 37) were male. More than 88% (n = 61) of the adolescents met criteria for high nicotine dependence from e-cigarette use and 30.4% (21 of 69) of them screened positive for depression. Findings of the mixed model analyses indicated that there was not a statistically significant association between nicotine dependence from e-cigarette use and depressive symptoms (aOR = 1.07; 95% confidence interval, 0.93-1.23; P = .0365). Conclusions. Our findings show that while a third of the adolescents screened positive for depression and the majority (88%) depended on nicotine from e-cigarettes, there was no association between the outcomes. Future larger multicenter studies are needed to better understand the association between nicotine dependence from e-cigarettes and depressive symptoms as reported in the literature.&nbsp

Patient Perception of Medical Learners and Medical Education during Clinical Consultation at a Family Medicine Residency

Introduction. Experience in treating patients under supervisionof faculty is an important factor in medical education at all levels.However, unpleasant patient experiences with a medical learnerduring clinical consultation can damage the relationship betweenthe medical learner, physician supervisor, and patient. A goal of thisstudy was to examine patient experiences and preferences regardingmedical learners during clinical consultation at a family medicineresidency clinic. Another goal was to determine factors relating topatients’ experiences and preferences regarding medical learners. Methods. This cross-sectional study relied on patients completinga survey designed from extant questionnaires to measure patients’experiences and preferences relating to interactions with medicallearners at a family medicine clinic. Data were collected from 216patients between December 2016 and August 2017. We correlatedpatients’ feelings, overall experiences with medical learners and theimportance of medical education. Results. There was a 93% participation rate. The patients rated theiroverall experiences with medical learners as 3.8 on a 5-point scale,suggesting positive experiences. Eighty-eight percent prefer not morethan three medical learners to be involved in their care during clinicalconsultation. Patients’ overall experiences with medical learnersparticipating in medical care correlated with their preferences regardingmedical learners’ involvement in their treatment (r[209] = .524;p = 0.01). Patients’ perception of medical learners participating inmedical care correlated with the importance of medical education(r[209] = .878; p = 0.01). Conclusions. The results showed that most patients have positiveexperiences with medical learners and are generally in favor ofmedical education.Kans J Med 2018;11(4):102-105

Patients satisfaction and treatment outcomes of primary care practice in Ghana

Background: General evidence suggests a strong association between patient satisfaction and treatment outcomes, but data specific to the general Ghanaian population is lacking. Purpose: To use nationally representative data to examine the effects of primary care practices on patient satisfaction and how satisfaction influences treatment outcomes. Methods: The study utilized WAVE 1 data from a nationally representative survey (n = 2,967) of patients who received outpatient medical care in Ghana. The data were collected by the World Health Organization between 2007 and 2010 and were analyzed using Kruskal Wallis test, binomial logistic regression, and correlations. Predictors for patients’ experiences were waiting time, respectfulness, clear communication, privacy, decision-making, choice, and cleanliness. Results: Overall, the patients reported positive experiences with all aspects of their primary care services. Thirty-three percent were very satisfied and 57% were satisfied with their last outpatient visit. Adjusted for sociodemographic and other variables, patient satisfaction with primary care was predominantly determined through privacy, decision-making, communication, and respectfulness. The model explained 54.6% (Nagelkerke R2) of the variance in satisfaction and correctly classified 85.2% of cases. Patient satisfaction and treatment outcomes were significantly related, r(2959) = .54, p < .001. Conclusion: In a nationally representative sample, quality of patient experiences was associated with high satisfaction, which in turn was positively associated with improved treatment outcomes. Funding: None Keywords: Patient satisfaction, treatment outcomes, primary car

Burnout and Quality of Life among Active Member Physicians of the Medical Society of Sedgwick County

Introduction. The medical literature suggests disturbingly high ratesof burnout among US physicians. The objective of this study was todetermine the rates of burnout, other forms of distress, and overallquality of life among physicians in Sedgwick County.Methods.xThe study involved a convenience sample of 197 physicianswho were active member physicians of the Medical Society of SedgwickCounty (MSSC). Between July and August 2018, we surveyed872 physicians who were active members of the MSSC. The surveyassessed manifestations of burnout, symptoms of depression and suicidalideation, fatigue, and quality of life. The authors used standarddescriptive summary statistics, Mann-Whitney U test/independentsamples t-Test, Fisher’s exact test, and correlations to analyze thedata.Results. The participation rate was 44.6%, with 49.5% of therespondents reporting manifestations of burnout. Although 85% ofthe participants rated their overall quality of life as good/very good,45% screened positive for depression, 5% had thoughts of suicideduring the past year, and 44% reported excessive fatigue during thepast week. Those with manifestations of burnout were 2.13 (100%vs 46.9%, p &lt; 0.01) times more likely to report thoughts of suicidalideation, 2.43 (72.6% vs 30.4%; p &lt; 0.001) times more likely to screenpositive for depression, and 1.89 (67.5% vs 35.8%; p &lt; 0.001) timesmore likely to have high degrees of fatigue. All of the participants whohad suicidal ideation reported manifestations of burnout.Conclusions. Burnout was prevalent among active member physiciansof the MSSC. Burnout among the participants was associatedwith symptoms of depression, fatigue, suicidal ideation, and intentionof leaving the medical profession via early retirement and/or careerchange. Kans J Med 2019;12(2):33-39

Assessment of Emergency Medical Services Personnel Compliance with Escalating Airway Algorithm Protocol

Introduction. When emergency medical service (EMS) personnel respond to emergencies, the decisions they make can often mean life or death for the patient. This is especially true in the case of advanced airway management. Protocols are set in place to ensure that the least invasive airway management techniques are used initially before more invasive techniques. The purpose of this study was to determine how often EMS personnel followed this protocol, while adequately achieving the goals of appropriate oxygenation and ventilation. Methods. This retrospective chart review was approved by the Institutional Review Board of The University of Kansas Medical Center. The authors reviewed the Wichita/Sedgewick County EMS system for cases in which patients required airway support. We examined de-identified data to determine if invasive methods were applied in sequence. Cohen's kappa coefficient (κ) and immersion-crystallization approach were used to analyze the data. Results. A total of 279 cases were identified in which EMS personnel used advanced airway management techniques. In 90% (n = 251) of cases, less invasive techniques were not used prior to more invasive techniques and in 80% (n = 222) of cases, the more invasive technique was used alone. A dirty airway was the most common reason for the EMS choice using more invasive approaches in achieving the goals of appropriate oxygenation and ventilation. Conclusions. Our data showed that EMS personnel in Sedgwick County/Wichita, Kansas often deviate from the advanced airway management protocols when caring for patients in need of respiratory intervention. Dirty airway was found to be the main reason for using a more invasive approach in achieving the goals of appropriate oxygenation and ventilation. It is important to fully understand reasons why deviations in protocol are occurring to ensure that current protocols, documentation, and training practices are effective in producing the best possible patient outcomes

Why Patients Miss Scheduled Outpatient Appointments at Urban Academic Residency Clinics: A Qualitative Evaluation

Introduction Missed outpatient appointments are a common problem for academic residency clinics, and reducing their rate improves office efficiency, income, and resident education. Identifying specific reasons why some patients miss outpatient appointments may provide insight into developing targeted approaches to reducing their rates. This study sought to find reasons associated with patients’ missed appointments at two family medicine residency clinics. Methods The study utilized a qualitative research design involving patients at two urban, university-affiliated family medicine residency outpatient clinics. Twenty-five randomly selected patients who were dismissed from the clinics for missing three or more scheduled appointments during a five-year span (July 2012 to July 2017) were interviewed over the phone about reasons they did not keep their scheduled clinic appointments. The authors, individually and as a group, used an immersion-crystalization approach to analyze the content of the interviews. Results Responses from 25 participants (21 females and four males) are presented. Fifty-two percent of patients were Caucasian, 32% Black, 12% Hispanic, and 4% Asian. Five themes emerged from the data analysis as major reasons the patients missed their scheduled outpatient appointments: forgetfulness, transportation issues, personal health issues, family and employer obligations, and other issues, such as anticipated long clinic wait times, bad weather, and financial problems. Conclusions The findings showed there are several logistical, situational, and clinical reasons for patients’ missed scheduled outpatient appointments

Assessment of Emergency Medical Services Personnel Compliance with Escalating Airway Algorithm Protocol

Introduction. When emergency medical service (EMS) personnel respond to emergencies, the decisions they make can often mean life or death for the patient. This is especially true in the case of advanced airway management. Protocols are set in place to ensure that the least invasive airway management techniques are used initially before more invasive techniques. The purpose of this study was to determine how often EMS personnel followed this protocol, while adequately achieving the goals of appropriate oxygenation and ventilation. Methods. This retrospective chart review was approved by the Institutional Review Board of The University of Kansas Medical Center. The authors reviewed the Wichita/Sedgewick County EMS system for cases in which patients required airway support. We examined de-identified data to determine if invasive methods were applied in sequence. Cohen's kappa coefficient (κ) and immersion-crystallization approach were used to analyze the data. Results. A total of 279 cases were identified in which EMS personnel used advanced airway management techniques. In 90% (n = 251) of cases, less invasive techniques were not used prior to more invasive techniques and in 80% (n = 222) of cases, the more invasive technique was used alone. A dirty airway was the most common reason for the EMS choice using more invasive approaches in achieving the goals of appropriate oxygenation and ventilation. Conclusions. Our data showed that EMS personnel in Sedgwick County/Wichita, Kansas often deviate from the advanced airway management protocols when caring for patients in need of respiratory intervention. Dirty airway was found to be the main reason for using a more invasive approach in achieving the goals of appropriate oxygenation and ventilation. It is important to fully understand reasons why deviations in protocol are occurring to ensure that current protocols, documentation, and training practices are effective in producing the best possible patient outcomes

Low-Power and Programmable Analog Circuitry for Wireless Sensors

Embedding networks of secure, wirelessly-connected sensors and actuators will help us to conscientiously manage our local and extended environments. One major challenge for this vision is to create networks of wireless sensor devices that provide maximal knowledge of their environment while using only the energy that is available within that environment. In this work, it is argued that the energy constraints in wireless sensor design are best addressed by incorporating analog signal processors. The low power-consumption of an analog signal processor allows persistent monitoring of multiple sensors while the device\u27s analog-to-digital converter, microcontroller, and transceiver are all in sleep mode. This dissertation describes the development of analog signal processing integrated circuits for wireless sensor networks. Specific technology problems that are addressed include reconfigurable processing architectures for low-power sensing applications, as well as the development of reprogrammable biasing for analog circuits