Physician Satisfaction Research Articles

Bipolar Radiofrequency Combined with Non-Crosslinked Hyaluronic Acid Mesotherapy: A Protocol for Skin Enhancement

Changes associated with aging, such as alterations in epidermal hydration, pigmentation, thickness, and cell renewal, impact skin appearance and may result in laxity, dryness, and uneven skin tone. This case series aimed to evaluate the combined effects of bipolar radiofrequency and non-crosslinked hyaluronic acid mesotherapy on skin appearance, with the goal of achieving synergistic benefits. This retrospective data analysis included subjects aged 33-67 years with facial skin dryness and laxity. Subjects received treatment with a bipolar radiofrequency device on the face, followed immediately by mesotherapy with 2.5 ml of non-crosslinked hyaluronic acid. Photographic documentation and skin analysis were conducted before treatment and 30 days post-treatment. Fourteen subjects with a mean age of 45 years (range 33-67) and presenting with dry, lax facial skin were included. All measured indicators showed significant improvement following the combined radiofrequency and mesotherapy protocol. The combined protocol also correlated with greater improvement in both patient and physician satisfaction, observed immediately after the procedure and at 30 days post-procedure. The treatment was well tolerated, and no adverse events were reported. The combination of bipolar radiofrequency and non-crosslinked hyaluronic acid mesotherapy resulted in significant improvements in skin appearance, firmness, tone, and overall subject satisfaction compared to the baseline condition. The treatments were well received, leading to noticeable enhancements in facial aesthetics. No adverse events were reported, confirming the safety of the protocol.

Influence of a community practice innovation on a statewide cancer drug repository network.

115 Background: Cancer drug repositories (CDRs) have the potential to minimize cancer medication waste while improving medication access to patients in need. Despite multiple states having legislation allowing for CDR programs, implementation remains suboptimal. The first CDRs to launch in Michigan were a fortuitous result of the support provided in embedding clinical pharmacists into community oncology practices via the Pharmacists Optimizing Oncology Care Excellence in Michigan, POEM, program. We describe these grassroot efforts as well as barriers to sustainability, ultimately resulting in formation of a statewide CDR Network, YesRx. Methods: This qualitative analysis of barriers and facilitators was conducted from interviews with Michigan’s first CDRs. Virtual group meetings were conducted monthly for 6-months from January 2023 – June 2023. Meetings were led by the coordinating center team of POEM. Workgroup attendees included POEM pharmacists who established the first 3 CDR programs in the State, a medical oncologist and longstanding advocate of CDRs, and a patient representative. Brainstorming sessions included open ended questions on experiences to date, benefits of CDR programs, barriers to growth, limitations in current CDR models, and beneficial areas for support. Interview findings were categorized as barriers or facilitators of site-specific implementation and recommendations for CDR model optimization. Results: All 3 CDRs reported positive outcomes from initiating the CDRs related to patient benefit and physician satisfaction. Items reported as challenges/barriers in the sustainability of individual site-managed CDRs: space (inventory growth exceeded designated storage capacity), complexity of inventory tracking, resources (staff and financial), inability to search state-wide for available inventory, inability to easily transfer medications between CDR sites (due to cost, documentation, and staff), inability to ship medications directly to a patient’s home, inability to serve cancer patients across the State who may be in need of medication or interested in donating. The top recommendations for CDR model optimization formed by this workgroup were a centralized, shared database of CDR inventory across the State, support for CDR medication transfers, and additional resource and storage capabilities. YesRx, a nonprofit service organization, was founded in July 2023 in collaboration with the first 3 CDRs to address the experienced barriers resulting in exponential state-wide access. Conclusions: Grassroot efforts of community-based clinical oncology pharmacists resulted in the first CDR programs in Michigan and their experiences guided the launch of a statewide network of CDRs created to expand cancer medication access for vulnerable and underserved people and communities.

Empowering Health Care Providers: A Collaborative Approach to Enhance Financial Performance and Productivity in Clinical Practice.

The combination of inadequate financial training, limited benchmarks, and mindset contribute to many physicians prioritizing revenue below quality, outcomes, and safety. This creates a challenge as hospital administrators aim to motivate clinicians to improve RVU generation and increase revenue. Creating physician/administrator teams that defines and explores the gap between observed and expected financial performance in parallel with appreciating the physician's practice preferences can create new opportunities for billing. The proposed 3 phase approach emphasizes nonjudgmental communication, education and partnership. The most common and effective opportunities for improvement include billing optimization, scheduling and system infrastructure modifications. As reimbursement decrease, balancing revenue generation with physician satisfaction has become paramount. Promoting data drive bidirectional communication can lead to identifying previously unrecognized billing opportunities where change is driven by providers rather than by 1-dimensional institutional goals.

Abdominal Etching-A Novel Classification Method for Surgical Approach.

The abdomen is the aesthetic and physical center of the body. Abdominal etching is used to enhance the appearance of the abdominal musculature. Body contouring and abdominal etching are popular among both men and women, and these procedures have been shown to result in high patient satisfaction and are considered safe. The aim of this study was to describe a novel classification for abdominal etching based on the senior author's technique and experience. This single surgeon, nonrandomized, retrospective study was conducted from December 2016 to September 2022. Patients were classified into 4 groups based on their body habitus, abdominal skin pinch test and skin quality, and the surgical plan was tailored accordingly. Sixty-two patients (42 male) with an average age of 36years underwent abdominal etching during the study period. Subgrouping included 4 (6.45%) in Class 1, 22 (35.5%) in Class 2, 32 (51.6%) in Class 3 and 4 (6.45%) in Class 4. The most common complication was seroma. Concomitant procedures included silicone implants to the pectoral region (male), fat injection to the buttocks, breast reduction and mastopexy and treatment of post-liposuction irregularities. The abdominal etching technique is safe and reproducible. It has demonstrated long-lasting results and high patient satisfaction. Our classification of patients will enable surgeons to better understand the problem presented and provide aesthetic and efficient results. Use of these guidelines and tailoring treatment options will further improve patient and physician satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Optimizing access to care for new patients with cancer discharged from an observation unit.

119 Background: Each year, approximately 33,000 new cancer patients seek treatment at our dedicated cancer hospital, with many placed in our observation unit, the Clinical Decision Unit (CDU). These patients often experience significant delays in receiving oncologic care after discharge resulting in distress for both patients and providers. Our goal is to reduce the two-week appointment time from CDU discharge to outpatient oncologic care by more 10% for those eligible to be seen at the hospital. Methods: In fiscal year 2023, we gathered data on patients admitted to and discharged from the CDU, focusing on new patients. A multidisciplinary team developed a fishbone diagram, process flowcharts, and an impact matrix. Interventions included automated referrals, discharge notifications, patient and provider education, discharge booklets, and oncology recommendations for urgent consults. A physician satisfaction survey was conducted pre- and post-intervention. Three months of post-intervention data (February-May 2024) were reviewed, measuring the baseline percentage of patients receiving an appointment within two weeks, one month or more after CDU discharge. Results: In 2023, 90 eligible patients new to the institution were discharged from the CDU. Of those, 3 (3%) had follow-up appointments within 2 weeks, and 39 (43%) had appointments after 30 days or no appointment at all. Post-intervention data showed that out of 15 new patients discharged between February and May 2024, 10 (66%) had follow up appointments within 2 weeks, 4 (27%) within 30 days, while 1 (7%) had not yet received an appointment. Conclusions: Streamlining the referral process through a central service, automating the requests, and educating both providers and patients can reduce the time to establish oncologic care through an observation unit. However, limitations remain for patients with out-of-network insurance or lack of insurance coverage. Further research is necessary to assess whether expediting follow up cancer care for new patients improves clinical outcomes and relieves associated stress as we suspect it does. Time interval for new patients to acquire oncology clinic appointments post discharge. Dates/Time Frame Eligible New Patients with Appointments Within 2 weeks Eligible New Patients with Appointments within 15 to 30 days Eligible New Patients with No Appointment or Appointment > 30 days* Baseline DataFY 2023 3%(3/90) 53%(48/90) 43%(39/90) Post-Intervention:2/6/24 – 5/6/24 66%%(10/15) 27%(4/15) 7%(1/15) *Includes patients without follow up.

Cohen versus Pfannenstiel Cesarean Skin Incision for BMI =35 kg/m2: a Randomized Controlled Trial

Background: Maternal obesity is recognized as a significant risk factor for adverse pregnancy outcomes, including increased cesarean delivery rates and heightened surgical complications. It is unclear if the Cohen or Pfannenstiel skin incisions at cesarean delivery are associated with different outcomes. Objective: To evaluate the impact of either Cohen or Pfannenstiel cesarean skin incision type on maternal morbidity. Study Design: Pregnant individuals with a BMI of ≥35 kg/m2, carrying either singleton or multiple gestations, were consented prenatally and in labor. Eligible participants who underwent a cesarean delivery between 24 and 41 weeks of gestation were randomized to either Pfannenstiel or Cohen skin incisions at Thomas Jefferson University Hospital from October 2016 to March 2020. The study aimed to recruit 284 participants based on a sample size calculation assuming a 50% reduction in wound complications with Cohen versus Pfannenstiel incisions (80% power, α=0.05), but recruitment was terminated early after 72 participants were randomized. The primary outcome was a composite maternal morbidity within six weeks, which consisted of the following: wound infection, hematoma, seroma, separation of skin ≥1 cm, readmission for wound complications, endometritis, and postpartum hemorrhage. Statistical analyses included bivariate tests, t-tests, and non-parametric analyses. Results: Of 331 pregnant individuals consented prenatally and in labor, 72 eventually underwent cesarean delivery and were randomized, 34 to Cohen and 38 to Pfannenstiel skin incisions. The mean BMI was >42 kg/m2, about two thirds of the patients had a pannus, 56% were Black, 47% had diabetes, and 56% hypertensive disorders. The primary outcome of composite maternal morbidity occurred in 47.1% in the Cohen and 36.8% in the Pfannenstiel groups (RR 1.24, 95% CI 0.71-2.08), and was also similar regardless of the presence of a pannus, or by degree of obesity. Surgical site infection, hematoma, seroma, wound separation/dehiscence, endometritis, and postpartum hemorrhage were each similar between Cohen and Pfannenstiel participants. Neonatal outcomes were also similar between the Cohen and Pfannenstiel groups, except that the Cohen group was found to have statistically significant lower Apgar score at 5 minutes and higher need for respiratory support compared to the Pfannenstiel group, possibly related to the trend for a longer time from skin incision to delivery. Physicians were found to be significantly less satisfied with the Cohen compared to the Pfannenstiel incision. Conclusion: In pregnant patients with BMI of ≥35 kg/m2, obstetrical providers can chose from either a Cohen or an Pfannenstiel skin incision, as they are associated in general with similar outcomes, except for lower Apgar scores and lower physician satisfaction associated with the Cohen incision. The findings of this study are limited by its early cessation for logistical reasons, leading to an underpowered analysis. It is crucial to acknowledge that these results must be interpreted cautiously due to the reduced sample size and the circumstances surrounding the study's termination. These data can inform future trial design and implementation as well as fuel individual patient level meta-analyses on this topic.

The efficacy of light-guiding microneedle patch for stimulating hair growth in androgenetic alopecia.

Androgenetic alopecia (AGA) is the most common form of hair loss characterized by miniaturization of hair follicles. Low-level light therapy (LLLT) and microneedling have shown potential in promoting hair regrowth. This study aims to evaluate the efficacy of an innovative light-emitting diode (LED) helmet cooperated with a novel light-guiding microneedle patch (LMNP) for stimulating hair growth in AGA. In this randomized clinical trial, 16 AGA patients received treatments using light-guiding microneedle patches (LMNPs) illuminated by a LED helmet equipped with green (522nm) and red (633nm) LEDs, delivering 50mW/cm2 power and 40J/cm2 energy. Treatments were applied weekly for 24weeks, targeting the frontal recession area. The right side of the scalp was treated with green light and the left with red light, each combined with a LMNP featuring 900µm height needles at a density of 105 per square centimeter. Hair density and diameter, along with patient and physician satisfaction scores, were assessed monthly. Both red and green LED treatments with LMNP, significantly enhanced hair density and diameter. Satisfaction scores, as reported by both physicians and participants, increased over time. Comparative analyses revealed no statistically significant differences in average satisfaction scores or in changes in hair density and diameter between the groups by the end of the study. Additionally, no serious adverse effects were reported, highlighting the safety of the treatments. The combined Light sources which is portable LED helmet and LMNPs shows promise as a non-invasive, effective treatment for AGA, with similar efficacy between red and green wavelengths.

The Redefinition and Volumization of the Lip Area with Hyaluronic Acid: A Case Series

Background: The increasing popularity of non-surgical cosmetic enhancements for the lower face and perioral area, particularly through hyaluronic acid (HA) fillers, reflects the growing desire for improved lip volume and definition. This study showcases the effects of a specific HA filler on lip fullness, shape, and overall perioral rejuvenation. Methods: We conducted a retrospective single-site observational analysis of adult female patients treated with Genefill Soft Fill HA injections in the lips and perioral areas. Both patient and physician satisfaction were evaluated using the Likert scale and Global Aesthetic Improvement Scale (GAIS), respectively. The outcomes for natural appearance, volume, and durability were assessed using a five-point scale. The patients were followed up with for up to six months to monitor any adverse events. Results: The cohort included thirteen female patients with an average age of 55.3 ± 8.3 years. Approximately 1.2 ± 0.4 mL of filler was used per patient. The results indicate high satisfaction, with scores above 4 for naturalness, volume, and durability. Over 92% of patients reported a significant improvement in appearance. No moderate or severe adverse events were reported. Conclusions: Genefill Soft Fill HA filler is both effective and safe for enhancing lip esthetics, with high satisfaction rates among recipients and no significant adverse events observed.

Application of linaclotide in bowel preparation for colonoscopy in patients with constipation: A prospective randomized controlled study.

Colonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre-colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG). In this prospective, single-center, randomized controlled trial, 322 participants were divided into two groups: a 3-L PEG+870-μg linaclotide group (administered as a single dose for 3days) and a 4-L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction. The study included 319 patients. The 3-L PEG+linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4-L PEG group (89.4% vs 73.6% and 37.5% vs 25.3%, respectively; P<0.05). The mean BBPS score for the right colon in the 3-L PEG+linaclotide group was significantly higher than that in the 4-L PEG group. There were no significant between-group differences regarding the detection rates of colonic polyps and adenomas (44.4% vs 37.7% and 23.1% vs 20.1%, respectively; P>0.05). There were no significant between-group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3-L PEG+linaclotide group. The combination of 3-L PEG and 870-μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly.

Workplace violence against junior doctors in Iraq: implications for job satisfaction and retention

IntroductionHealth workers worldwide report being exposed to workplace violence, but those in conflict settings (or post-conflict settings) are especially targeted, as political conflict shifts societal norms. Iraq has suffered war and conflict for decades. A 2013 study of 567 Iraqi-trained physicians found nearly 2/3 had emigrated to mostly English-speaking countries; further, half of those remaining wished to leave Iraq. While prior studies have examined the phenomenon of violence against health workers in Iraq, no qualitative study has characterized Iraqi front line junior doctors’ experiences of workplace violence within a workplace violence causal framework, to inform an educational and policy response.MethodsWe consented and interviewed 73 junior physicians at six teaching hospitals across Central Iraq between December 2021, and January 2022. We analyzed 22 of the 73 conversations, after rejecting 29 because they were terminated prematurely when doctors were called away for patient care, and 22 others where doctors indicated they had no experience with workplace violence. (Our goal was to understand these interactions, not to quantify them).ResultsThe physicians we interviewed had been practicing an average 3 years since graduating from medical school (ranging from 6 months to 7 years). Interviewees represented eight hospital departments, with most coming from internal medicine and surgery. Within a socio-ecological framework, we identified two primary individual-level factors prompting patient-associated violence: patients and their families don’t understand triage (and resent being pushed to the side when doctors focus on more serious cases), and junior doctors (by definition) are young and inexperienced. At the family level, doctors reported patient relatives often demonstrate their devotion to the patient by acting out. At the hospital level, institutions are operating in an environment of scarcity, which generates high emotions as patients compete for attention, supplies and space. At a societal level, doctors reported family attacks persist because perpetrators face no real legal consequences. In addition to causes of violence, there are consequences. Doctors who are targets of violence reported experiencing mental health problems, including depression and loss of self-esteem, and reported thoughts of leaving their positions and even their country. Doctors also expressed regret for choosing a career in medicine.ConclusionYoung, inexperienced junior doctors in Iraq are bearing the brunt of patient frustrations with the scarcity of resources in the health system. Hospitals would likely improve the job satisfaction of junior physicians, and their longevity in the health system, by attending to this problem.

Patient and Physician Communication in the Allogeneic Transplantation Setting: Challenges and Potential Solutions

Allogeneic hematopoietic cell transplantation is a challenging treatment characterized by multiple morbidities, the need for long-term care, and a significant mortality risk. Consequently, close patient and physician communication throughout treatment is crucial. We aimed to review the literature examining patient and physician communication around critical aspects experienced by allogeneic survivors over the transplantation trajectory, such as the informed consent process, transplantation-related morbidity (eg, psychosocial distress, cognitive dysfunction, sexuality), adherence to treatment, and the use of complementary and alternative medicine, as well as interventions and strategies to improve patient and physician communication. We found a paucity of studies examining communication on these topics. Nevertheless, there is evidence of significant communication gaps around morbidities often experienced by allogeneic survivors, such as psychosocial distress, fatigue, and sexual functioning, due to both patient and physician barriers. Similarly, there is a concern that gaps also exist when addressing the informed consent process, cognitive dysfunction, adherence to treatment, and use of complementary and alternative medicine. The use and discussion of patient-reported outcome measures as part of clinical care is associated with patient and physician satisfaction with communication and better detection and management of symptoms. Although other strategies, such as decision aids, question prompt lists, and communication skills training, have improved communication in oncology, they have not been tested in the allogeneic setting. Future research is clearly needed to examine patient and physician communication in the allogeneic transplantation setting and test strategies to improve communication during this challenging treatment.

Physician Satisfaction Should Be the Measure of Electronic Health Record Quality for the Nation.

Physician Satisfaction Should Be the Measure of Electronic Health Record Quality for the Nation.

Comparing the Efficacy of “Spray as You Go” Technique Versus Combined Airway Nerve Block and “Spray as You Go” as Topical Anesthesia During Flexible Bronchoscopy; a Double-Blinded Randomized Clinical Trial

Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P&lt;0.001). Thirteen individuals (38.2%) in the SAYGO and four individuals (11.8%) in SAYGO+ANB experienced a drop in oxygen levels (P=0.023). Additionally, sedation levels (Ramsay sedation scale score) were significantly higher in the first group (4) compared to the second group (3) (P=0.001). Combining ANB with SAYGO resulted in higher patient and physician comfort during bronchoscopy in comparison to SAYGO alone with no increase in complications.

Adopting academic rank in a rural community practice affiliated with an academic medical center

BackgroundUnited States rural community-based practices are increasingly participating in undergraduate and graduate medical education to train the workforce of the future, and are required or encouraged to provide academic appointments to physicians who have typically not held an academic appointment. Mechanisms to identify faculty and award academic appointments across an entire health system have not been reported.MethodsOur rural community regional practice identified academic appointments as important for participating in medical education. Over a three-year period, our regional leadership organized a formal education committee that led a variety of administrative changes to promote the adoption of academic rank. Data on attainment of academic appointments was obtained from our Academic Appointment and Promotion Committee, and cross referenced with data from our regional human resources department using self-reported demographic data.ResultsWe describe a successful adoption strategy for awarding academic rank in a rural regional practice in which the percentage of physician staff with academic rank increased from 41.1 to 92.8% over a 3-year period.ConclusionsOur experience shows that process changes can rapidly increase and then sustain academic appointments for physicians over time. More rural health systems may want to consider the use of academic rank to support educational programs while enhancing physician satisfaction, recruitment and retention.

Selective opioid agonist Taphalgin® as a component of postoperative analgesia in various surgical areas: “NIKITA” observational multicenter study

Introduction. The role of peptides in antinociceptive system regulation has became a subject of interest for scientists worldwide. The first registered peptide analgesic tyrosyl-D-arginyl-phenylalanyl-glycinamide acetate which currently can be used in clinical practice was developed in Russia under the name Taphalgin® (PharmFirma “Sotex”, Russia). The effectiveness and safety of this pharmaceutical in postoperative pain management was evaluated in the all-Russia multicenter prospective observation program NICITA (Non-interventional Clinical Trial of Taphalgin ®).Aim. To analyze the effectiveness and safety of Taphalgin® in postoperative pain management in various surgical fields.Materials and methods. The observational program NICITA included 887 patients including patients with malignant tumors of various locations from 15 study centers in different Russian cities. All patients underwent surgical interventions in various anatomical areas under general, regional and combination anesthesia. The principal scheme of postoperative pain management was based on the multimodal approach which included peptide opioid agonist alongside acetaminophen, cyclooxygenase inhibitors in combination with regional anesthesia or without it. The study also included patients who underwent small-volume surgeries, and pain was managed through Taphalgin® monotherapy with subsequent switch to cyclooxygenase inhibitors. The primary endpoint of the NICITA observational program was response to therapy after the first Taphalgin® administration. Decreased pain syndrome per the numerical rating scale 15–60 min after subcutaneous injection and maintenance of analgesic effect 3 h later were considered treatment response. The secondary endpoints included mean time to analgesia start after administration of the 1st single drug dose (in min), duration of effect, types and frequency of adverse reactions including serious in the central nervous system, pulmonary system, gastrointestinal tract developed during the observational program, as well as patient and research physician satisfaction with pain management. To evaluate the significance of pain intensity change at rest and in motion in time, analysis of variance with repeat measurements was used; for pairwise comparison of two time periods, Student’s t-test for dependent samples was used. The differences were considered significant at p = 0.05.Results. Statistically significant decrease in pain intensity in the total patient group was observed 15 minutes after Taphalgin® administration; it reached its minimum 40 min after the injection (р &lt;0.05). The percentage of patients responding to analgesic therapy with Taphalgin® was 96.5 %. During administration of the drug, insignificant decrease (10–15 mmHg) in arterial blood pressure (1.7 % of cases) and vertigo (1 % of cases) were observed. In some patients, several adverse reactions were observed. Satisfaction with analgesic effect of Taphalgin® was relatively high both in patients and research physicians.Conclusion. Taphalgin® has pronounced analgesic effect and is effective for pain management after surgical interventions of various volumes and injury level. The use of this drug is associated with low rate of adverse reactions and absence of pulmonary depression characterizing opioid agonists. Therefore, Taphalgin® can be recommended for clinical use for postoperative pain management after various types of surgical interventions.

A Randomized Controlled Comparison of Guardian-Perceived Cosmetic Outcome of Simple Lacerations Repaired With Either Dermabond, Steri-Strips, or Absorbable Sutures.

The aim of this study was to compare the guardian-perceived 3-month cosmetic outcome for pediatric lacerations repaired with absorbable sutures, Dermabond, or Steri-Strips. Secondarily, pain and satisfaction with the procedure from both guardian and provider perspectives were compared. In this randomized controlled trial, we enrolled a convenience sample of children aged 0 to <18 years who presented with simple linear lacerations (≤5 cm in length, ≤0.5 cm in width, and <12 hours old) to a pediatric emergency department. Children were randomized to receive laceration repair with absorbable sutures, Dermabond, or Steri-Strips. Topical L.E.T. solution (lidocaine, epinephrine, tetracaine) was applied to wounds which were then closed by the primary team. Guardians and providers completed questionnaires regarding perceived pain and satisfaction with the procedure. Guardians were contacted 3 months after the repair and asked to email a picture of the scar with their perception of cosmesis rated on a visual analog scale from 0 to 100. Fifty-five patients were enrolled, of whom 30 completed 3-month follow-up (12 suture, 7 Dermabond, 11 Steri-strips). There was no statistical evidence of an association between scar appearance and closure method based on medians and interquartile ranges for cosmetic ratings of scar: suture median 70.5 (IQR 59.8-76.8), Dermabond median 85 (IQR 73-90), Steri-strips median 67 (IQR 55-78) (P = 0.254). Guardian satisfaction with length of stay, guardian and physician satisfaction with the procedure, and guardian and physician-perceived pain also showed no differences. No differences were observed in guardian-perceived cosmesis of simple lacerations repaired with sutures, Dermabond, or Steri-Strips when evaluated 3 months after intervention. In addition, there were no differences in guardian or physician-perceived pain or satisfaction with the closure methods. The results of this study suggest that all 3 closure methods appear to be clinically equivalent, which is largely consistent with other evidence. Further study should be expanded to a larger demographic.

Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians

Electronic health record (EHR) work has been associated with decreased physician well-being. Understanding the association between EHR usability and physician satisfaction and burnout, and whether team and technology strategies moderate this association, is critical to informing efforts to address EHR-associated physician burnout. To measure family physician satisfaction with their EHR and EHR usability across functions and evaluate the association of EHR usability with satisfaction and burnout, as well as the moderating association of 4 team and technology EHR efficiency strategies. This study uses data from a cross-sectional survey conducted from December 12, 2021, to October 17, 2022, of all family physicians seeking American Board of Family Medicine recertification in 2022. Physicians perceived EHR usability across 6 domains, as well as adoption of 4 EHR efficiency strategies: scribes, support from other staff, templated text, and voice recognition or transcription. Physician EHR satisfaction and frequency of experiencing burnout measured with a single survey item ("I feel burned out from my work"), with answers ranging from "never" to "every day." Of the 2067 physicians (1246 [60.3%] younger than 50 years; 1051 men [50.9%]; and 1729 [86.0%] practicing in an urban area) who responded to the survey, 562 (27.2%) were very satisfied and 775 (37.5%) were somewhat satisfied, while 346 (16.7%) were somewhat dissatisfied and 198 (9.6%) were very dissatisfied with their EHR. Readability of information had the highest usability, with 543 physicians (26.3%) rating it as excellent, while usefulness of alerts had the lowest usability, with 262 physicians (12.7%) rating it as excellent. In multivariable models, good or excellent usability for entering data (β = 0.09 [95% CI, 0.05-0.14]; P < .001), alignment with workflow processes (β = 0.11 [95% CI, 0.06-0.16]; P < .001), ease of finding information (β = 0.14 [95% CI, 0.09-0.19]; P < .001), and usefulness of alerts (β = 0.11 [95% CI, 0.06-0.16]; P < .001) were associated with physicians being very satisfied with their EHR. In addition, being very satisfied with the EHR was associated with reduced frequency of burnout (β = -0.64 [95% CI, -1.06 to -0.22]; P < .001). In moderation analysis, only physicians with highly usable EHRs saw improvements in satisfaction from adopting efficiency strategies. In this survey study of physician EHR usability and satisfaction, approximately one-fourth of family physicians reported being very satisfied with their EHR, while another one-fourth reported being somewhat or very dissatisfied, a concerning finding amplified by the inverse association between EHR satisfaction and burnout. Electronic health record-based alerts had the lowest reported usability, suggesting EHR vendors should focus their efforts on improving alerts. Electronic health record efficiency strategies were broadly adopted, but only physicians with highly usable EHRs realized gains in EHR satisfaction from using these strategies, suggesting that EHR burden-reduction interventions are likely to have heterogenous associations across physicians with different EHRs.

Reducing turnaround time for routine outpatient biochemical tests through Lean Six Sigma: A case study in China.

Routine clinical biochemistry tests are crucial for clinical diagnostics and play a key role in enhancing outpatient turnover efficiency and patient satisfaction. This study aimed to implement Lean Six Sigma in the biochemistry laboratory of a hospital in China to improve efficiency and quality by reducing turnaround time. The study was conducted from January to December 2023, using the DMAIC (Define, Measure, Analyze, Improve, Control) framework, and employed tools such as the voice of the customer, Value Stream Mapping, '5 whys' technique, Nominal Group Technique, and Pareto chart. The turnaround time for outpatient routine clinical biochemistry tests was reduced from 139 min to 58 min (p < 0.05), effectively increasing both patient and physician satisfaction. Lean Six Sigma aimed to reduce the turnaround time for biochemical tests have significant advantages. This study confirms the effectiveness of Lean Six Sigma in a Chinese clinical laboratory setting and provides guidance for optimizing efficiency in global clinical laboratories with limited implementation experience, constrained technical and equipment resources, and high demand for medical diagnostics.

Satisfaction of Patients and Physicians with Telehealth Services during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

The rapid spread of coronavirus disease 2019 (COVID-19) posed significant challenges to healthcare systems, prompting the widespread adoption of telehealth to provide medical services while minimizing the risk of virus transmission. This study aimed to assess the satisfaction rates of both patients and physicians with telehealth during the COVID-19 pandemic. Searches were conducted in the Web of Science, PubMed, and Scopus databases from January 1, 2020, to January 1, 2023. We included studies that utilized telehealth during the COVID-19 pandemic and reported satisfaction data for both patients and physicians. Data extraction was performed using a form designed by the researchers. A meta-analysis was carried out using random-effects models with the OpenMeta-Analyst software. A subgroup analysis was conducted based on the type of telehealth services used: telephone, video, and a combination of both. From an initial pool of 1,454 articles, 62 met the inclusion criteria for this study. The most commonly used methods were video and telephone calls. The overall satisfaction rate with telehealth during the COVID-19 pandemic was 81%. Satisfaction rates were higher among patients at 83%, compared to 74% among physicians. Specifically, telephone consultations had a satisfaction rate of 77%, video consultations 86%, and a mix of both methods yielded a 77% satisfaction rate. Overall, satisfaction with telehealth during the COVID-19 pandemic was considered satisfactory, with both patients and physicians reporting high levels of satisfaction. Telehealth has proven to be an effective alternative for delivering healthcare services during pandemics.

Ethical considerations in telehealth and artificial intelligence for work related musculoskeletal disorders: A scoping review

BACKGROUND: Artificial Intelligence (AI) refers to the simulation of human intelligence in machines that are programmed to perform tasks that typically require human intelligence. The integration of AI and telehealth applications in healthcare raises ethical concerns such as bias, transparency, data privacy, and accountability for errors. Several studies have assessed this topic, particularly with regard to musculoskeletal disorders, which will be the focus of this manuscript. OBJECTIVE: We will examine key ethical concepts including informed consent, data protection, confidentiality, physician malpractice, liability, and telemedicine regulations. METHODS: Ethical issues pertaining to the topic were explored through a review paper. The primary objective of this scoping review was to map and synthesize the existing literature concerning ethical considerations in telehealth and AI for work-related musculoskeletal disorders. RESULTS: Research demonstrates that medication effectiveness, patient and physician satisfaction, and accessibility costs are higher with telemedicine and AI methods compared to in-person approaches, particularly for work-related musculoskeletal disorders. Therefore, addressing ethical issues, including patient data privacy and security, is crucial in this field. By considering these factors, the adoption of emerging AI and telemedicine applications, especially for work-related musculoskeletal disorders, is likely to increase. CONCLUSION: AI and telemedicine offer significant advantages, particularly in addressing work-related musculoskeletal disorders. However, ethical and legal issues surrounding their practice require standardized rules to ensure equitable access, quality care, sustainable costs, professional liability, patient privacy, data protection, and confidentiality. Further practical research studies are needed to address these considerations more effectively.