scholarly journals Technology: A Friend or Foe? Do Electronic Health Records Increase Burn Out Amongst Anaesthesiologists?

2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Poonam S Ghodki
Keyword(s):  
Airway Pressure ◽  
Clinical Skill ◽  
Laparoscopic Hysterectomy ◽  
Health Records ◽  
Anaesthesia Machine ◽  
A Value ◽  
Ventilatory Pattern ◽  
Burn Out ◽  
Long Time ◽  
Technical Advances

3D total laparoscopic hysterectomy in progress under general anaesthesia; steep head low, everyone delighted to see the 3D picture on screen with the goggles including the anaesthesia resident. I enter the OT (needless to say that as a senior one has to supervise more than one OT at a time). The high-end Anaesthesia machine standing tall inside the OT with all the sophisticated monitoring gadgets. I look at the ventilatory pattern on monitor: etCO2 graph upsloping with a value of 42mm of Hg, airway pressure 26mm of Hg and rising! I ask a rhetoric question to my resident as to where his attention is and to my dismay, he expresses his dissatisfaction that the monitors neither give us alarms against rising etCO2 or airway pressure nor do they warn us about changing capnograph slopes!! I am appalled. THROWBACK- Not long time ago when we were residents, we used our ‘educated hands’ to monitor the airway pressure with manual ventilation. Differential diagnosis of tight bag used to be one of the favourite questions seniors used to ask us during on-table teaching. We had no etCO2 monitor then (the mandatory minimum monitoring standard); leave alone the hi-tech ventilatory gadgets and associated airway gas monitoring. Sooner the educated hand was replaced by ventilator and arguments will continue whether to declare this as a loss of clinical skill; an unresolved riddle due to paucity of evidence. The least that I can say is with the hand on pulse and bag in hand, we used to ‘stay connected’ to the patient; with the technical advances this connection got lost. Does this make the ventilator and the advances in monitoring evil?? Obviously not. The advances in science and technology are not only for our comfort but they also play a pivotal role in improving patient’s safety and offering better patient care. Over years surgery has advanced enormously and most of these developments are attributed to advances in the field of anaesthesia which has evolved itself from the Stone Age t

Super-Fine Structure in the Critical Flow-Rate of Critical Flow Venturi Nozzles

2002 ◽  
Author(s):  
Masahiro Ishibashi
Keyword(s):  
Fine Structure ◽  
Steady State ◽  
Discharge Coefficient ◽  
Constant Pressure ◽  
Pressure Ratio ◽  
Critical Flow ◽  
Time Intervals ◽  
Critical Flow Rate ◽  
A Value ◽  
Long Time

It is shown that critical flow Venturi nozzles need time intervals, i.e., more than five hours, to achieve steady state conditions. During these intervals, the discharge coefficient varies gradually to reach a value inherent to the pressure ratio applied. When a nozzle is suddenly put in the critical condition, its discharge coefficient is trapped at a certain value then afterwards approaches gradually to the inherent value. Primary calibrations are considered to have measured the trapped discharge coefficient, whereas nozzles in applications, where a constant pressure ratio is applied for a long time, have a discharge coefficient inherent to the pressure ratio; inherent and trapped coefficients can differ by 0.03–0.04%.

Value Configurations

2010 ◽  
pp. 75-97
Author(s):  
Hans Solli-Sæther ◽  
Petter Gottschalk
Keyword(s):  
Value Chain ◽  
Theory And Practice ◽  
Professional Service ◽  
Insurance Companies ◽  
Service Firms ◽  
Professional Service Firms ◽  
Value Network ◽  
A Value ◽  
Long Time ◽  
Contingent Approach

Understanding how firms differ is a central challenge for both theory and practice of management. For a long time, Porter’s (1985) value chain was the only value configuration known to managers. Stabell and Fjeldstad (1998) identified two alternative value configurations. First, a value shop schedules activities and applies resources in a fashion that is dimensioned and appropriate to the needs of client problems, while a value chain performs a fixed set of activities that enables it to produce a standard product in large numbers. Examples of value shops are professional service firms, as found in medicine, law, architecture and engineering. Next, a value network links clients or customers who are or wish to be interdependent. Examples of value networks are logistic companies, telephone companies, retail banks and insurance companies. In this chapter, we apply the contingent approach to systems outsourcing by making the outsourcing decision dependent on the value configuration of the enterprise. We present the three different value configurations – the value chain, the value shop, and the value network. Next, the three different value configurations are compared according to key characteristics, e.g. use of information systems. Then, we take a look at interfirm relations to be able to identify areas for outsourcing, and value configuration as a determinant and predictor for the extent of outsourcing. Finally, we discuss levels of strategy and we introduce the Y-model for IS/IT strategy work.

High Burden of Burnout on Rheumatology Practitioners

2020 ◽  
Vol 47 (12) ◽  
pp. 1831-1834
Author(s):  
Vivekanand Tiwari ◽  
Arthur Kavanaugh ◽  
George Martin ◽  
Martin Bergman
Keyword(s):  
Electronic Health Records ◽  
Emotional Exhaustion ◽  
Work Hours ◽  
Personal Accomplishment ◽  
Group Practice ◽  
Health Records ◽  
High Burden ◽  
Burn Out ◽  
Lack Of Exercise ◽  
Electronic Health

ObjectiveBurnout among physicians is common and has important implications. We assessed the extent of burnout among rheumatology practitioners and its associations.Methods.One hundred twenty-eight attendees at the 2019 Rheumatology Winter Clinical Symposium were surveyed using the Maslach Burnout Index (MBI) and a demographics questionnaire. Scores for emotional exhaustion (EE) ≥ 27, depersonalization (DP) ≥ 10, and personal accomplishment (PA) ≤ 33 were considered positive for burnout. Data regarding practitioner characteristics including age, sex, years in practice, and other demographics of interest were also collected. These data were used to determine prevalence and interactions of interest between practitioner characteristics and the risk of burnout.Results.Of the 128 respondents, 50.8% demonstrated burnout in at least 1 MBI domain. Dissatisfaction with electronic health records was associated with a 2.86-times increased likelihood of burnout (OR 2.86, 95% CI 1.23–6.65, P = 0.015). Similar results were found for lack of exercise (OR 5.00, 95% CI 1.3–18.5, P = 0.016) and work hours > 60 per week (OR 2.6, 95% CI 1.16–5.6, P = 0.019). Practitioners in group practice were 57% less likely to burn out (OR 0.43, 95% CI 0.20–0.92, P = 0.029), as were those who spend > 20% of their time in personally satisfying work (OR 0.32, 95% CI 0.15–0.71, P = 0.005).Conclusion.In what we believe to be one of the largest studies regarding burnout among rheumatology practitioners, we found a substantial prevalence of burnout, with 51% of all respondents meeting criteria in at least 1 domain defined by the MBI and 54% of physicians meeting these same criteria.

On the dispersion of small particles suspended in an isotropic turbulent fluid

1977 ◽  
Vol 83 (3) ◽  
pp. 529-546 ◽  
Author(s):  
M. W. Reeks
Keyword(s):  
Relaxation Time ◽  
Fluid Velocity ◽  
Fluid Motion ◽  
Particle Diffusion ◽  
Small Particles ◽  
Mean Velocity ◽  
Turbulent Fluid ◽  
A Value ◽  
Long Time ◽  
The Mean

A solution to the dispersion of small particles suspended in a turbulent fluid is presented, based on the approximation proposed by Phythian for the dispersion of fluid points in an incompressible random fluid. Motion is considered in a frame moving with the mean velocity of the fluid, the forces acting on the particle being taken as gravity and a fluid drag assumed linear in the particle velocity relative to that of the fluid. The probability distribution of the fluid velocity field in this frame is taken as Gaussian, homogeneous, isotropic, stationary and of zero mean. It is shown that, in the absence of gravity, the long-time particle diffusion coefficient is in general greater than that of the fluid, approaching with increasing particle relaxation time a value consistent with the particle being in an Eulerian frame of reference. The effect of gravity is consistent with Yudine's effect of crossing trajectories, reducing unequally the particle diffusion in directions normal to and parallel to the direction of the gravitational field. To characterize the effect of flow and gravity on particle diffusion it has been found useful to use a Froude number defined in terms of the turbulent intensity rather than the mean velocity. Depending upon the value of this number, it is found that the particle integral time scale may initially decrease with increasing particle relaxation time though it eventually rises and approaches the particle relaxation time. It is finally shown how this analysis may be extended to include the extra forces generated by the fluid and particle accelerations.

scholarly journals "Gotong-Royong" (Mutual Assistance of Indonesia) According to Soekarno in Max Scheler's Axiology Perspective

2018 ◽  
Author(s):  
Agustinus Dewantara
Keyword(s):  
Historical Analysis ◽  
Search For Meaning ◽  
Literature Study ◽  
Mutual Cooperation ◽  
Mutual Assistance ◽  
Founding Fathers ◽  
A Value ◽  
Long Time ◽  
Objective Meaning ◽  
People Today

“Gotong-Royong” (mutual assistance of Indonesia) According to Sukarno in Max Scheler’s Axiology Perspective aims to find analytically the objective meaning of the principle of gotong-royong in the perspective of axiology. Axiology selected as an object to be formal because this research focused on “gotong-royong” as a typical value of Indonesia. This theme is expected to contribute to the life of the Indonesian people today who seem to live in a crisis of mutual cooperation in various fields. Sukarno summarizes Pancasila in a single value, namely the "gotong-royong" or he describes as Ekasila. The essence of Pancasila finds a great challenge today.The research in this dissertation is a qualitative study philosophy. The research model used a qualitative research by conducting a literature study. Hermeneutics is then used to search for meaning in this study. Methodical elements used in this study are: verstehen, historical analysis, analytic language, and heuristics. Sukarno's speech will be studied by following the hermeneutics of Dilthey. The results of the analysis of Dilthey then will be the material that will discussed from the standpoint of axiological objectivism of Max Scheler.The meaning of “gotong-royong” of Soekarno found in this research is to work together, help each other, shoulder to shoulder, cooperation, deliberation, and mutual respect as a nation. The “gotong-royong” was not the result of subjective feelings of Sukarno. The value of gotong-royong is exist without speech of Soekarno, and attached to Indonesian. Pancasila is not created by Sukarno or the founding fathers. Sukarno, in the language of Scheler, precisely found the values of Pancasila and gotong-royong that has lived a long time in the Earth Indonesia. Gotong-royong as a value, in this line of thought Scheler fixed and objective. The practice of gotong-royong appears in the shared ethos..

scholarly journals Gaining User Trust in Crowdsourcing Startup Using Desirability Business Model (Case Study at PT. Gojek in Surabaya)

2021 ◽  
Vol 2 (2) ◽  
pp. 47-52
Author(s):  
Ayouvi Wardhanie ◽  
Sri Hariani Eko Wulandari
Keyword(s):  
Business Model ◽  
Sampling Technique ◽  
Total Sample ◽  
Value Proposition ◽  
Model Case ◽  
A Value ◽  
Long Time ◽  
Positive Effect ◽  
User Trust

This study aims to explore the strategy of gaining user trust in a crowdsourcing startup based on the Desirability Business Model. This study may uncover the user trust of crowdsourcing startup which may help startup enhancing engagement and participation from crowd. The difficulties in crowdsourcing is engage user to stay with application for a long time, so this study try to help startup finding indicators to gain user trust.  This paper first propose a model to depict the effect of four parameter of Desirability Business Model with User Trust, which may influence Gojek users, then using Stratified Random Sampling Technique with a total sample of 97 people which are the subject is the society in Surabaya that in a month is at least 2 times and a maximum of more than 10 times using the Go Ride application on the Gojek company. The data collection used a questionnaire distributed through google form and social media such as Line and WhatsApp, while for the tabulation stage, it will be processed using Smart PLS-SEM. The results of this study show that of the four indicators in the Desirability Business Model variable only two indicators have a positive effect on user trust firstly, Value Proposition consisting of Performance, Design, Accessibility, Convenience, Risk Reduction, Cost Reduction and Newness then secondly, Channels consisting of Awareness, Evaluation, Purchase and After Sales. To gain user trust on the crowdsourcing startup, business owners can focus on two things firstly, provide beneficial value of the product or service offered to the user and secondly, design channel which can make business communicates with its users to convey a value proposition.

Respiratory effects of airflow through the upper airways in newborn kittens and puppies

1982 ◽  
Vol 53 (4) ◽  
pp. 805-814 ◽  
Author(s):  
S. F. Al-Shway ◽  
J. P. Mortola
Keyword(s):  
Airway Pressure ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Steady Flows ◽  
Breathing Frequency ◽  
Upper Airways ◽  
Respiratory Effects ◽  
Pentobarbital Sodium ◽  
Ventilatory Pattern ◽  
Stimulation Of

Kittens, puppies, cats, and dogs were anesthetized with pentobarbital sodium and tracheotomized. The ventilatory pattern was recorded before, during, and after the delivery of steady flows of room air of 20 or 50 ml X s-1 X kg-1 in the expiratory direction through a cannula inserted just below the larynx. In the newborn, a reduction in breathing frequency, mainly due to a prolongation of the expiratory time, and a decrease in tidal volume contributed to a reduction in minute ventilation particularly with the higher flows; in some instances apnea resulted. Small or no effects were observed in the adult. The ventilatory inhibition was still present when humidified 37 degrees C warmed airstreams were delivered, and it was unchanged when airflows of 4.9% CO21.5% O2–82.6% N2 were applied. After local anesthesia of the laryngeal region or after bypassing the larynx, the ventilatory inhibition disappeared. By closure of a nostril at any given airflow, the upper airway pressure was substantially increased; however, this maneuver did not enhance the respiratory depression. We conclude that airflow through the upper airways can inhibit ventilation in newborn kittens and puppies presumably through the stimulation of airflow-sensitive laryngeal receptors.

A Case Study to Assess Implementation of Electronic Health Records at Central Flacq Hospital, Mauritius

2012 ◽  
Vol 3 (1) ◽  
pp. 1-13
Author(s):  
Mohit Arora ◽  
Ashish Joshi
Keyword(s):  
Electronic Health Records ◽  
Quantitative Methods ◽  
Middle Level ◽  
Health Records ◽  
Qualitative And Quantitative Methods ◽  
Long Time ◽  
Quantitative Results ◽  
Electronic Health ◽  
Mixed Approach

The challenges of implementing electronic health records (EHRs) have received some attention, but little is known about the process of transitioning from paper-based to electronic files. In this paper, a mixed approach using combined qualitative and quantitative methods is utilized. The authors enrolled nine administrative managers and 87 employees from different backgrounds, all part of a regional hospital at Flacq in Mauritius, from April to May 2011. Employees responded to a survey on various aspects pertaining to their eagerness to accept the shift to electronic health records and their views on the probability of success. Descriptive and inferential statistics were used to analyze the quantitative results and content analysis was performed on the qualitative data. Nurses performing at middle level agreed that a shift to EHR is positive but felt that it might take a long time to effect the change. With its implementation, they agreed that advantages like up to date information, diminished workload, and cost effectiveness would be easily attained. In contrast, focus groups confirmed that without the collaboration and support of management, implementation of EHR would prove arduous.

Value Shop Configuration

2011 ◽  
pp. 1-9
Author(s):  
Petter Gottschalk
Keyword(s):  
Value Chain ◽  
Business Processes ◽  
Theory And Practice ◽  
Professional Service ◽  
Insurance Companies ◽  
Service Firms ◽  
Professional Service Firms ◽  
A Value ◽  
Long Time ◽  
The Way

To comprehend the value that information technology provides to organizations, we must first understand the way a particular organization conducts business and how information systems affect the performance of various component activities within the organization. Understanding how firms differ is a central challenge for both theory and practice of management. For a long time, Porter’s (1985) value chain was the only value configuration known to managers. Stabell and Fjeldstad (1998) have identified two alternative value configurations. A value shop schedules activities and applies resources in a fashion that is dimensioned and appropriate to the need’s of the client’s problem, while a value chain performs a fixed set of activities that enables it to produce a standard product in large numbers. Examples of value shops are professional service firms, as found in medicine, law, architecture and engineering. A value network links clients or customers who are or wish to be interdependent. Examples of value networks are telephone companies, retail banks and insurance companies. A value configuration describes how value is created in a company for its customers. A value configuration shows how the most important business processes function to create value for customers. A value configuration represents the way a particular organization conducts business.

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