Physician Burnout and the Electronic Health Record Leading up to and During The First Year of COVID-19: A Systematic Review (Preprint)

2022 ◽  
Author(s):  
Clemens Scott Kruse ◽  
Michael Mileski ◽  
Gevin Dray ◽  
Zakia Johnson ◽  
Cameron Shaw ◽  
...  
Keyword(s):  
Empirical Evidence ◽  
Human Subjects ◽  
First Year ◽  
Physician Burnout ◽  
Life Balance ◽  
Loss Of Autonomy ◽  
Lack Of Control ◽  
Two Factors ◽  
The Hours ◽  
Design Experiments

BACKGROUND Physician burnout was first identified in 1974, and it has been particularly prevalent during the first year of the pandemic. OBJECTIVE To objectively analyze the literature over the last five years for empirical evidence of burnout incident to the EHR and to identify barriers, facilitators, associated patient satisfaction to using the EHR to improve symptoms of burnout. METHODS No human subjects were used in this review, however 100% of participants in studies analyzed were adult physicians. Four research databases and one targeted journal were queried for studies commensurate with the objective statement from January 1, 2016 through January 31st 2021 (n=25). RESULTS The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one’s schedule, cognitive fatigue, a general loss of autonomy and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes to alleviate the administrative burden of the EHR and decreased symptoms of burnout. CONCLUSIONS The solutions provided in the literature only addressed two of the three factors, workflow and documentation time, but not the third, usability. Practitioners and administrators should focus on the former two factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify usability features with the greatest impact to improve. Researchers should design experiments to explore solutions that address all three factors of the EHR that contribute to burnout. INTERNATIONAL REGISTERED REPORT RR2-10.2196/15490

scholarly journals Envisioning the atmospheric effect through (im)materiality

2019 ◽  
Vol 64 ◽  
pp. 02007
Author(s):  
Nilay Ünsal Gülmez ◽  
Dürnev Atılgan Yagan ◽  
Murat Şahin ◽  
Efsun Ekenyazıcı Güney ◽  
Hande Tulum
Keyword(s):  
Interior Design ◽  
Analytical Method ◽  
Design Studio ◽  
First Year ◽  
Second Phase ◽  
Design Practice ◽  
Atmospheric Effect ◽  
Two Phases ◽  
Light Color ◽  
Design Experiments

In an attempt to bridge the gap between architectural/interior design practice and education, ‘atmosphere’ as a prolific contemporary architectural debate in practice and theory is covered by the experiment of ‘Staging Poe’ carried out as a first year Design Studio through the study of Edgar Allen Poe’s selected poems. Poe’s 1846 text of ‘The Philosophy of Composition’, unfolding his analytical method of writing and emphasis on “effect” in poetry, provides a ground for experimenting with facets of materiality and structuring the studio. Aiming to cultivate intuitive design experiments of students into informed processes in hybridizing conceptual/textual and material/sensual aspects, studio is structured in two phases. In the first phase, “materialization”, idiosyncratic interpretations of students from words to materials with a focus on tectonic experiments and haptic experiences are sought in between materializing and dematerializing processes. In the second phase, the “atmospheric”, emphasis on dematerialization of the perception of materials through tools, such as light, color and sound is exercised to transform the object into a performance stage. Outcomes of the studio on aspects pertaining to material and materialities in creation of the immaterial that is the atmosphere is followed and evaluated through responses of students’ weekly reports.

scholarly journals Sourcebook update: intestinal smooth muscle contractility and autonomic control

2018 ◽  
Vol 42 (2) ◽  
pp. 311-320 ◽  
Author(s):  
Philip D. Langton
Keyword(s):  
First Year ◽  
Smooth Muscle Contractility ◽  
Gut Motility ◽  
First Year Students ◽  
Authentic Inquiry ◽  
Student Teams ◽  
Functional Antagonism ◽  
The Individual ◽  
Design Experiments

This laboratory practical requires first-year students to anticipate the effects of drugs active at cholinergic and adrenergic receptors on gut motility in order to design experiments during an authentic inquiry exercise. Rather than specifying a strict sequence of drug additions that aim to provide ideal demonstrations of pharmacological and physiological antagonism, I have instead designed switches into the drugs provided and set students, working in small teams, the task of identifying the switched drugs, an inquiry activity. To extend the teamwork aspect, laboratory reports were submitted by the student teams rather than individual students. Staff observed that discussions within the teams were stimulated by the inquiry-led nature of the practical. The quality of the laboratory reports submitted by teams were substantially improved over the individual reports submitted in previous years. (Students previously worked in teams, but simply followed a list of prescribed experiments and wrote individual reports.) Although, in conversation, teams of students had an improved understanding of the regulation of gut motility by the parasympathetic and sympathetic divisions of the autonomic nervous system and could readily distinguish between pharmacological and functional antagonism, no attempt was made to evaluate learning because the revision was triggered by the observed effect of a technical error and was not otherwise planned. It is likely that laboratory practicals, in general, would benefit from inclusion of inquiry.

scholarly journals The impact of a shade from the growth and the results of two varieties soybean ( glycine max l .Merrill ) superior nationa

2016 ◽  
Vol 1 (1) ◽  
pp. 90-100
Author(s):  
Mia Herisva ◽  
Taufan Hidayat ◽  
Zaitun Zaitun
Keyword(s):  
Limited Resources ◽  
Soybean Plant ◽  
Plant Design ◽  
Tall Plant ◽  
Two Factors ◽  
Production Techniques ◽  
Glycine Max L ◽  
Plantation Crops ◽  
The Impact ◽  
Design Experiments

Abstract. Soybean needs national until now as still filled with than the import value that production in the country not enough. In solve the problems the low rate production soybean required production techniques of technology and awareness nice about the cultivation of plants soybean , the expansion of the increase , fix the quality , the environment and the use of varieties superior. Efforts to improving production soybean bounded by the limited by land ownership because some rice-fields productive have changed to a non farming. Behind the limited resources land for the expansion of the acreage of a farm, there are land potential to to use, namely land under kanofi plantation crops. The purpose of this study is to find the impact of shade and varieties and interaction between them to growth and the production of the soybean plant. Design experiments used in this research is a swath separate ( RPT) with two factors treatment. The research results show that treatment shade very had have real impact on some parameters that observed , on the parameter tall plant , diameter of the stem , flowering age , age harvest , the number of pods total , the number of pods pithy , heavy seeds 100 points and potential the results , the best result in find in treatment nuangan 60 % . Varieties influential very real to pertumbuhandan production the soybean plant, based on the results of observation tall plant, diameter of the stem, flowering age, the use of varieties anjasmoro showed growth and best in compared with varieties ringing. There are the interaction that very real between shade and varietas.kombinasi that tends to both in find in varieties anjasmoro but shade 60 %

scholarly journals Work-life balance of employees working in power sectors of krishnagiri district

2018 ◽  
Vol 7 (2.20) ◽  
pp. 164
Author(s):  
A Sathiya Priya ◽  
Dr D. Muruganandam
Keyword(s):  
Empirical Evidence ◽  
Work Satisfaction ◽  
Work Life ◽  
T Test ◽  
Work Life Balance ◽  
Power Sector ◽  
Life Balance ◽  
Special Training

The purpose of this study is to highlight the necessity of adopting work-life balance in a power sector. The paper examines different elements of work-life balance especially with reference to employees working in power sectors. The main objective of the study is to study the work- life balance and work satisfaction of the employees in power sector. Based on the empirical evidence, the study proposes that there is a need for focusing on factors that aid in enhancing the work-life balance among employees. The data for the study was collected from 100 employees working in a power sector of Krishnagiri District of TamilNadu. The data collected were analyzed and interpretation and it’s derived by using tests like t-test, simple percentage analysis. The findings imply that employees expect rewards, awarding policies, special training, and stress less work from the company. Hence the study helped to find out the work- life balance among employees working in power sector.  

Symposium ON PEDIATRIC SURGERY

PEDIATRICS ◽  
1948 ◽  
Vol 1 (6) ◽  
pp. 771-798
Author(s):  
HERBERT E. COE
Keyword(s):  
Gall Bladder ◽  
Typhoid Fever ◽  
First Year ◽  
Variable Degree ◽  
Developmental Defects ◽  
Intestinal Perforations ◽  
Obstructive Lesion ◽  
Lack Of Control ◽  
Preanesthetic Medication ◽  
The Difference

There are a surprisingly large number of anatomic and developmental defects that result in urinary incontinence in infancy and childhood. While most cases of "enuresis" are merely the result of inadequate or improper training, the doubtful case should receive careful neurologic and urologic studies before psychiatric therapy in its various forms is undertaken. It is particularly important to study such cases in instances where urinary control has already been established and then the symptoms of incontinence develop. The most dangerous cases of all are those due to some defect which results in the "dribbling incontinence" of an overdistended bladder. These are particularly dangerous, in that the "incontinence" may be regarded during the first year or two of life as only the normal lack of training on the part of the child. The difference between this and pathologic lack of control is usually easily apparent. The normal child allows his bladder to become full, empties it all at once, and then will remain dry for varying periods of time. In obstruction, with overdistention of the bladder, the lack of control is constant, is small in amount and, if this possibility is considered, diagnosis of an obstructive lesion is easy. Urethral valves may be removed, but bladder tumor has a grave prognosis. Neurologic cord lesions also present a constant, though variable degree of incontinence day and night, and careful history will bring this out. Ordinary enuresis is inconstant. The experience at the Hospital Infantil of Mexico City in dealing with intestinal perforations and rupture of the gall bladder in typhoid fever is presented. Four hundred and fifty-seven cases of typhoid fever among 15,688 general admissions in 3 years, with 29 cases of intestinal perforations and 4 ruptured gall bladders form the basis of this report. Twenty-one were operated on, with a survival of 9 (43% survivals with operation), 8 were not operated on. Seven of these died (85% mortality). Of four cases of rupture of the gall bladder all were operated on and one survived. It has been pointed out in this paper that most technics which are employed successfully in adult anesthesia can be used to a large extent with the same advantages in infants and children. Therefore, in pediatric centers one finds preanesthetic medication, inhalation, intravenous, rectal, spinal and regional anesthesia employed safely and with advantage to both patient and surgeon.

scholarly journals Silence, Solitude, and Serotonin: Neural Mechanisms Linking Hearing Loss and Social Isolation

2020 ◽  
Vol 10 (6) ◽  
pp. 367
Author(s):  
Sarah M. Keesom ◽  
Laura M. Hurley
Keyword(s):  
Hearing Loss ◽  
Social Isolation ◽  
Human Subjects ◽  
Brain Regions ◽  
Neural Systems ◽  
Depression And Anxiety ◽  
Auditory Cognition ◽  
Regulatory Systems ◽  
Two Factors ◽  
And Function

For social animals that communicate acoustically, hearing loss and social isolation are factors that independently influence social behavior. In human subjects, hearing loss may also contribute to objective and subjective measures of social isolation. Although the behavioral relationship between hearing loss and social isolation is evident, there is little understanding of their interdependence at the level of neural systems. Separate lines of research have shown that social isolation and hearing loss independently target the serotonergic system in the rodent brain. These two factors affect both presynaptic and postsynaptic measures of serotonergic anatomy and function, highlighting the sensitivity of serotonergic pathways to both types of insult. The effects of deficits in both acoustic and social inputs are seen not only within the auditory system, but also in other brain regions, suggesting relatively extensive effects of these deficits on serotonergic regulatory systems. Serotonin plays a much-studied role in depression and anxiety, and may also influence several aspects of auditory cognition, including auditory attention and understanding speech in challenging listening conditions. These commonalities suggest that serotonergic pathways are worthy of further exploration as potential intervening mechanisms between the related conditions of hearing loss and social isolation, and the affective and cognitive dysfunctions that follow.

Process vs. Impact in Men's and Women's Achievement Motivation

1977 ◽  
Vol 1 (3) ◽  
pp. 283-293 ◽  
Author(s):  
Joseph Veroff
Keyword(s):  
Empirical Evidence ◽  
Achievement Motivation ◽  
Task Demand ◽  
Two Factors ◽  
Social Reference ◽  
American Society ◽  
The Individual ◽  
The Impact

The author presents a new taxonomy of six achievement motivation types, with the categories based on an interaction between two factors: (a) whether the individual emphasizes the process of achieving or the impact of the accomplishment itself; and (b) whether the person derives his standards of excellence from within himself, from some social reference, or from an impersonal task demand. The hypothesis is proposed that females in American society have been taught to emphasize the process of their achievement strivings and males the impact of their achievement attempts. Empirical evidence is given to support this hypothesis and to elucidate the six types of achievement motivation.

I. On the solar-diurnal variation of the magnetic declination at Pekin

1860 ◽  
Vol 10 ◽  
pp. 360-374
Keyword(s):  
Diurnal Variation ◽  
First Year ◽  
Magnetic Observatory ◽  
Magnetic Element ◽  
Monthly Means ◽  
The North ◽  
The Hours ◽  
The Mean ◽  
The Times ◽  
North End

When the first year of hourly observations of the declination, January 1 to December 31st, 1841, was received at Woolwich from the Magnetic Observatory at Hobarton, and when means had been taken of the readings of the collimator-scale at the several hours in each month, and these monthly means had been collected into an­nual means, it was found that the mean daily motion of the declina­tion magnet at Hobarton presented, as one of its most conspicuous and well-marked features, a double progression in the twenty-four hours, moving twice from west to east, and twice from east to west; the phases of this diurnal variation were, that the north end of the magnet moved progressively from west to east in the hours of the forenoon, and from east to west in the hours of the afternoon ; and again from west to east during the early hours of the night, return­ing from east to west during the later hours of the night: the two easterly extremes were attained at nearly homonymous hours of the day and night, as were also the two westerly extremes; the ampli­tudes of the arcs traversed during the hours of the day were con­siderably greater than those traversed during the hours of the night. When, in like manner, the first year of hourly observations, July 1st, 1842, to June 30th, 1843, was received from the Toronto Ob­servatory, and the mean diurnal march of the declination magnet was examined, it was found to exhibit phenomena in striking corre­spondence with those at Hobarton. At Toronto also a double pro­gression presented itself, of which the easterly extremes were attained at nearly homonymous hours, as were also the westerly; whilst the hours of extreme elongation were nearly the same (solar) hours at the two stations, but with this distinction, that the hours at which the north end of the magnet reached its extreme easterly elongation at Hobarton were the same, or nearly the same, as those at which it reached its extreme westerly elongation at Toronto, and vice verâ Pursuing, therefore, the ordinary mode of designating the direction of the declination by the north end of the magnet in the southern as well as in the northern hemisphere, the diurnal motion of the magnet may be said to be in opposite directions at Hobarton and Toronto; but if (in correspondence with our mode of speaking in regard to another magnetic element, the Inclination) the south end of the magnet is employed to designate the direction of the motion in the southern hemisphere, and the north end in the northern hemisphere, the apparent contrariety disappears, and the directions, as well as the times of the turning hours, are approximately the same at both stations.

The relation between weather and fruitfulness of the sultana vine

1964 ◽  
Vol 15 (6) ◽  
pp. 920 ◽  
Author(s):  
JG Baldwin
Keyword(s):  
Daily Maximum ◽  
Bud Burst ◽  
Confidence Limits ◽  
Two Factors ◽  
The Hours ◽  
Maximum Temperatures

The percentage of fruitful buds on sultanas is shown to be closely related to the weather over 3 weeks in late November and early December mdash; that is, during the period when the inflorescence primordia are differentiated. The two factors concerned are the hours of bright sunshine and the sum of daily maximum temperatures from 82 to 90°F. An estimate of the start of the period for which these weather elements are effective can be made by summing mean temperatures from bud burst. The study covers 18 years, 1945 to 1962 inclusive. Fruitfulness was lower than expected in the first 9 years, and higher in the second 9 years, possibly because of the use of Bordeaux spray in the first period and its replacement by organic sprays in the second. Fruitfulness can be forecast within practical confidence limits from a regression developed for fruitfulness from 1954 to 1962 inclusive on sunshine and maximum temperatures.

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