Face mask use in healthcare settings: effects on communication, cognition, listening effort and strategies for amelioration

Aim To investigate mask use and the difficulties it may pose during communication in healthcare settings. Methods A survey utilizing a series of Likert scales was administered. Mask use challenges between clinicians and their patients were examined in the domains of communication, listening effort, cognition, and rehabilitation. Results Across 243 participants, mask use significantly increased listening effort, with hearing loss having an additive effect on listening effort. Listening effort was also significantly associated with more trouble understanding conversation, decreased interest in conversation, more difficulty connecting with patients, changes in cognition for both providers and patients, and changes in the clinical efficiency of providers. Hearing loss had an additive effect for trouble understanding conversations and changes in clinical efficiency. Conclusion These results provide information about the clinical strain introduced from mask use in healthcare settings. Overall, results show that in healthcare settings there is increased cognitive load and listening effort for both patients and providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss. Results showed that patients reported written and visual instructions would be most beneficial to include in appointments among the other rehabilitative strategies which are discussed.

Foundation of concept of constitutional homeopathic remedy by using electropuncture methods

The work is dedicated to the issue concerning the foundation of the concept of constitutional homeopathic remedy in homeopathy and informational medicine by using the methods of vegetative resonance test and bioresonance therapy (VRT-BRT), using high signal mineral elements. In order to objectivize the mentioned concept, are identified three possible approaches. Are proposed the criteria of selection of the constitutional homeopathic preparation - VRT. Is presented the statistic equivalence, the validity and the clinical efficiency of these criteria.

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

Nearly all patients interact with critical gatekeepers—insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

Reducing clinician inefficiency and restoring meaning in practice: A professional coaching approach for family medicine residents

Burnout is widespread among primary care physicians (PCPs). Several key drivers of burnout in this specialty that have been increasingly recognized are the growing complexity and work demands placed on PCPs by outpatient clinical work environments. These high demands, from the perspective of the physician, detract from other valued tasks which provide meaning in daily work such as relationship-building and fellowship with the medical team. Given these trends, we believe that a viable means to address burnout can be found in utilizing a performance coaching approach to equip resident physicians for the practical and emotional demands of the primary care work environment into which they are entering. Specifically, we recommend a focus on clinical efficiency as an area for coaching development due to its potential impact on resident physician well-being. In this brief review article, we provide a summary of evidence for coaching interventions, along with evidence supporting an expansion to these approaches in clinical efficiency in outpatient settings based on the connection between workflow and engagement in meaningful medical practice. Lastly, we outline a prospective coaching approach which targets common sources of clinic inefficiency for resident practitioners.

Precision bite ramps and aligners: An elective choice for deep bite treatment

Objective: To review a series of clinical studies demonstrating the clinical efficiency of aligners with bite ramps in the treatment of severe deep bite. Materials and Methods: In order to predictably manage the correction of deep bite with aligners, precision bite ramps on maxillary incisors have been used while posterior extrusion and anterior intrusion in the lower jaw with lateral attachments and proper levelling of the curve of Spee have been planned. Transverse correction and controlled upper and lower incisors proclination completed the treatment plan. Results: Full deep bite correction with normal overbite was obtained in nine months of treatment by a combination of anterior intrusion and posterior torque correction, distal tipping and relative extrusion. Conclusion: The use of bite ramps represents a valid option for the successful treatment of deep bite with aligners creating proper space for lateral sector extrusion and supporting lower anterior intrusion and controlled proclination.

More blastocysts are produced from fewer oocytes in ICSI compared to IVF – results from a sibling oocytes study and definition of a new key performance indicator

Background Which fertilization method, between ICSI and IVF in split insemination treatments, has the highest clinical efficiency in producing clinically usable blastocyst? Methods 211 infertile couples underwent split insemination treatments for a non-severe male factor. 1300 metaphase II (MII) oocytes were inseminated by conventional IVF and 1302 MII oocytes were micro-injected with the same partner’s semen. Embryo development until blastocyst stage on day V and clinical outcomes were valuated trough conventional key performance indicators (KPI), and new KPIs such as blastocyst rate per used MII oocytes and the number of MII oocytes to produce one clinically usable blastocyst from ICSI and IVF procedures. Results The results were globally analyzed and according to ovarian stimulation protocol, infertility indication, and female age. The conventional KPI were online with the expected values from consensus references. From global results, 2.3 MII oocyte was needed to produce one clinically usable blastocyst after ICSI compared to 2.9 MII oocytes in IVF. On the same way, more blastocysts for clinical use were produced from fewer MII oocytes in ICSI compared to IVF in all sub-groups. Conclusions In split insemination treatments, the yield of clinically usable blastocysts was always superior in ICSI compared to IVF. The new KPI "number of needed oocytes to produce one clinically usable embryo" tests the clinical efficiency of the IVF laboratory.