EHR Algorithms Overwhelm Physician Inboxes and Contribute to Burnout

MedicalResearch.com Interview with:

Ming Tai-Seale, PhD, MPH Professor Department of Family Medicine and Public Health University of California San Diego School of Medicine 

Dr. Tai-Seale

Ming Tai-Seale, PhD, MPH
Professor
Department of Family Medicine and Public Health
University of California San Diego School of Medicine 

MedicalResearch.com: What is the background for this study?

Response: The electronic health record (EHR) potentially creates a 24/7 work environment for physicians. Its impact on physicians’ wellness has become a challenge for most health care delivery organizations. Understanding the relationships between physicians’ well-being and “desktop medicine”1 work in the EHR and work environment is critical if burnout is to be addressed more effectively.

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Even With Reduced Permits, Hiking Yosemite’s Half Dome Just as Dangerous

MedicalResearch.com Interview with:

Yosemite National Parks Half Dome

Yosemite National Parks Half Dome
nps.gov

Susanne J Spano MD, FACEP, FAWM
Associate Professor of Clinical Emergency Medicine
Director, Wilderness Medicine Fellowship
UCSF Fresno
Medical Director
Department of Continuing Medical Education, Community Medical Centers
Fresno, CA

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Yosemite National Park’s Half Dome is a popular day hike and climbing area, and to improve safety, a lottery to issue permits to visitors to hike up the dome was started in 2010.

While the permits lowered the number of hikers in the area by 66 percent, it made hiking the region no less dangerous.  

MedicalResearch.com: What should readers take away from your report?

Response: Trailhead quotas are often used in national parks to limit the number of visitors and provide opportunities for solitude, but it’s less common for permit policies to be created in order to protect the health of hikers and backpackers. If people are getting hurt, it’s important to figure out why. Limiting day-hiking access to only a few hundred people may not be the best strategy for the public, or the park, unless preventing resource degradation is the key objective of a permit intervention.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Yosemite, like several other national parks, has recently experienced rising numbers of tourists and increasing popularity. If people are getting hurt, it’s important to figure out why, but the optimal experimental design to get at this question is not currently evident. Expanding the data set to a larger scope than the summit of Half Dome, especially very popular hiking areas in the same park, might identify “low risk” trails. Appreciative inquiry of low risk areas might provide more useful information than drilling down on features of “higher risk” areas.

Citation:

Impact of a Half Dome Cable Permitting Process on Search and Rescue Activity, Hiker Mortality Rates, and Operational Costs Above Little Yosemite Valley
Susanne JSpanoMD1John ASeymerBS2Desiree HCraneDO1Paul SAuerbachMD, MS3

Wilderness & Environmental Medicine
Volume 30, Issue 2, June 2019, Pages 113-120

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Can Mindfulness-Based Training Reduce Stress and Burnout in Surgeons?

MedicalResearch.com Interview with:

Carter Lebares, MDAssistant Professor of SurgeryDirector, Center for Mindfulness in SurgeryDepartment of Surgery, UCSF

Dr. Lebares

Carter Lebares, MD
Assistant Professor of Surgery
Director, Center for Mindfulness in Surgery
Department of Surgery, UCSF 

MedicalResearch.com: What is the background for this study?

 Response: This study was inspired by extensive evidence of the effectiveness of mindfulness-based interventions (MBIs) for mitigating stress and enhancing performance in other high-stress populations like police and the military.  We know that overwhelming stress is related to burnout and to cognitive errors – two critical issues within surgery, today. This prompted us to tailor and streamline an MBI specifically for surgeons, and to test it in our trainees.

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Caring for Sick Family Members Exacerbates Burnout in Female Physicians

MedicalResearch.com Interview with:

Christina Mangurian, MD MAS Professor Department of Psychiatry, Weill Institute for Neurosciences Center for Vulnerable Populations, University of California, San Francisco

Dr. Mangurian

Christina Mangurian, MD MAS
Professor
Department of Psychiatry, Weill Institute for Neurosciences
Center for Vulnerable Populations,
University of California, San Francisco

Veronica Yank, MD Division of General Internal Medicine Department of Medicine University of California, San Francisco

Dr. Yank


Veronica Yank, MD
Assistant Professor
Division of General Internal Medicine
Department of Medicine
University of California
San Francisco

MedicalResearch.com: What is the background for this study?

Response: This article is about the behavioral health and burnout consequences among physician mothers who are caring for seriously ill loved ones. Our work was inspired, in part, by some of the authors’ own experiences caring for loved ones with serious illnesses while also being physician mothers themselves.  We sought to determine the proportion of physician mothers with such caregiving responsibilities beyond their patients and children and the how these additional responsibilities affected the women’s health and practice.

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Biomarkers Suggest Intensive Blood Pressure Treatment Does Not Cause True Kidney Damage in CKD Patients

MedicalResearch.com Interview with:

Michael G. Shlipak, MD, MPH Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu/) Professor of Medicine, Epidemiology & Biostatistics University of California, San Francisco Associate Chief of Medicine for Research Development San Francisco VA Medical Center

Dr. Shlipak

Michael G. Shlipak, MD, MPH
Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu)
Professor of Medicine, Epidemiology & Biostatistics
University of California, San Francisco
Associate Chief of Medicine for Research Development
San Francisco VA Medical Center

MedicalResearch.com: What is the background for this study?

  • Our study represents major advancements in our understanding of whether kidney tissue damage accompanies the diagnosis of chronic kidney disease during hypertension therapy.
  • The Systolic Blood Pressure Intervention Trial (SPRINT) was a landmark clinical trial that demonstrated that more intensive systolic blood pressure management (target <120 mmHg) reduced rates of major cardiovascular events and mortality compared with standard therapy (<140 mmHg). A recent announcement indicated that the lower systolic blood pressure target also slowed the rate of cognitive decline and dementia incidence.
  • The major concern with intensive blood pressure lowering in SPRINT is the 3-fold incidence of chronic kidney disease, as defined using the clinical standard of serum creatinine levels. This detrimental impact on the kidney was surprising because hypertension is a predominant risk factor for kidney disease, and hypertension therapy should reduce CKD risk.
  • Given the lower blood pressure targets in the recently-updated national hypertension guidelines, there has been substantial concern that guideline implementation of blood pressure targets could cause an epidemic of CKD and the attendant suffering from its downstream consequences of cardiovascular disease, heart failure, and kidney failure.
  • In our study, we compared SPRINT participants who developed CKD with matched controls, using a panel of validated urinary biomarkers of kidney damage. These urine tests can measure actual kidney damage, rather than relying on the creatinine which is an indirect reflection of the kidney’s filtering function.
  • In the group undergoing intensive blood pressure lowering in SPRINT, we found that the new cases of CKD had an overall lowering of the kidney damage biomarkers compared with the controls, contrary to what would have been expected if they were developing “real” CKD.
  • In contrast, the new CKD cases that developed in the standard treatment group did have overall elevations in the urinary biomarkers of kidney damage; 5 of the 9 biomarkers significantly increased relative to the CKD cases in the intensive treatment group. 

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