health department

From the NEJM: More than half of U.S. physicians report significant symptoms of burnout — a rate more than twice that among professionals in other fields. Medical students and residents have higher rates of burnout and depression than their peers who are pursuing nonmedical careers. Physicians with symptoms of burnout are twice as likely to leave an organization as those without such symptoms "The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care". What to do? Here are some examples (more reading available at the reference links below): - To prevent burnout, Mayo Clinic has leadership-effectiveness scores for every division head and department chair. - University of Colorado health uses medical assistants to set the agenda for patient visits and write the notes (almost 3 assistants per physician) References: http://bit.ly/2rFjlxx http://bit.ly/2DFQ0sz Comments: Amazing when you offload physician administrative task

In a recent study, playing computer games, using social media, texting and video chatting were all associated with less happiness. “The advent of the smartphone is the most plausible explanation for the sudden decrease in teens’ psychological well-being.” The happiest teenagers were those who used digital media a little less than an hour a day. The key to digital media use and happiness is limited use. Here is the 2-step solution: 1. Aim to spend no more than one hour a day on digital media 2. Increase the amount of time you spend seeing friends face-to-face and exercising – two activities reliably linked to greater happiness Prof Jean Twenge has made a whole career of this topic (http://www.psychology.sdsu.edu/people/jean-twenge). Here is a recent interview: Are smartphones making a generation unhappy? References: Teenage screen addicts lose out on happiness, study shows http://bit.ly/2rt9TNR

From the NEJM: What if health care were designed so that in-person visits were the second, third, or even last option for meeting routine patient needs, rather than the first? At Kaiser Permanente, 52% of 100 million patient encounters each year are now “virtual visits”. It spends 25% of its annual $3.8 billion budget on information technology. "Payment models are an obvious barrier to deemphasizing in-person visits, but every provider’s business success depends on market share. The best way to win market share is to design and deliver better care, then modify the payment system to support it. Moreover, payment systems are already evolving to support nonvisit care. For example, use of bundled payment programs and accountable care organizations — which reward nontraditional care delivery models that reduce spending and meet patients’ needs — is growing." Patients are increasingly asking, “Isn’t there a way to do this without my having to drive to your office?” References: In-P

Several studies have shown that problematic smartphone use (PSU) is related to detrimental outcomes, such as: - worse psychological well-being - higher cognitive distraction - poorer academic outcomes Problematic smartphone use (PSU) is strongly related to social media use. The study participants were 415 Estonian university students aged 19-46 years (79% females). Problematic smartphone use (PSU) and the frequency of social media use in lectures were negatively correlated with a deep approach to learning (defined as learning for understanding) and positively correlated with a surface approach to learning (defined as superficial learning). Mediation analysis showed that social media use in lectures completely mediates the relationship between PSU and approaches to learning. These results indicate that the frequency of social media use in lectures might explain the relationships between poorer academic outcomes and PSU. References: Problematic Smartphone Use, Deep and Surface Approaches

How common are dye eyes? The prevalence of dry eyes has been estimated to be 5-30% percent in persons aged 50 years and older, 7% of US adult population has been diagnosed with dry eye disease. The prevalence increases with age (2.7% in those 18 to 34 years old vs. 19% in those aged 75 years and older). Prevalence is higher in women than men (9% versus 4%). What are the risk factors for dry eye disease? - Advanced age - Female gender - Hormonal changes (primarily due to decreased androgens) - Systemic diseases (eg, diabetes mellitus, Parkinson disease) - Contact lens wear - Systemic medications (antihistamines, anticholinergics, estrogens, isotretinoin, selective serotonin receptor antagonists, amiodarone, nicotinic acid) - Ocular medications (especially those containing preservatives) - Nutritional deficiencies (eg, vitamin A deficiency) - Decreased corneal sensation, for example, after Laser-assisted in situ keratomileusis (LASIK) - Ophthalmic surgery (especially corneal refractive s

Hemophilia B Gene Therapy with a High-Specific-Activity Factor IX Variant: the researchers infused a single-stranded adeno-associated viral (AAV) vector consisting of a bioengineered capsid, liver-specific promoter and factor IX Padua (factor IX–R338L) transgene in 10 men with hemophilia B who had factor IX coagulant activity of 2% or less of the normal value. They found sustained therapeutic expression of factor IX coagulant activity after gene transfer in the 10 participants with hemophilia who received the same vector dose. Transgene-derived factor IX coagulant activity enabled the termination of baseline prophylaxis and the near elimination of bleeding and factor use. More info here: http://www.nejm.org/doi/full/10.1056/NEJMoa1708538