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Article ; Online: Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network.

O'Connell, Ryan / Hosain, Fatima / Colucci, Leah / Nath, Bidisha / Melnick, Edward R

Journal of the American Board of Family Medicine : JABFM

2024 Volume 36, Issue 6, Page(s) 1050–1057

Abstract: Background: Physician departure causes considerable disruption for patients, colleagues, and staff. The cost of finding a new physician to replace the loss coupled with lost productivity as they build their practice can cost as much as $1 million per ... ...

Abstract	Background: Physician departure causes considerable disruption for patients, colleagues, and staff. The cost of finding a new physician to replace the loss coupled with lost productivity as they build their practice can cost as much as $1 million per departure. Therefore, we sought to characterize drivers of departure from practice with the goal of informing retention efforts (with a special emphasis on the connection between electronic health record (EHR)-related stress and physician departure). Methods: This qualitative study of semistructured interviews was conducted between October 2021 and April 2022 among 13 attending physicians who had voluntarily departed their position from 2018 to 2021 in a large multispecialty, productivity-based, ambulatory practice network in the Northeast with a 5% annual turnover rate to understand their reasons for departing practice. Results: Among the 13 participants, 8 were women (61.5%), 3 retired (23.1%), and 6 (46.2%) left for new positions. Major domains surrounding the decision to depart included current features of the health care delivery landscape, leadership/local practice culture, and personal considerations. Major factors within these domains included the EHR, compensation model, emphasis on metrics, leadership support, teamwork/staffing, burnout, and work-life integration. Conclusions: Opportunities for medical practices to prevent ambulatory physicians' turnover include: (1) addressing workflow by distributing responsibility across team members to better address patient expectations and documentation requirements, (2) ensuring adequate staffing across disciplines and roles, and (3) considering alternative care or payment models.
MeSH term(s)	Humans ; Female ; Male ; Physicians ; Delivery of Health Care ; Burnout, Professional/prevention & control ; Workforce ; Qualitative Research ; Electronic Health Records
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2023.230052R2
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Article ; Online: Supporting Rural Community Emergency Planning, Response, and Recovery.

Kappel, Rachel / Chavez, Alva / Melnick, Meghan / Siegfried, Alexa L

Journal of public health management and practice : JPHMP

2023 Volume 30, Issue 1, Page(s) 130–132

Abstract: When rural communities are faced with an emergency or disaster, their capacity to support the response is often exceeded. The NORC Walsh Center for Rural Health Analysis and the Rural Health Information Hub (RHIhub) developed the Rural Emergency ... ...

Abstract	When rural communities are faced with an emergency or disaster, their capacity to support the response is often exceeded. The NORC Walsh Center for Rural Health Analysis and the Rural Health Information Hub (RHIhub) developed the Rural Emergency Preparedness and Response Toolkit (the Toolkit) to support rural communities with disaster planning, response, and recovery. The Toolkit provides information drawn from literature, subject matter experts, and case studies and shares key considerations for emergency preparedness. This article highlights the development of and key insights from the Toolkit, including preparedness frameworks, population considerations, plan and assessment examples, and funding support. Investing in emergency preparedness is vital for rural communities and this Toolkit offers strategies and best practices for each phase of a disaster.
MeSH term(s)	Humans ; Rural Population ; Disaster Planning ; Rural Health
Language	English
Publishing date	2023-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2027860-3
ISSN	1550-5022 ; 1078-4659
ISSN (online)	1550-5022
ISSN	1078-4659
DOI	10.1097/PHH.0000000000001823
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Article ; Online: Humans as an Essential Source of Safety: A Frameshift for System Resilience.

Farley, Heather L / Harry, Elizabeth M / Sinsky, Christine A / Boehm, Elizabeth W / Privitera, Michael R / Melnick, Edward R

Mayo Clinic proceedings. Innovations, quality & outcomes

2023 Volume 7, Issue 4, Page(s) 241–243

Language	English
Publishing date	2023-06-02
Publishing country	Netherlands
Document type	Journal Article
ISSN	2542-4548
ISSN (online)	2542-4548
DOI	10.1016/j.mayocpiqo.2023.05.001
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Article ; Online: Emergency physicians' EHR use across hospitals: A cross-sectional analysis.

Iscoe, Mark S / Holland, Margaret L / Paek, Hyung / Flood, Colin / Melnick, Edward R

The American journal of emergency medicine

2022 Volume 61, Page(s) 205–207

MeSH term(s)	Humans ; Cross-Sectional Studies ; Hospitals ; Electronic Health Records ; Physicians
Language	English
Publishing date	2022-07-09
Publishing country	United States
Document type	Letter
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2022.07.014
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Zs.A 2005: Show issues

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Article ; Online: Limited restoration of contrast sensitivity with training after V1 damage in humans.

Yang 杨菁艺, Jingyi / Saionz, Elizabeth L / Cavanaugh, Matthew R / Fahrenthold, Berkeley K / Melnick, Michael D / Tadin, Duje / Briggs, Farran / Carrasco, Marisa / Huxlin, Krystel R

eNeuro

2024

Abstract: Stroke damage to the primary visual cortex (V1) causes severe visual deficits, which benefit from perceptual retraining. However, whereas training with high-contrast stimuli can locally restore orientation and motion direction discrimination abilities at ...

Abstract	Stroke damage to the primary visual cortex (V1) causes severe visual deficits, which benefit from perceptual retraining. However, whereas training with high-contrast stimuli can locally restore orientation and motion direction discrimination abilities at trained locations, it only partially restores luminance contrast sensitivity (CS). Recent work revealed that high-contrast discrimination abilities may be preserved in the blind field of some patients early after stroke. Here, we asked if CS for orientation and direction discrimination is similarly preserved inside the blind field, to what extent, and whether it could benefit from a visual training intervention. Thirteen subacute patients (<3 months post-V1-stroke) and 12 chronic patients (>6 months post-V1-stroke) were pre-tested, then trained to discriminate either orientation or motion direction of Gabor patches of progressively lower contrasts as their performance improved. At baseline, more subacute than chronic participants could correctly discriminate the orientation of high-contrast Gabors in their blind field, but all failed to perform this task at lower contrasts, even when 10Hz flicker or motion direction were added. Training improved CS in a greater portion of subacute than chronic participants, but no-one attained normal CS, even when stimuli contained flicker or motion. We conclude that, unlike the near-complete training-induced restoration of high-contrast orientation and motion direction discrimination abilities, V1 damage in adulthood may severely limit the residual visual system's ability to regain normal CS. Our results support the notion that CS involves different neural substrates and computations than those required for orientation and direction discrimination in V1-damaged visual systems.
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2800598-3
ISSN	2373-2822 ; 2373-2822
ISSN (online)	2373-2822
ISSN	2373-2822
DOI	10.1523/ENEURO.0020-24.2024
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Article ; Online: Functional preservation and enhanced capacity for visual restoration in subacute occipital stroke.

Saionz, Elizabeth L / Tadin, Duje / Melnick, Michael D / Huxlin, Krystel R

Brain : a journal of neurology

2020 Volume 143, Issue 6, Page(s) 1857–1872

Abstract: Stroke damage to the primary visual cortex (V1) causes a loss of vision known as hemianopia or cortically-induced blindness. While perimetric visual field improvements can occur spontaneously in the first few months post-stroke, by 6 months post-stroke, ... ...

Abstract	Stroke damage to the primary visual cortex (V1) causes a loss of vision known as hemianopia or cortically-induced blindness. While perimetric visual field improvements can occur spontaneously in the first few months post-stroke, by 6 months post-stroke, the deficit is considered chronic and permanent. Despite evidence from sensorimotor stroke showing that early injury responses heighten neuroplastic potential, to date, visual rehabilitation research has focused on patients with chronic cortically-induced blindness. Consequently, little is known about the functional properties of the post-stroke visual system in the subacute period, nor do we know if these properties can be harnessed to enhance visual recovery. Here, for the first time, we show that 'conscious' visual discrimination abilities are often preserved inside subacute, perimetrically-defined blind fields, but they disappear by ∼6 months post-stroke. Complementing this discovery, we now show that training initiated subacutely can recover global motion discrimination and integration, as well as luminance detection perimetry, just as it does in chronic cortically-induced blindness. However, subacute recovery was attained six times faster; it also generalized to deeper, untrained regions of the blind field, and to other (untrained) aspects of motion perception, preventing their degradation upon reaching the chronic period. In contrast, untrained subacutes exhibited spontaneous improvements in luminance detection perimetry, but spontaneous recovery of motion discriminations was never observed. Thus, in cortically-induced blindness, the early post-stroke period appears characterized by gradual-rather than sudden-loss of visual processing. Subacute training stops this degradation, and is far more efficient at eliciting recovery than identical training in the chronic period. Finally, spontaneous visual improvements in subacutes were restricted to luminance detection; discrimination abilities only recovered following deliberate training. Our findings suggest that after V1 damage, rather than waiting for vision to stabilize, early training interventions may be key to maximize the system's potential for recovery.
MeSH term(s)	Adult ; Aged ; Blindness, Cortical/etiology ; Blindness, Cortical/physiopathology ; Blindness, Cortical/rehabilitation ; Female ; Functional Laterality/physiology ; Humans ; Learning/physiology ; Male ; Middle Aged ; Motion Perception/physiology ; Neuronal Plasticity/physiology ; Occipital Lobe/pathology ; Stroke/complications ; Stroke Rehabilitation/methods ; Vision, Ocular/physiology ; Visual Cortex/physiopathology ; Visual Fields/physiology ; Visual Perception/physiology
Language	English
Publishing date	2020-05-19
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80072-7
ISSN	1460-2156 ; 0006-8950
ISSN (online)	1460-2156
ISSN	0006-8950
DOI	10.1093/brain/awaa128
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Article ; Online: Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine.

Li, Huan / Rotenstein, Lisa / Jeffery, Molly M / Paek, Hyung / Nath, Bidisha / Williams, Brian L / McLean, Robert M / Goldstein, Richard / Nuckols, Teryl K / Hoq, Lalima / Melnick, Edward R

Journal of general internal medicine

2023 Volume 39, Issue 4, Page(s) 557–565

Abstract: Background: The gender gap in physician compensation has persisted for decades. Little is known about how differences in use of the electronic health record (EHR) may contribute.: Objective: To characterize how time on clinical activities, time on ... ...

Abstract	Background: The gender gap in physician compensation has persisted for decades. Little is known about how differences in use of the electronic health record (EHR) may contribute. Objective: To characterize how time on clinical activities, time on the EHR, and clinical productivity vary by physician gender and to identify factors associated with physician productivity. Design, setting, and participants: This longitudinal study included general internal medicine physicians employed by a large ambulatory practice network in the Northeastern United States from August 2018 to June 2021. Main measures: Monthly data on physician work relative value units (wRVUs), physician and practice characteristics, metrics of EHR use and note content, and temporal trend variables. Key results: The analysis included 3227 physician-months of data for 108 physicians (44% women). Compared with men physicians, women physicians generated 23.8% fewer wRVUs per month, completed 22.1% fewer visits per month, spent 4.0 more minutes/visit and 8.72 more minutes on the EHR per hour worked (all p < 0.001), and typed or dictated 36.4% more note characters per note (p = 0.006). With multivariable adjustment for physician age, practice characteristics, EHR use, and temporal trends, physician gender was no longer associated with productivity (men 4.20 vs. women 3.88 wRVUs/hour, p = 0.31). Typing/dictating fewer characters per note, relying on greater teamwork to manage orders, and spending less time on documentation were associated with higher wRVUs/hour. The 2021 E/M code change was associated with higher wRVUs/hour for all physicians: 10% higher for men physicians and 18% higher for women physicians (p < 0.001 and p = 0.009, respectively). Conclusions: Increased team support, briefer documentation, and the 2021 E/M code change were associated with higher physician productivity. The E/M code change may have preferentially benefited women physicians by incentivizing time-intensive activities such as medical decision-making, preventive care discussion, and patient counseling that women physicians have historically spent more time performing.
MeSH term(s)	Male ; Humans ; Female ; Electronic Health Records ; Longitudinal Studies ; Internal Medicine ; Efficiency, Organizational ; General Practitioners
Language	English
Publishing date	2023-10-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-023-08428-5
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Article ; Online: Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol.

Wong, Ambrose H / Nath, Bidisha / Shah, Dhruvil / Kumar, Anusha / Brinker, Morgan / Faustino, Isaac V / Boyce, Michael / Dziura, James D / Heckmann, Rebekah / Yonkers, Kimberly A / Bernstein, Steven L / Adapa, Karthik / Taylor, Richard Andrew / Ovchinnikova, Polina / McCall, Terika / Melnick, Edward R

BMJ open

2024 Volume 14, Issue 2, Page(s) e082834

Abstract: Introduction: The burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre- ... ...

Abstract	Introduction: The burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre-emptive intervention using de-escalation techniques to prevent agitation. Time pressure, fluctuating work demands, and other systems-related factors pose challenges to efficient decision-making and adoption of best practice recommendations during an unfolding behavioural crisis. As such, we propose to design, develop and evaluate a computerised clinical decision support (CDS) system, Early Detection and Treatment to Reduce Events with Agitation Tool (ED-TREAT). We aim to identify patients at risk of agitation and guide ED clinicians through appropriate risk assessment and timely interventions to prevent agitation with a goal of minimising restraint use and improving patient experience and outcomes. Methods and analysis: This study describes the formative evaluation of the health record embedded CDS tool. Under aim 1, the study will collect qualitative data to design and develop ED-TREAT using a contextual design approach and an iterative user-centred design process. Participants will include potential CDS users, that is, ED physicians, nurses, technicians, as well as patients with lived experience of restraint use for behavioural crisis management during an ED visit. We will use purposive sampling to ensure the full spectrum of perspectives until we reach thematic saturation. Next, under aim 2, the study will conduct a pilot, randomised controlled trial of ED-TREAT at two adult ED sites in a regional health system in the Northeast USA to evaluate the feasibility, fidelity and bedside acceptability of ED-TREAT. We aim to recruit a total of at least 26 eligible subjects under the pilot trial. Ethics and dissemination: Ethical approval by the Yale University Human Investigation Committee was obtained in 2021 (HIC# 2000030893 and 2000030906). All participants will provide informed verbal consent prior to being enrolled in the study. Results will be disseminated through publications in open-access, peer-reviewed journals, via scientific presentations or through direct email notifications. Trial registration number: NCT04959279; Pre-results.
MeSH term(s)	Adult ; Humans ; Decision Support Systems, Clinical ; Research Design ; Informed Consent ; Emergency Service, Hospital ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2024-02-19
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-082834
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Article ; Online: Author Correction: A purine scaffold Hsp90 inhibitor destabilizes BCL-6 and has specific antitumor activity in BCL-6-dependent B cell lymphomas.

Cerchietti, Leandro C / Lopes, Eloisi C / Yang, Shao Ning / Hatzi, Katerina / Bunting, Karen L / Tsikitas, Lucas A / Mallik, Alka / Robles, Ana I / Walling, Jennifer / Varticovski, Lyuba / Shaknovich, Rita / Bhalla, Kapil N / Chiosis, Gabriela / Melnick, Ari

Nature medicine

2024

Language	English
Publishing date	2024-04-03
Publishing country	United States
Document type	Published Erratum
ZDB-ID	1220066-9
ISSN	1546-170X ; 1078-8956
ISSN (online)	1546-170X
ISSN	1078-8956
DOI	10.1038/s41591-024-02957-0
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Zs.A 4212: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Lichenoid vulvar disease: A review.

Fruchter, R / Melnick, L / Pomeranz, M K

International journal of women's dermatology

2017 Volume 3, Issue 1, Page(s) 58–64

Abstract: Vulvar dermatoses are common, potentially debilitating conditions that can be seen by a variety of medical specialists. Lichenoid vulvar diseases, namely lichen sclerosus (LS), lichen planus (LP), and lichen simplex chronicus (LSC), can all negatively ... ...

Abstract	Vulvar dermatoses are common, potentially debilitating conditions that can be seen by a variety of medical specialists. Lichenoid vulvar diseases, namely lichen sclerosus (LS), lichen planus (LP), and lichen simplex chronicus (LSC), can all negatively impact patients' quality of life and LS and LP also have an association with squamous cell carcinoma. It is essential that dermatologists are familiar with the unique features of each of these conditions to ensure the appropriate management and follow up. Herein, we provide an update on the epidemiology, clinical presentation, histopathology, and treatment of patients with vulvar LS, LP, and LSC.
Language	English
Publishing date	2017-03-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2832233-2
ISSN	2352-6475
ISSN	2352-6475
DOI	10.1016/j.ijwd.2017.02.017
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