The impact of mindfulness-based interventions on doctors’ well-being and performance: A systematic review

The well-being of doctors is at risk, as evidenced by high burnout rates amongst doctors around the world. Alarmingly, burned-out doctors are more likely to exhibit low levels of professionalism and provide suboptimal patient care. Research suggests that burnout and the well-being of doctors can be improved by mindfulness-based interventions (MBIs). Furthermore, MBIs may improve doctors’ performance (eg in empathy). However, there are no published systematic reviews that clarify the effects of MBIs on doctor well-being or performance to inform future research and professional development programmes. We therefore systematically reviewed and narratively synthesised findings on the impacts of MBIs on doctors’ well-being and performance.

We searched PubMed and PsycINFO from inception to 9 May 2018 and independently reviewed studies investigating the effects of MBIs on doctor wellbeing or performance. We systematically extracted data and assessed study quality according to the Medical Education Research Study Quality Instrument (MERSQI), and narratively reported study findings.

We retrieved a total of 934 articles, of which 24 studies met our criteria; these included randomised, (un)controlled or qualitative studies of average quality. Effects varied across MBIs with different training contents or formats: MBIs including essential mindfulness training elements, or employing group-based training, mostly showed positive effects on the well-being or performance of doctors across different educational and hospital settings. Doctors perceived both benefits (enhanced self- and otherunderstanding) and challenges (time limitations and feasibility) associated with MBIs. Findings were subject to the methodological limitations of studies (eg the use of selfselected participants, lack of placebo interventions, use of self-reported outcomes).

This review indicates that doctors can perceive positive impacts of MBIs on their well-being and performance. However, the evidence was subject to methodological limitations and does not yet support the standardisation of MBIs in professional development programmes. Rather, health care organisations could consider including group-based MBIs as voluntary modules for doctors with specific well-being needs or ambitions regarding professional development.

The full article can be downloaded below.  

Physician Burnout, Resilience, and Patient Experience in a Community Practice: Correlations and the Central Role of Activation

Clinician burnout and patient experience are important issues that are often considered separately. New measures of resilience may influence both. We explored relationships among clinician resilience, burnout, and patient experience. Analysis included 490 physicians who completed surveys measuring burnout and resilience (decompression and activation) and had at least 30 patient experience surveys available for analysis. Burnout was measured with 2 items from the Maslach Burnout Inventory (MBI) which were part of the organization’s ongoing measurement of clinician experience. Resilience was measured with 8 items from 2 Press Ganey validated subscales related to clinicians’ ability to decompress from work and their experience of feeling of activation and connection to purpose while at work. Clinicians reporting more frequent symptoms of burnout based on the MBI items reported less ability to decompress (r for individual measures ranged from .183 to .475, P < .01) and less feeling of activation (r for individual measures ranged from .116 to .401, P < .01). Individual elements of decompression and activation were significantly associated with patient experience. In terms of activation, feeling that one’s work makes a difference (r ranged from .121 to .159, P < .05) and believing one’s work to be meaningful (r ranged from .102 to .135, P < .05) were positively associated with patient experience with their care provider. However, elements of decompression such as being able to free one’s mind from work (r ranged from .092 to .119, P < .05) and being able to disconnect from work communications such as e-mails (r ranged from .094 to .130, P < .05) were negatively associated with patient experience with their care providers. Patient and provider experience are intertwined in that clinician resilience is associated with both burnout and patient experience, but individual mechanisms of resilience may be beneficial for the clinician but not for the patient.

The full article can be downloaded below.  

Full noncontact laser ultrasound: first human data

Full noncontact laser ultrasound (LUS) imaging has several distinct advantages over current medical ultrasound (US) technologies: elimination of the coupling mediums (gel/water), operator-independent image quality, improved repeatability, and volumetric imaging. Current light-based ultrasound utilizing tissue-penetrating photoacoustics (PA) generally uses traditional piezoelectric transducers in contact with the imaged tissue or carries an optical fiber detector close to the imaging site. Unlike PA, the LUS design presented here minimizes the optical penetration and specifically restricts optical-to-acoustic energy transduction at the tissue surface, maximizing the generated acoustic source amplitude. With an appropriate optical design and interferometry, any exposed tissue surfaces can become viable acoustic sources and detectors. LUS operates analogously to conventional ultrasound but uses light instead of piezoelectric elements. Here, we present full noncontact LUS results, imaging targets at ~5 cm depths and at a meterscale standoff from the target surface. Experimental results demonstrating volumetric imaging and the first LUS images on humans are presented, all at eye- and skin-safe optical exposure levels. The progression of LUS imaging from tissue-mimicking phantoms, to excised animal tissue, to humans in vivo is shown, with validation from conventional ultrasound images. The LUS system design insights and results presented here inspire further LUS development and are a significant step toward the clinical implementation of LUS.

The full article can be downloaded below.  

Speech Emotion Detection using IoT based Deep Learning for Health Care

Human emotions are essential to recognize the behavior and state of mind of a person. Emotion detection through speech signals has started to receive more attention lately. This paper proposes the method for detecting human emotions using speech signals and its implementation in realtime using the Internet of Things (IoT) based deep learning for the care of older adults in nursing homes. The research has two main contributions. First, we have implemented a real-time system based on audio IoT, where we have recorded human voice and predicted emotions via deep learning. Secondly, for advance classification, we have designed a model using data normalization and data augmentation techniques. Finally, we have created an integrated deep learning model, called Speech Emotion Detection (SED), using a 2D convolutional neural networks (CNN). The best accuracy that was reported by our method was approximately 95%, which outperformed all state-of-the-art approaches. We have further extended to apply the SED model to a live audio sentiment analysis system with IoT technologies for the care of older adults in nursing homes.

The full article can be viewed at this link.  

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

The usability of current EHRs as assessed by US physicians using a standardized metric of technology usability is markedly lower than for most other technologies and falls into the grade category of F. A strong dose-response relationship between EHR usability and risk for burnout among physicians was observed. Given the association between EHR usability and physician burnout, improving EHR usability may be an important approach to help reduce health care professional burnout.

The full article can be downloaded below.  

Electronic Health Records Creating A ‘New Era’ Of Health Care Fraud

Derek Lewis was working as an electronic health records specialist for the nation’s largest hospital chain when he heard about software defects that might even “kill a patient.”

The doctors at Midwest (City) Regional Medical Center in Oklahoma worried that the software failed to track some drug prescriptions or dosages properly, posing a “huge safety concern,” Lewis said. Lewis cited the alleged safety hazards in a whistleblower lawsuit that he and another former employee of Community Health Systems (CHS) filed against the Tennessee-based hospital chain in 2018.

The suit alleges that the company, which had $14 billion in annual revenue in 2018, obtained millions of dollars in federal subsidies fraudulently by covering up dangerous flaws in these systems at the Oklahoma hospital and more than 120 others it owned or operated at the time.

The full Kaiser Health News article can be viewed at this link.  

POLLUTION AND HEALTH METRICS: Global, Regional, and Country Analysis- December 2019

Pollution is an enormous and poorly addressed health problem. In October 2017, The Lancet Commission on pollution and health quantified the human toll of worldwide pollution—9 million premature deaths a year. The data for that analysis was from 2015. This report updates those results with the most recent dataset—2017—and also breaks down the results by country, enabling us to rank the best and worst performers in each region.

The new data shows pollution still to be the largest environmental cause of premature death on the planet, killing 8.3 million people in 2017, or nearly one death in seven. These deaths are caused by exposure to toxic air, water, soil, and chemical pollution globally. The results are still conservative, as many known toxins are not included in the analysis. This report draws its data from the Institute for Health Metric’s (IHME’s) 2017 Global Burden of Disease Study.

The full Global Alliance on Health and Pollution report can be found at this link.  

How Medical AI Can Save Patients From Excessive Exposure To Radiation

AI's potential in medicine has already attracted large amounts of media and public attention. However, some of the specific uses and consequences of AI in the context of health care aren't particularly well known, at least not compared to awareness of the general utility of artificial intelligence.

Some of these uses may be life-saving, and in more ways than one. In recent months, a small number of companies and researchers have begun using AI for the purposes of medical imaging, harnessing machine learning algorithms in order to construct 3D models out of 2D images.

This may seem like a fairly standard employment of AI at first glance, but what's special about this emerging use is that it's focused on avoiding the need for MRI, CT and PET scans. In the case of CT and PET scans, this means that patients aren't subjected to abnormal levels of radiation, which with CT scans at least can result in an increased risk of cancer.

The full Forbes article can be viewed at this link.  

Inside the 2019 Forbes Healthcare Summit

Healthcare is a $3.75 trillion dollar industry that touches every aspect of our lives. It’s also facing a number of challenges, from rising drug prices and the fragmentation of medical records to antibiotic resistance and more.

At the eighth-annual Forbes Healthcare Summit, which took place in New York City December 4-5, the brightest minds in healthcare converged to find solutions to these and other challenges facing the healthcare industry. Here, learn about key takeaways they shared on the future of healthcare for the brain, body and business.

Best Practices 

1. Eradicating the Mental Health Stigma - In an engaging discussion moderated by Dr. Mehmet Oz, media personality Charlamagne tha God, former congressman Patrick Kennedy, and NFL wide receiver Brandon Marshall discussed their own struggles with mental health and the importance of reducing the stigma around it so that people can get the help they need.
2. Replacing Antiquated Regulations with Market-Friendly Policies - Seema Verma is the administrator of Centers for Medicare & Medicaid Services, but she doesn’t think her office has all the answers in healthcare. “Government is not the solution, and government is often the problem,” she said. Her team spends a lot of time unraveling past policies that no longer apply to the way healthcare works today, she said.  Though Verma doesn’t always think government is the solution, she does think it can nudge the system toward more free-market principles—such as an increased emphasis on price transparency for medical treatments and drug prices.
3. Improving Patient Care with Better Data - Forty years after founding Epic, billionaire CEO Judy R. Faulkner shared a rare look inside the clinical database and healthcare software company. Considering the future of electronic health data, she predicts a Cambridge Analytica-esque challenge: the risk that family members’ data will be compromised by a members’ data authorization.
4. Saving Costs by Focusing on Primary Care - Moderator Moira Forbes joked with Sir Andrew Witty, President of UnitedHealth Group and CEO of Optum, about the mystery surrounding his company. “It is one of the biggest healthcare companies that no one knows anything about,” she said. Yet while many people may not know the inner workings of Optum, it touches millions of healthcare consumers across the U.S. What makes the company so profitable? A focus on efficiency without compromising patient care, Witty said.
5. Bring Technological Innovation to Emerging Markets - Partners in Health cofounder and Harvard Medical School professor Paul Farmer reflected on progress he made in 11 resource-poor countries the past 32 years, tackling widespread diseases like AIDS, tuberculosis, ebola and malaria. Asked what new technologies have been most critical in his mission, he emphasized that definitions of “technology” in healthcare should include vaccines, therapies and diagnostics—not just devices and gadgets.
6. Empowering Patients with AI and Telecommunications - How do you help patients make better health choices? Empower them to take control of their health with telemedicine, three digital health companies said. 

The full Forbes article can be viewed at this link.  

On the Digital Health Conundrum (Part II)

This is a continuation of the ideas laid out in Part I of this post. In this part, I’ll talk about how to think about changing healthcare and lay out my framework for the kinds of companies that can disrupt it. 

The full article can be viewed at this link.