Hui Ching Weng

Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction

Medical Education 2011: 45: 835–842

τ Proteins in Serum Predict Outcome After Severe Traumatic Brain Injury

BACKGROUND The identification of reliable outcome predictors after traumatic brain injury (TBI) is crucial. The objective of our study was to investigate the role of tau protein as a serum marker of TBI. METHODS Thirty-four patients with severe TBI (Glasgow Coma Scale [GCS] score at admission <or= 8) were considered. The tau protein level in the blood samples obtained at the time of admission was measured. The outcome was assessed by using the Glasgow Outcome Scale (GOS) at 6 mo post-injury. Demographic, clinical, and laboratory variables were analyzed to study their effect on the outcome. RESULTS tau Protein levels were higher in the poor outcome group (436.2 +/- 473.6 pg/mL) than in the good outcome group (51.6 +/- 81.5 pg/mL) (P < 0.0001). Univariate analyses demonstrated that poor outcome was significantly associated with a poor GCS score (P = 0.001), higher serum tau protein levels (P < 0.001), abnormal pupil light reflex (P = 0.013), and basal cistern compression on computed tomogram (CT) (P = 0.026). Multivariate analyses revealed that a poor GCS score (P = 0.049) and higher serum tau protein levels (P = 0.043) were independent prognostic factors for poor outcome. The receiver-operating characteristic (ROC) curve demonstrated that a tau protein level >or= 114.5 pg/mL yielded 88% sensitivity and 94% specificity for predicting a poor outcome. CONCLUSIONS These results suggest that in addition to GCS; serum tau protein levels may serve as indicators for the prediction of outcome following severe TBI. However; it should be viewed with caution because of the small sample size and wide standard deviations.

Doctors' emotional intelligence and the patient-doctor relationship

Context  Current studies have found limited evidence for an association between doctor emotional intelligence (EI) and the patient−doctor relationship (PDR). This study explored the associations among doctor EI, patient trust and the PDR using multi‐source and multi‐level approaches.

Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction.

BACKGROUND Much of the literature pertinent to management indicates that service providers with high emotional intelligence (EI) receive higher customer satisfaction scores. Previous studies offer limited evidence regarding the impact of physicians EI on patient-physician relationship. PURPOSES Using a multilevel and multisource data approach, the current study aimed to build a model that demonstrated the impact of a physicians EI on the patients trust and the patient-physician relationship. METHODOLOGY The survey sample included 983 outpatients and 39 physicians representing 11 specialties. FINDINGS Results of path analyses demonstrated that the ratio of patients follow-up visits (p < .01) and the nurse-rated EI for physicians (p < .05) had positive effects on the patients trust. The impact of patients trust on patients satisfaction was mediated by the patient-physician relationship at a significant level (p < .01). The patient-physician relationship had a significantly positive effect on patients satisfaction (p < .001). The model accounted for 37% of the variance of patients trust, 67% of the PDR, and 58% of patients satisfaction on physician services. PRACTICE IMPLICATIONS This study suggests that nurses had the sensitivity and intellectual skills in assessing the physicians performance and the patients need. Our findings suggest that patients trust is the cornerstone of the patient-physician relationship; however, mutual trust and professional respect between nurses and physicians play a critical role in reinforcing the patient-physician relationship to effect improvements in the provision of patient-centered care.

Inhibition of extracellular signal-regulated kinases 1/2 provides neuroprotection in spinal cord ischemia/reperfusion injury in rats: Relationship with the nuclear factor-κB-regulated anti-apoptotic mechanisms

J. Neurochem. (2010) 114, 237–246.

The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy.

Study Design. Prospective case series. Objective. The study aimed to investigate the therapeutic efficacy of sacroiliac joint (SIJ) blocks with triamcinolone acetonide in patients with SIJ pain without spondyloarthropathy. Summary of Background Data. Numerous studies have demonstrated that SIJ blocks with corticosteroid/anesthetic provide long-term pain relief in seronegative spondyloarthropathy. However, only one report on SIJ dysfunction patients without spondyloarthropathy shows promising results. Methods. We conducted a prospective observational study of patients at a University Spine Center from March 2005 to May 2006. The above mentioned SIJ blocks were performed in 150 patients, and dual SIJ blocks confirmed SIJ pain in 39 patients (26%). Results. Twenty-six patients (66.7%) experienced significant pain reduction for more than 6 weeks; the overall mean duration of pain reduction in these responders was 36.8 ± 9.9 weeks. SIJ blocks were ineffective in 13 patients (33.3%); the mean duration of pain reduction in these patients was 4.4 ± 1.8 weeks. Univariate analysis revealed that treatment failure was significantly associated with a history of lumbar/lumbosacral fusion (P = 0.03). Conclusion. SIJ blocks with triamcinolone acetonide are beneficial for some patients with SIJ pain without spondyloarthropathy. The SIJ blocks showed a long-lasting efficacy in two-thirds of the patients; however, the duration of its efficacy was shorter in patients with a history of lumbar/lumbosacral fusion. These findings suggest the need for further studies.

Relationship between injury severity and serum tau protein levels in traumatic brain injured rats

BACKGROUND Although serum tau protein levels increase following TBI, the time course is unknown. The aim of the present study was to determine whether serum tau protein levels increased in both a severity-dependent and time-dependent manner in an experimental model of rat traumatic brain injury (TBI). METHODS A total of 24 Sprague-Dawley rats were subjected to varying grades of TBI using a contusion injury model on the right parietal cortex. Enzyme-linked Immunoabsorbent Assay (ELISA) analysis for serum was performed at 15 min pre-injury, 1, 6, 24, 48, and 168 h post-injury. Immunoblotting for serum tau protein, neurological evaluation and histological observation were also performed. RESULTS Tau protein levels rapidly increased after 1 h in both mild and severe TBI groups (p<0.001), and declined after 6 h. In the sham-operated group, tau protein levels did not change significantly after TBI. Tau protein levels were severity-dependent at 1 and 6 h after TBI. The levels were higher in the severe TBI group than in the mild TBI group at 1 h (p<0.001) and 6 h (p<0.001). CONCLUSIONS Serum tau protein levels were severity-dependent and time-dependent at 1 and 6 h after TBI. However, the serum tau protein may not be a useful marker 24 h after TBI.

Modeling the Costs and Outcomes of Cardiovascular Surgery

Coronary artery bypass graft (CABG) operations consume more health care resources than any other single procedure. The objective of this study was to develop a computer simulation model that can be used to predict costs and patient outcomes of CABG surgery. The analysis is based on a systems dynamic model developed using STELLA software. Two sets of data from Medicare patients who underwent CABG operations at Methodist Hospital of Indiana were used to construct and validate the model. The model predictions of length of hospital stay, use of specialists in caring for patients, costs and postoperative functional status are reasonably close to actual data on patients who underwent CABG surgery. The analysis indicates the most important factors affecting costs and outcomes are gender, age, whether or not the surgery is a reoperation and whether the patient experiences postoperative complications. The model can be used to predict costs and outcomes for a patient population from a small set of preoperative characteristics (i.e., age, gender, DRG, whether the surgery is a reoperation, and the patients operative status). A second potential use of the model is to answer clinical questions such as do the costs and risks of CABG operations outweigh the benefits for patients with certain risk factors.

Comparing Clinical Outcomes Following Percutaneous Vertebroplasty with Conservative Therapy for Acute Osteoporotic Vertebral Compression Fractures

OBJECTIVE To compare the efficacy of percutaneous vertebroplasty (PV) with conservative therapy for patients with acute vertebral compression fractures. DESIGN Prospective, nonrandomized, comparison study. BACKGROUND The efficacy of PV has not been well established because there have been few comparative studies with conservatively treated control groups. PATIENTS AND METHODS Fifty-five consecutive patients (8 men and 47 women, age 47-94) with osteoporosis and symptomatic acute vertebral compression fractures were enrolled. thirty-two patients received pv, whereas 23 received conservative therapy. OUTCOME MEASURES Changes in pain intensity, physical functioning, and pain medication requirement were evaluated. RESULTS Both PV and conservative therapy provided pain reduction (P < 0.001), improvements in physical functioning (P < 0.001), and decreased medication (P < 0.001). Reductions in visual analogue pain scores were more significant in the vertebroplasty group at 1 (P < 0.001) and 4 weeks (P < 0.001) but not at 12 months. Improvements in physical functioning were significant at 1 (P < 0.001) and 4 weeks (P < 0.001). Medication requirements were lower in the vertebroplasty group at all three time points. CONCLUSIONS Pain relief, physical functioning improvement, and medication requirement after vertebroplasty are immediately and significantly better when compared with conservative therapy.

Computers in the Consulting Room: A Case Study of Clinician and Patient Perspectives

Few clinicians in the United States use computers during patient encounters and many still worry that computers will depersonalize their interactions with patients. This case study describes patient and clinician reactions to a computer‐based health appraisal system. Findings showed no difference in any aspect of patient satisfaction between computer and non‐computer groups. Use of a computer in the consulting room neither depersonalized nor enhanced patient satisfaction. Clinicians (in this case, nurse practitioners and physician assistants) were willing to use the system, which they perceived as having benefits for patient care, but were concerned about the increased time required for exams, effort required to learn the system while still interacting appropriately with the patient, increased monitoring of their performance, and other organizational issues. Clinicians who used the system showed a higher tolerance for uncertainty and communicated more frequently with each other and with others throughout the department. Implementation was slowed by the need to demonstrate the monetary value of the system.