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1. The association between use of ambient voice technology documentation during primary care patient encounters, documentation burden, and provider burnout.

Author

Owens, Lance M, Wilda, Joshua J, Hahn, Peter Y, Koehler, Tracy, and Fletcher, Jeffrey J

Subjects
DOCUMENTATION, NATURAL language processing, PSYCHOLOGICAL burnout, PRIMARY care, PATIENT care, ELECTRONIC health records
Abstract

Background The burden of documentation in the electronic medical record has been cited as a major factor in provider burnout. The aim of this study was to evaluate the association between ambient voice technology, coupled with natural language processing and artificial intelligence (DAX™), on primary care provider documentation burden and burnout. Methods An observational study of 110 primary care providers within a community teaching health system. The primary objectives were to determine the association between DAX™ usage and provider burnout scores on the Oldenburg Burnout Inventory (OLBI) as well as the effect on documentation time per patient encounter (minutes). Results The completion rate for the survey was 75% (83/110) and high DAX™ use (>60% of encounters) was seen in 28% of providers (23/83). High DAX™ use was associated with significantly less burnout on the OLBI disengagement sub-score (MD [Mean Difference] −2.1; 95% confidence interval [CI] −3.8 to −0.4) but not the OLBI disengagement sub-score (−1.0; 95% CI −2.9 to 1.0) or total score (MD −3.0; 95% CI −6.4 to 0.3). Nineteen providers with high implementation of DAX™ had pre and postimplementation data on documentation time per encounter. After DAX™ implementation average documentation time in notes per encounter was significantly reduced by 28.8% (1.8 min; 95% CI 1.4–2.2). Conclusions The use of ambient voice technology during patient encounters was associated with significantly reduced documentation burden and primary care provider disengagement but not total provider burnout scores. [ABSTRACT FROM AUTHOR]

Published
2024
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7. sj-pdf-1-imr-10.1177_03000605221135446 - Research Data for Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome

Author

Fletcher, Jeffrey J, Aughenbaugh, Arielle, Svabek, Catherine, Hahn, Peter Y, and Grifka, Ronald G

Subjects
111199 Nutrition and Dietetics not elsewhere classified, Cardiology, 170199 Psychology not elsewhere classified, 111799 Public Health and Health Services not elsewhere classified, 110604 Sports Medicine, FOS: Health sciences, 110306 Endocrinology, 110308 Geriatrics and Gerontology, 111099 Nursing not elsewhere classified, 111708 Health and Community Services, 160807 Sociological Methodology and Research Methods, 111702 Aged Health Care, 111403 Paediatrics, 110904 Neurology and Neuromuscular Diseases, 110203 Respiratory Diseases, 110315 Otorhinolaryngology, FOS: Clinical medicine, 110319 Psychiatry (incl. Psychotherapy), FOS: Sociology, FOS: Psychology, 110599 Dentistry not elsewhere classified, 110323 Surgery, 110305 Emergency Medicine, 111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified, 111299 Oncology and Carcinogenesis not elsewhere classified, 110314 Orthopaedics
Abstract

Research Data, sj-pdf-1-imr-10.1177_03000605221135446 for Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome by Jeffrey J Fletcher, Arielle Aughenbaugh, Catherine Svabek, Peter Y Hahn and Ronald G Grifka in Journal of International Medical Research

Published
2022
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10. Use of exhaled nitric oxide in predicting response to inhaled corticosteroids for chronic cough

Author

Hahn, Peter Y., Morgenthaler, Timothy I., and Lim, Kaiser G.

Subjects
Corticosteroids -- Dosage and administration, Corticosteroids -- Physiological aspects, Cough -- Drug therapy, Nitric oxide -- Health aspects, Nitric oxide -- Usage
Abstract

OBJECTIVE: To evaluate our experience with patients who presented with chronic cough and how exhaled nitric oxide predicted response to inhaled corticosteroid (ICS) therapy. PATIENTS AND METHODS: This retrospective observational [...]

Published
2007

12. Health care reform--12 steps to recovery

Author

Pai, Rakesh K., Kennedy, Michael P., and Hahn, Peter Y.

Subjects
Medical care, Cost of -- Laws, regulations and rules, Health care reform -- Methods -- Interpretation and construction, Health care industry -- Laws, regulations and rules, Prospective payment systems (Medical care) -- Laws, regulations and rules, Health care industry, Government regulation, Business
Abstract

In this article ... The authors share their ideas on the next steps they believe need to be taken to reform health care. THERE IS LITTLE DOUBT THAT IF WE [...]

Published
2016

15. CONTRIBUTORS

Author

Ahooja, Vineeta, primary, Ajay, Vamadevan S., additional, Amar, Laurence, additional, Appel, Lawrence J., additional, Azizi, Michel, additional, Bakris, George L., additional, Bazzano, Lydia A., additional, Beevers, D. Gareth, additional, Beilin, Lawrence J., additional, Blann, Andrew D., additional, Boegehold, Matthew A., additional, Booz, George W., additional, Braam, Branko, additional, Brandon, Elizabeth L., additional, Brands, Michael W., additional, Britton, Mark, additional, Brunner, Hans R., additional, Burke, Beverley, additional, Burke, Valerie, additional, Cappuccio, Francesco P., additional, Carey, Robert M., additional, Carter, Barry L., additional, Caulfield, Mark J., additional, Chen, Yuqing, additional, Cohn, Jay N., additional, Connell, John M.C., additional, Cox, Anthony, additional, Das, Madhusudan, additional, Davy, Kevin P., additional, Dennison, Cheryl R., additional, Sarkissian, Shant Der, additional, Díez, Javier, additional, Doris, Peter A., additional, Drummond, Heather A., additional, Duprez, Daniel A., additional, Elijovich, Fernando, additional, Elliott, Henry L., additional, Elliott, William J., additional, Eveson, David J., additional, Fink, Gregory D., additional, Fiotti, Nicola, additional, Flack, John M., additional, Flynn, Joseph T., additional, Foëx, Pierre, additional, Fortepiani, Lourdes A., additional, Fotherby, Martin D., additional, Fouad-Tarazi, Fetnat, additional, Franklin, Stanley S., additional, Friese, Ryan, additional, Funder, John W., additional, Galligan, James J., additional, Garvin, Jeffrey L., additional, Gentile, Christopher L., additional, George, Jacob, additional, Ghiadoni, Lorenzo, additional, Giansante, Carlo, additional, Gilbert, Richard E., additional, Gomez, Sabas I., additional, Gradman, Alan H., additional, Granger, Joey P., additional, Grassi, Guido, additional, Greenland, Philip, additional, Grossman, Ehud, additional, Gungadoo, Johannie, additional, Haas, John A., additional, Hahn, Peter Y., additional, Hall, John E., additional, Hamilton, Bruce A., additional, Haywood, Joseph R., additional, He, Jiang, additional, Herrera, Marcela, additional, Hill, Martha N., additional, Iliescu, Radu, additional, Isles, Chris, additional, Izzo, Joseph L., additional, Jaumdally, Rumi, additional, Jones, Daniel W., additional, Kearney, Patricia M., additional, Koomans, Hein A., additional, Krasuski, Richard A., additional, Krum, Henry, additional, Laffer, Cheryl L., additional, Lang, Chim C., additional, Langford, Nigel J., additional, Lawlor, Debbie A., additional, Lee, Dexter L., additional, Lévy, Bernard I., additional, Link, Daniel, additional, Lip, Gregory Y.H., additional, Lipkin, Graham W., additional, Lloyd-Jones, Donald M., additional, Lohmeier, Thomas E., additional, Loughrey, Brona V., additional, MacDonald, Thomas M., additional, MacFadyen, Robert J., additional, Mahata, Sushil K., additional, Mancia, Giuseppe, additional, Marçano, Ana Carolina B., additional, Martin, Jennifer, additional, McGiff, John C., additional, McInnes, Gordon T., additional, Messerli, Franz H., additional, Miller, Steven M., additional, Mitchell, Paul, additional, Moore, Jason, additional, Mori, Trevor A., additional, Moser, Marvin, additional, Mugo, Maryann N., additional, Munroe, Patricia B., additional, Naik, Nitish, additional, Nasser, Samar A., additional, Newhouse, Stephen J., additional, Ng, Leong L., additional, Northcott, Carrie A., additional, O'Connor, Shannon M., additional, O'Connor, Daniel T., additional, Oparil, Suzanne, additional, Ortiz, Pablo A., additional, Panjrath, Gurusher S., additional, Parthasarathy, Hari Krishnan, additional, Perry, Ivan J., additional, Pickering, Thomas G., additional, Plouin, Pierre-François, additional, Prabhakaran, Dorairaj, additional, Puddey, Ian B., additional, Quilley, John, additional, Raizada, Mohan K., additional, Rao, Fangwen, additional, Reckelhoff, Jane F., additional, Reddy, Kolli Srinath, additional, Rizzoni, Damiano, additional, Robertson, J. Ian S., additional, Robinson, Thompson G., additional, Romero, J. Carlos, additional, Rosei, Enrico Agabiti, additional, Rosenthal, Talma, additional, Rosskopf, Dieter, additional, Ryan, Michael J., additional, Safar, Michel E., additional, Salvetti, Antonio, additional, Sarafidis, Panteleimon A., additional, Sartori-Valinotti, Julio C., additional, Schork, Nicholas J., additional, Setaro, John F., additional, Shah, N.C., additional, Shiel, Julian, additional, Schiffrin, Ernesto L., additional, Sica, Domenic A., additional, Silva, Alexandre A. da, additional, Silva, Guillermo B., additional, Silva, J. Enrique, additional, Smith, George Davey, additional, Somers, Virend K., additional, Sowers, James R., additional, Spence, J. David, additional, Stanley, Adrian G., additional, Stec, David E., additional, Stranges, Saverio, additional, Struthers, Allan D., additional, Stump, Craig S., additional, Tabet, Fatiha, additional, Taddei, Stefano, additional, Taupenot, Laurent, additional, Tayebjee, Muzahir H., additional, Teixeira, Cleber E., additional, Thakali, Keshari M., additional, Touyz, Rhian M., additional, Traub, Darren, additional, Tse, Hung-Fat, additional, Umans, Jason G., additional, Uthappa, Puchimada, additional, Valina-Toth, Anna B., additional, Varughese, George I., additional, Virdis, Agostino, additional, Watts, Stephanie W., additional, Webb, R. Clinton, additional, Wen, Gen, additional, Whelton, Paul K., additional, Whitworth, Judith A., additional, Wong, Tien Yin, additional, Woodham, Ryan M., additional, Wyne, Kathleen, additional, Yanes, Licy Lorena, additional, Ying, Zhekang, additional, Young, Ian S., additional, Zanchetti, Alberto, additional, Zhang, Kuixing, additional, Zhang, Lian, additional, and Ziegler, Michael G., additional

Published
2007
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20. Healthcare-acquired coronavirus disease 2019 (COVID-19) is less symptomatic than community-acquired disease among healthcare workers

Author

Fletcher, Jeffrey J., Feucht, Eric C., Hahn, Peter Y., McGoff, Theresa N., Dehart, Del J., El Mortada, Mohamad E., and Grifka, Ronald G.

Abstract

AbstractObjective:We hypothesized that healthcare workers (HCWs) with high-risk exposures outside the healthcare system would have less asymptomatic coronavirus 2019 (COVID-19) disease and more symptoms than those without such exposures.Design:A longitudinal point prevalence study was conducted during August 17–September 4, 2020 (period 1) and during December 2–23, 2020 (period 2).Setting:Community based teaching health system.Participants:All HCWs were invited to participate. Among HCWs who acquired COVID-19, logistic regression models were used to evaluate the adjusted odds of asymptomatic disease using high-risk exposure outside the healthcare system as the explanatory variable. The number of symptoms between exposure groups was evaluated with the Wilcoxon rank-sum test. The risk of seropositivity among all HCS by work exposure was evaluated during both periods.Interventions:Survey and serological testing.Result:Seroprevalence increased from 1.9% (95% confidence interval [CI], 1.2%–2.6%) to 13.7% (95% CI, 11.9%–15.5%) during the study. Only during period 2 did HCWs with the highest work exposure (versus low exposure) have an increased risk of seropositivity (risk difference [RD], 7%; 95% CI, 1%–13%). Participants who had a high-risk exposure outside of work (compared to those without) had a decreased probability of asymptomatic disease (odds ratio [OR], 0.38; 95% CI, 0.16–0.86) and demonstrated more symptoms (median 3 [IQR, 2–6] vs 1 [IQR, 0–4]; P= .001).Conclusions:Healthcare-acquired COVID-19 increases the probability of asymptomatic or mild COVID-19 disease compared to community-acquired disease. This finding suggests that infection prevention strategies (including masks and eye protection) may be mitigating inoculum and supports the variolation theory in COVID-19.

Published
2022
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36. Hepatic hydrothorax: Possible etiology of recurring pleural...

Author

Hahn, Myung Ho and Hahn, Peter Y.

Subjects
PLEURAL effusions, HYDROTHORAX, ETIOLOGY of diseases
Abstract

Provides information on causative factors causing pleural effusion. Effect of hepatic hydrothorax in pleural effusion; Illustrative case of pleural effusion; Clinical presentation of hepatic hydrothorax; Pathophysiology of hepatic hydrothorax.

Published
1997

39. Pneumocystis cell wall beta-glucans stimulate alveolar epithelial cell chemokine generation through nuclear factor-kappaB-dependent mechanisms.

Author

Evans SE, Hahn PY, McCann F, Kottom TJ, Pavlovic' ZV, and Limper AH

Subjects
Animals, Antigens, CD metabolism, Chemokine CXCL2, Gene Expression immunology, In Vitro Techniques, Lactosylceramides metabolism, Lectins, C-Type, Membrane Proteins metabolism, Monokines genetics, Monokines metabolism, Nerve Tissue Proteins metabolism, Pneumonia, Pneumocystis metabolism, Protein Kinase C metabolism, Pulmonary Alveoli cytology, Pulmonary Alveoli immunology, Pulmonary Alveoli microbiology, Rats, Respiratory Mucosa cytology, Respiratory Mucosa immunology, Tumor Necrosis Factor-alpha genetics, Chemokines metabolism, NF-kappa B metabolism, Pneumocystis carinii metabolism, Pneumonia, Pneumocystis immunology, Respiratory Mucosa microbiology, beta-Glucans metabolism
Abstract

Exuberant inflammatory responses are associated with respiratory failure during Pneumocystis pneumonia. Alveolar epithelial cells (AECs) promote Pneumocystis attachment and proliferation, but also contribute prominently to host cytokine-mediated inflammation during pneumonia. Recent investigations indicate that AECs produce macrophage inflammatory protein-2 (MIP-2) and tumor necrosis factor-alpha (TNF-alpha) following challenge with Pneumocystis carinii. Nuclear factor-kappaB (NF-kappaB) is a ubiquitous transcription factor critical for regulation of proinflammatory cytokine expression. Herein, we assess rat AEC NF-kappaB responses to challenge with a P. carinii beta-glucan cell wall component (PCBG). Prominent nuclear translocation of p65 NF-kappaB was demonstrated following PCBG challenge. NF-kappaB activation was in part mediated through Protein Kinase C (PKC) signaling pathways. PCBG challenge of AECs was also shown to induce MIP-2 and TNF-alpha mRNA production, a response that was ameliorated by NF-kappaB inhibition. MIP-2 protein expression was also dramatically increased by PCBG challenge, in a manner that was significantly attenuated by both PKC and NF-kappaB inhibition. The data further demonstrate that AEC chemokine responses were not mediated by the recently described dectin-1 receptor, but instead involved participation of cell surface lactosylceramide. These data support a significant role for AECs in host responses during Pneumocystis pneumonia, and further indicate that beta-glucan induces inflammatory cytokine production through NF-kappaB-dependent mechanisms.

Published
2005
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40. Pneumocystis carinii cell wall beta-glucan induces release of macrophage inflammatory protein-2 from alveolar epithelial cells via a lactosylceramide-mediated mechanism.

Author

Hahn PY, Evans SE, Kottom TJ, Standing JE, Pagano RE, and Limper AH

Subjects
Animals, Chemokine CXCL2, Chemokines, CXC, Epithelial Cells metabolism, Intercellular Signaling Peptides and Proteins, Monokines genetics, Pulmonary Alveoli cytology, RNA, Messenger genetics, RNA, Messenger metabolism, Rats, Rats, Sprague-Dawley, Antigens, CD metabolism, Cell Wall metabolism, Glucans metabolism, Lactosylceramides metabolism, Monokines metabolism, Pneumocystis metabolism, Pulmonary Alveoli metabolism
Abstract

Infiltration of the lungs with neutrophils promotes respiratory failure during severe Pneumocystis carinii (PC) pneumonia. Recent studies have shown that alveolar epithelial cells (AECs), in addition to promoting PC attachment, also participate in lung inflammation by the release of cytokines and chemokines. Herein, we demonstrate that a PC beta-glucan rich cell wall isolate (PCBG) stimulates the release of macrophage inflammatory protein-2 (MIP-2) from isolated AECs through a lactosylceramide-dependent mechanism. The results demonstrate that MIP-2 mRNA and protein production is significantly increased at both early and late time points after PCBG challenge. Although CD11b/CD18 (Mac-1, CR3) is the most widely studied beta-glucan receptor, we demonstrate that CD11b/CD18 is not present on AECs. This study instead demonstrates that preincubation of AECs with an antibody directed against the membrane glycosphingolipid lactosylceramide (CDw17) results in a significant decrease in MIP-2 secretion. Preincubation of the anti-CDw17 antibody with solubilized lactosylceramide reverses this effect. Furthermore, incubation of AECs with inhibitors of glycosphingolipid biosynthesis, including N-butyldeoxyno jirimycin and d-threo-1-phenyl-2-decanoylamino-3-morpholino-1-propanol-HCl, also results in a significant decrease in AEC MIP-2 production following challenge with PCBG. These data demonstrate that PC beta-glucan induces significant production of MIP-2 from AECs and that CDw17 participates in the glucan-induced inflammatory signaling in lung epithelial cells during PC infection.

Published
2003
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