Effects of the electronic health record on job satisfaction of academic pediatric faculty.

OBJECTIVE(S): To evaluate the association of Electronic Health Record (EHR) skills and available support with job satisfaction for pediatric faculty at an academic institution. To identify key opportunities for improvement. STUDY DESIGN: Cross-sectional study of pediatric academic faculty physicians using a REDCap survey to inquire about faculty EHR skills, support services, and associations between EHR workflow and job satisfaction. Results were analyzed using bivariate testing. RESULTS: The majority of respondents (n = 127, response rate 37%), rated the effect of EHR workflow on job satisfaction as neutral (36%) or negative (44%). Users with more EHR skills were more likely to indicate a positive effect of the EHR on overall job satisfaction (p = 0.019). 7% of respondents had none of the EHR skills queried and few felt that initial training (35%) or the Information Technology department (26%) were useful in acquiring skills. Two similar divisions, one with three and one without Physician Builders (providers with specialized training in EHR personalization), had statistically significant different EHR satisfaction ratings (p = 0.0012). CONCLUSIONS: Most faculty indicated a negative/neutral effect of the EHR on their overall job satisfaction. Users who indicated more EHR skills had a higher satisfaction rating. Existing training and support were not helpful to users. The division with the most Physician Builders ranked highest in satisfaction. We speculate that 1) adding EHR skills could increase overall job satisfaction and 2) adding Physician Builder resources could increase skills and satisfaction.

A population-based study of parkinsonism in an Amish community.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder with unknown cause. Genetic mutations account for a minority of cases but the role of environmental factors is unclear. METHODS: We performed a population-based screening for PD in subjects in an Amish community over age 60. PD was diagnosed using standard clinical criteria and the Unified Parkinson Disease Rating Scale motor subsection 3 (UPDRS3). Community prevalence was calculated. We constructed a community pedigree and calculated kinship coefficients, a measure of relatedness between 2 subjects, for every pair of subjects in diagnostic categories: clinically definite PD, UPDRS3 score >9, Mini-Mental State Exam (MMSE) score <25, and normal. RESULTS: Of 262 eligible subjects, 213 agreed to participate, 15 had PD, 43 had MMSE <25, 73 had UPDRS3 >9. The prevalence of PD was 5,703/100,000 with increasing prevalence in every decade of age. Excluding first-degree relatives, normal subjects were more related to each other (0.0102, SD = 0.0266) than subjects with clinically definite PD (0.0054, SD = 0.0100; p = 0.00003), subjects with UPDRS >9 (0.0076, SD = 0.0155; p = 0.00001), and subjects with MMSE <25 (0.0090, SD = 0.0180; p = 0.00003). CONCLUSIONS: PD and parkinsonian signs are common in this population and the prevalence increases with age. The finding that subjects with PD were not more related than normal subjects suggests that environmental factors may contribute to the parkinsonian phenotype in this community.

Efficacy and tolerability of pregabalin in essential tremor: a randomized, double-blind, placebo-controlled, crossover trial.

We performed a double-blind, crossover-design study to assess the tolerability and efficacy of pregabalin (PGB) in patients with essential tremor (ET). Twenty patients (11 women; mean age of 62.2+/-12.7 years, mean ET duration of 25.5+/-14.9 years) with ET were randomized for treatment with PGB (150-600 mg/day) or placebo, titrated over 6 weeks. Identical assessments of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) (primary endpoint), Clinical Global Impression of Change (CGI-C), Quality of Life in Essential Tremor Questionnaire (QUEST), Hamilton Anxiety Scale (HAM-A), and a sleep hygiene questionnaire (HD-16) were made at the baseline, at the end of treatment periods for both drug and placebo, and following the 2-week washout period preceding crossover. We found no improvement in any of the TRS measures and a statistically significant worsening of QUEST scores while patients were taking PGB. Adverse events were similar in frequency to previously published studies of PGB, the most common being drowsiness and dizziness.