A sentiment analysis on online psychiatrist reviews to identify clinical attributes of psychiatrists that shape the therapeutic alliance.

Background: While online reviews from physician rating websites are increasingly utilized by healthcare providers to better understand patient needs, it remains difficult to objectively identify areas for improvement in providing psychiatric care. Objectives: To quantitatively characterize the sentiment of online written reviews of psychiatrists to determine clinical attributes that can be strengthened to improve psychiatrists' therapeutic alliance with their patients. Materials and methods: Sentiment scores of 6,400 written reviews of 400 US-based psychiatrists on a US-based online physician rating website were obtained through a natural-language-processing-based sentiment analysis. Relationships among sentiment scores, average star ratings, and demographics were examined. Linguistic analyses determined words and bigrams that were highly associated with reviews with the most positive and negative sentiment. Findings: Sentiment scores were significantly correlated with average star ratings of the psychiatrists (R = 0.737, p < 0.001). Psychiatrists who were younger (< 56 years old) and/or practiced in the Northeast had significantly higher average star ratings than those older and/or practicing in the Southwest. Frequency analysis showed that positive reviews most frequently contained "time" (N = 1,138) and "caring" (N = 784) while negative reviews most frequently contained "medication" (N = 495) and "time" (N = 379). Logistic regression analysis revealed that reviews were more likely to be considered positive when they included "great listener" (OR = 16.89) and "comfortable" (OR = 10.72) and more likely to be negative when they included "meds" (OR = 0.55) and "side effect" (OR = 0.59). Conclusion: Psychiatrists who are younger and located in the Northeast receive more positive reviews; there may be potential for demographic bias among patient reviewers. Patients positively rate psychiatrists who make them feel heard and comfortable but negatively rate encounters centered around medications and their side effects. Our study lends quantitative evidence to support the importance of thorough and empathetic communication of psychiatrists in building a strong therapeutic alliance.

Biomechanical evaluation of a locking and nonlocking reconstruction plate in an osteoporotic calcaneal fracture model.

BACKGROUND: This study evaluated the effects of locking vs nonlocking configuration on the biomechanical performance of a calcaneal reconstruction plate in an osteoporotic cadaveric model. MATERIALS AND METHODS: A Saunders II B type calcaneal fracture was created in ten matched pair of cadaveric calcanei. Each pair was fixed with the Ascension calcaneal reconstruction plate using either locking or nonlocking screws in the same hole pattern. Specimens were axially loaded for 1000 cycles through the talus followed by load to failure. Statistical comparisons were made between the locking and nonlocking constructs on the displacements during cyclic loading as well as construct stiffness and load achieved at selected fragment displacements. RESULTS: No significant difference was detected between the locking and nonlocking constructs in displacement during cyclic loading (p > 0.2) for the numbers available. Similarly no significant difference was found in stiffness of the constructs between the groups: 445.7 ± 148.8 (N/mm ± SD) for the locking plate and 395.2 ± 127.7 for the nonlocking plate (p > 0.14). The load achieved at 2 mm displacement of the posterior fragment for the two groups were not different: locking plate at 744.6 ± 237.2 N and nonlocking plate at 739.3 ± 269.7 N (p > 0.99). CONCLUSION: This study did not reveal a mechanical advantage to locking technology for calcaneal fractures with the selected plate and fracture model. CLINICAL RELEVANCE: While locking plate technology has shown mechanical advantages for fracture management in other osteoporotic models, in our fracture model and plating construct, this was not found. It is still unclear which fixation technique is most beneficial in these calcaneal fractures.

Serratia marcescens outbreak in a neonatal intensive care unit related to the exit port of an oscillator.

OBJECTIVE: To interrupt transmission of Serratia marcescens colonization in a neonatal intensive care unit and determine the source of ongoing transmission. DESIGN: Multidisciplinary outbreak investigation and simulation of droplet generation by a high-frequency oscillator using fluorescent dye. SETTING: Level III neonatal intensive care unit. PATIENTS: Very low birth weight premature infants with respiratory failure. INTERVENTIONS: Infection control interventions, pulsed-field gel electrophoresis of isolates to determine relatedness, and construction of a scavenging system to capture the circuitry condensate expelled by the oscillator exit port. MEASUREMENTS AND MAIN RESULTS: Affected infants were housed in the same geographic site. Serratia marcescens isolates were indistinguishable or closely related using pulsed-field gel electrophoresis. Fluorescent droplet splatter from the circuitry, generated when no containment device covered the exit valve, was visible up to 49 in (107.8 cm) from the source. CONCLUSIONS: Implementation and adherence to infection control measures is essential to prevent transmission of opportunistic pathogens among ventilated infants. Oscillators can generate droplets that travel farther than 1 m from the source.

Use of noninvasive hemodynamics in hypertension management.

Hypertension is a chronic disease that is controlled in the United States in only 34% of those taking antihypertensive medications. Because hypertension is a hemodynamic disorder, the patient's hemodynamic profile before and after medical intervention may assist in the decision and evaluation of ongoing antihypertensive therapy. There are several medication classes used in the management of hypertension and it is challenging at best for the clinician to determine the optimal therapeutic combination of medications for each patient. Physician perceptions and patient symptoms are examples of barriers affecting the management and control of hypertension. Impedance cardiography is a noninvasive monitoring technique that provides reliable and reproducible hemodynamic measurements. Three case studies are presented that illustrate how hemodynamic parameters were used to achieve hypertension control in the outpatient setting.