BackgroundOver 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care.ObjectiveTo assess outpatient experience with different aspects of physician services at China’s public hospitals and its association with overcrowding of the hospital outpatient departments.Research designRetrospective analysis of a large survey of outpatient experience in Shanghai, China. We tested the hypotheses that patient experience was poorer with physician-patient communication, education, and shared decision-making and where and when there was greater overcrowding of the hospital outpatient departments. Ordered logistic models were estimated separately for general and specialty hospitals.Subjects7,147 outpatients at 40 public hospitals in Shanghai, China, in 2014.MeasuresPatient experience with physician services were self-reported based on 12 questions as part of a validated instrument. Indicators of overcrowding included time of visit (morning vs. afternoon, Monday vs. rest of the week) and hospital outpatient volume in the first half of 2014.ResultsOverall, patients reported very favorable experience with physician services. Two out of the 12 questions pertaining to both communication and shared decision-making consistently received lower ratings. Hospitals whose outpatient volumes were in the top two quartiles received lower patient ratings, but the relationship achieved statistical significance among specialty hospitals only.ConclusionsInadequate physician-patient communication and shared decision-making and hospital overcrowding compromise outpatient experience with physician services at Chinese public hospitals. Effective diversion of patients with chronic and less complex conditions to community health centers will be critical to alleviate the extreme workloads at hospitals with high patient volumes and, in turn, improve patient experience.
In this paper, we experimentally demonstrate the transmission of 56 Gbaud four-level pulse amplitude modulation (PAM4) signal over 2-km single mode fiber (SMF) with intensity modulation and direct detection (IM/DD) scheme, while the bit-error-ratio (BER) of the PAM4 signal is under hard-decision forward error correction (HD-FEC) threshold of 3.8 × 10. Linear pre-equalization is implemented in the transmitter side with a 3-tap finite-impulse-response (FIR) filter to compensate for the intersymbol interference (ISI) induced by system bandwidth limitation. Receiver side equalization is realized with training sequence (TS) based feed-forward equalizer (FFE) with decision-feedback equalizer (DFE). Furthermore, an Adaptive Notch Filter (ANF) is proposed to suppress the digital-to-analog converter (DAC) clock leakage induced narrowband interference for the first time, and the bandwidth of the ANF is optimized to achieve the best BER performance.
A low-cost intensity modulation and direct detection scheme using a 4-bit digital-to-analog converter for 56 Gbit/s pre-equalized PAM-4 generation at the transmitter and without receiver side post-equalization over 80 km single-mode fiber transmission in a C-band is experimentally demonstrated in this Letter. Pre-equalization includes pre-emphasis for channel response, a modified Gerchberg–Saxton algorithm with five iterations for chromatic dispersion compensation, and a noise shaping technique implemented by a five-tap finite impulse response filter for quantization noise suppression. Enabled by the pre-equalization techniques, the bit error rate of the received signal without post-equalization can reach the hard-decision forward error correction threshold with
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receiver optical power. The experimental results indicate that our proposed scheme is a promising candidate for the standardization of 400 GbE wavelength division multiplexing-based long-haul distance data center interconnects.
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