Sample records for academic hospital setting

  1. Implementing managed alcohol programs in hospital settings: A review of academic and grey literature.

    PubMed

    Brooks, Hannah L; Kassam, Shehzad; Salvalaggio, Ginetta; Hyshka, Elaine

    2018-04-01

    People with severe alcohol use disorders are at increased risk of poor acute-care outcomes, in part due to difficulties maintaining abstinence from alcohol while hospitalised. Managed alcohol programs (MAP), which administer controlled doses of beverage alcohol to prevent withdrawal and stabilise drinking patterns, are one strategy for increasing adherence to treatment, and improving health outcomes for hospital inpatients with severe alcohol use disorders. Minimal research has examined the implementation of MAPs in hospital settings. We conducted a scoping review to describe extant literature on MAPs in community settings, as well as the therapeutic provision of alcohol to hospital inpatients, to assess the feasibility of implementing formal MAPs in hospital settings and identify knowledge gaps requiring further study. Four academic and 10 grey literature databases were searched. Evidence was synthesised using quantitative and qualitative approaches. Forty-two studies met review inclusion criteria. Twenty-eight examined the administration of alcohol to hospital inpatients, with most reporting positive outcomes related to prevention or treatment of alcohol withdrawal. Fourteen studies examined MAPs in the community and reported that they help stabilise drinking patterns, reduce alcohol-related harms and facilitate non-judgemental health and social care. MAPs in the community have been well described and research has documented effective provision of alcohol in hospital settings for addressing withdrawal. Implementing MAPs as a harm reduction approach in hospital settings is potentially feasible. However, there remains a need to build off extant literature and develop and evaluate standardised MAP protocols tailored to acute-care settings. © 2018 Australasian Professional Society on Alcohol and other Drugs.

  2. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  3. Challenges of using Hospital Information Systems by nurses: comparing academic and non-academic hospitals.

    PubMed

    Ahmadian, Leila; Dorosti, Nafise; Khajouei, Reza; Gohari, Sadrieh Hajesmaeel

    2017-06-01

    Hospital Information Systems (HIS) are used for easy access to information, improvement of documentation and reducing errors. Nonetheless, using these systems is faced with some barriers and obstacles. This study identifies the challenges and the obstacles of using these systems in the academic and non-academic hospitals in Kerman. This is a cross-sectional study which was carried out in 2015. The statistical population in this study consisted of the nurses who had been working in the academic and non-academic hospitals in Kerman. A questionnaire consisting of two sections was used. The first section consisted of the demographic information of the participants and the second section comprised 34 questions about the challenges of HIS use. Data were analyzed by the descriptive and statistical analysis (t-test, and ANOVA) using SPSS 19 software. The most common and important challenges in the academic hospitals were about human environment factors, particularly "negative attitude of society toward using HIS". In the non-academic hospitals, the most common and important challenges were related to human factors, and among them, "no incentive to use system" was the main factor. The results of the t-test method revealed that there was a significant relationship between gender and the mean score of challenges related to the organizational environment category in the academic hospitals and between familiarity with HIS and mean score of human environment factors (p<0.05). The results of the ANOVA test also revealed that the educational degree and work experience in the healthcare environment (years) in the academic hospitals have a significant relationship with the mean score related to the hardware challenges, as well, experience with HIS has a significant relationship, with the mean score related to the human challenges (p<0.05). The most important challenges in using the information systems are the factors related to the human environment and the human factors. The

  4. Psychiatric Hospitalization and Academic Performance

    ERIC Educational Resources Information Center

    Ganz, Varda Peller; Pao, Jane

    1978-01-01

    Studies of college students hospitalized for psychiatric disturbances revealed that diagnosis did not significantly affect academic performance, nor did leave of absence following hospitalization ensure better re-entry adjustment. It is recommended that students be evaluated individually and be allowed to re-enter as soon as the acute illness…

  5. Financial Performance of Academic Health Center Hospitals, 1994-2000.

    ERIC Educational Resources Information Center

    Dobson, Allen; Koenig, Lane; Sen, Namrata; Ho, Silver; Gilani, Jawaria

    This study examined how competitive market dynamics between 1994 and 2000 have affected the financial stability of Academic Health Center (AHC) hospitals and their ability to support their academic and social missions. It looked at the financial challenges facing AHC hospitals through a survey involving 1,138 teaching hospitals. Findings…

  6. Treatment Patterns and Differences in Survival of Non-Small Cell Lung Cancer Patients Between Academic and Non-Academic Hospitals in the Netherlands.

    PubMed

    van der Linden, Naomi; Bongers, Mathilda L; Coupé, Veerle M H; Smit, Egbert F; Groen, Harry J M; Welling, Alle; Schramel, Franz M N H; Uyl-de Groot, Carin A

    2017-09-01

    The aims of this study are to analyze differences in survival between academic and non-academic hospitals and to provide insight into treatment patterns for non-small cell lung cancer (NSCLC). Results show the state of NSCLC survival and care in the Netherlands. The Netherlands Cancer Registry provided data on NSCLC survival for all Dutch hospitals. We used the Kaplan-Meier estimate to calculate median survival time by hospital type and a Cox proportional hazards model to estimate the relative risk of mortality (expressed as hazard ratios) for patients diagnosed in academic versus non-academic hospitals, with adjustment for age, gender, and tumor histology, and stratifying for disease stage. Data on treatment patterns in Dutch hospitals was obtained from 4 hospitals (2 academic, 2 non-academic). A random sample of patients diagnosed with NSCLC from January 2009 until January 2011 was identified through hospital databases. Data was obtained on patient characteristics, tumor characteristics, and treatments. The Cox proportional hazards model shows a significantly decreased hazard ratio of mortality for patients diagnosed in academic hospitals, as opposed to patients diagnosed in non-academic hospitals. This is specifically true for primary radiotherapy patients and patients who receive systemic treatment for non-metastasized NSCLC. Patients diagnosed in academic hospitals have better median overall survival than patients diagnosed in non-academic hospitals, especially for patients treated with radiotherapy, systemic treatment, or combinations. This difference may be caused by residual confounding since the estimates were not adjusted for performance status. A wide variety of surgical, radiotherapeutic, and systemic treatments is prescribed. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Nursing leadership in an academic hospital in Gauteng.

    PubMed

    Maboko, D R

    2012-10-01

    This study was aimed at describing nursing leadership in an academic hospital in Gauteng, South Africa. Nurse managers' leadership styles affect nurses' attitudes, behaviour and work performance. However, little is known about how nurses experience nurse leadership and what leadership styles are found in academic hospitals in Gauteng. The study was based on Maxwell's framework of leadership (relationships, equipping, leadership and attitude). A qualitative design was used in order to describe the experiences of registered nurses and nurse managers. The population of the study was all registered nurses and nurse managers of the hospital in which the study was conducted. In phase one of the study, a discussion group with 35 registered nurses using the nominal group technique was held to respond to the following statement: 'Please explain how you have experienced leadership by nurse managers in this hospital'. In phase two of the study, five nurse managers were interviewed individually, using a semi-structured interview guide. Some nurse managers were practising autocratic leadership in this hospital. he nurse managers need to be taught about contemporary leadership styles such as transformational leadership and visionary leadership and also about supervision, role modelling and caring. © 2011 Blackwell Publishing Ltd.

  8. Cheating Perceptions and Prevalence across Academic Settings

    ERIC Educational Resources Information Center

    Honz, Kelly; Kiewra, Kenneth A.; Yang, Ya-Shu

    2010-01-01

    This study investigated high school students' perceptions of cheating and its prevalence. Students were administered the Academic Honesty Survey to determine their perceptions and prevalence of cheating across three academic settings: tests, homework, and report writing. Overall, students had traditional perceptions of what constitutes cheating.…

  9. Rural versus urban academic hospital mortality following stroke in Canada.

    PubMed

    Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles

    2018-01-01

    Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

  10. Rural versus urban academic hospital mortality following stroke in Canada

    PubMed Central

    Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M.; Dupuis, Gilles

    2018-01-01

    Introduction Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. Objectives To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. Materials and methods We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. Results A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Conclusion Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for

  11. Conversational Competence in Academic Settings

    ERIC Educational Resources Information Center

    Bowman, Richard F.

    2014-01-01

    Conversational competence is a process, not a state. Ithaca does not exist, only the voyage to Ithaca. Vibrant campuses are a series of productive conversations. At its core, communicative competence in academic settings mirrors a collective search for meaning regarding the purpose and direction of a campus community. Communicative competence…

  12. A comparison of clinicians' access to online knowledge resources using two types of information retrieval applications in an academic hospital setting.

    PubMed

    Hunt, Sevgin; Cimino, James J; Koziol, Deloris E

    2013-01-01

    The research studied whether a clinician's preference for online health knowledge resources varied with the use of two applications that were designed for information retrieval in an academic hospital setting. The researchers analyzed a year's worth of computer log files to study differences in the ways that four clinician groups (attending physicians, housestaff physicians, nurse practitioners, and nurses) sought information using two types of information retrieval applications (health resource links or Infobutton icons) across nine resources while they reviewed patients' laboratory results. From a set of 14,979 observations, the authors found statistically significant differences among the 4 clinician groups for accessing resources using the health resources application (P<0.001) but not for the Infobuttons application (P = 0.31). For the health resources application, the preferences of the 4 clinical groups varied according to the specific resources examined (all P≤0.02). The information-seeking behavior of clinicians may vary in relation to their role and the way in which the information is presented. Studying these behaviors can provide valuable insights to those tasked with maintaining information retrieval systems' links to appropriate online knowledge resources.

  13. A comparison of clinicians' access to online knowledge resources using two types of information retrieval applications in an academic hospital setting

    PubMed Central

    Hunt, Sevgin; Cimino, James J.; Koziol, Deloris E.

    2013-01-01

    Objective: The research studied whether a clinician's preference for online health knowledge resources varied with the use of two applications that were designed for information retrieval in an academic hospital setting. Methods: The researchers analyzed a year's worth of computer log files to study differences in the ways that four clinician groups (attending physicians, housestaff physicians, nurse practitioners, and nurses) sought information using two types of information retrieval applications (health resource links or Infobutton icons) across nine resources while they reviewed patients' laboratory results. Results: From a set of 14,979 observations, the authors found statistically significant differences among the 4 clinician groups for accessing resources using the health resources application (P<0.001) but not for the Infobuttons application (P = 0.31). For the health resources application, the preferences of the 4 clinical groups varied according to the specific resources examined (all P≤0.02). Conclusion: The information-seeking behavior of clinicians may vary in relation to their role and the way in which the information is presented. Studying these behaviors can provide valuable insights to those tasked with maintaining information retrieval systems' links to appropriate online knowledge resources. PMID:23405044

  14. Roles and methods of performance evaluation of hospital academic leadership.

    PubMed

    Zhou, Ying; Yuan, Huikang; Li, Yang; Zhao, Xia; Yi, Lihua

    2016-01-01

    The rapidly advancing implementation of public hospital reform urgently requires the identification and classification of a pool of exceptional medical specialists, corresponding with incentives to attract and retain them, providing a nucleus of distinguished expertise to ensure public hospital preeminence. This paper examines the significance of academic leadership, from a strategic management perspective, including various tools, methods and mechanisms used in the theory and practice of performance evaluation, and employed in the selection, training and appointment of academic leaders. Objective methods of assessing leadership performance are also provided for reference.

  15. Supervisory needs of research doctoral students in a university teaching hospital setting.

    PubMed

    Caldwell, Patrina Hy; Oldmeadow, Wendy; Jones, Cheryl A

    2012-10-01

    Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of

  16. Physicians' job satisfaction and motivation in a public academic hospital.

    PubMed

    de Oliveira Vasconcelos Filho, Paulo; de Souza, Miriam Regina; Elias, Paulo Eduardo Mangeon; D'Ávila Viana, Ana Luiza

    2016-12-07

    Physician shortage is a global issue that concerns Brazil's authorities. The organizational structure and the environment of a medical institution can hide a low-quality life of a physician. This study examines the relationship between the hospital work environment and physicians' job satisfaction and motivation when working in a large public academic hospital. The study was restricted to one large, multispecialty Brazil's hospital. Six hundred hospital physicians were invited to participate by e-mail. A short version of the Physician Worklife Survey (PWS) was used to measure working satisfaction. Physicians were also asked for socio-demographic information, medical specialty, and the intention to continue working in the hospital. Data from 141 questionnaires were included in the analyses. Forty-five physicians graduated from the hospital's university, and they did not intend to leave the hospital under any circumstance (affective bond). The motivating factor for beginning the career at the hospital and to continue working there were the connection to the medical school and the hospital status as a "prestigious academic hospital"; the physicians were more satisfied with the career than the specialty. Only 30% completely agreed with the statement "If I had to start my career over again, I would choose my current specialty," while 45% completely agreed with the statement "I am not well compensated given my training and experience." The greater point of satisfaction was the relationship with physician colleagues. They are annoyed about the amount of calls they are requested to take and about how work encroaches on their personal time. No significant differences between medical specialties were found in the analysis. The participants were satisfied with their profession. The fact that they remained at the hospital was related to the academic environment, the relationship with colleagues, and the high prestige in which society holds the institution. The points of

  17. A nurse-led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines.

    PubMed

    Symonds, Erin L; Simpson, Kalindra; Coats, Michelle; Chaplin, Angela; Saxty, Karen; Sandford, Jayne; Young Am, Graeme P; Cock, Charles; Fraser, Robert; Bampton, Peter A

    2018-06-18

    To examine the compliance of colorectal cancer surveillance decisions for individuals at greater risk with current evidence-based guidelines and to determine whether compliance differs between surveillance models. Prospective auditing of compliance of surveillance decisions with evidence-based guidelines (NHMRC) in two decision-making models: nurse coordinator-led decision making in public academic hospitals and physician-led decision making in private non-academic hospitals. Selected South Australian hospitals participating in the Southern Co-operative Program for the Prevention of Colorectal Cancer (SCOOP). Proportions of recall recommendations that matched NHMRC guideline recommendations (March-May 2015); numbers of surveillance colonoscopies undertaken more than 6 months ahead of schedule (January-December 2015); proportions of significant neoplasia findings during the 15 years of SCOOP operation (2000-2015). For the nurse-led/public academic hospital model, the recall interval recommendation following 398 of 410 colonoscopies (97%) with findings covered by NHMRC guidelines corresponded to the guideline recommendations; for the physician-led/private non-academic hospital model, this applied to 257 of 310 colonoscopies (83%) (P < 0.001). During 2015, 27% of colonoscopies in public academic hospitals (mean, 27 months; SD, 13 months) and 20% of those in private non-academic hospitals (mean, 23 months; SD, 12 months) were performed more than 6 months earlier than scheduled, in most cases because of patient-related factors (symptoms, faecal occult blood test results). The ratio of the numbers of high risk adenomas to cancers increased from 6.6:1 during 2001-2005 to 16:1 during 2011-2015. The nurse-led/public academic hospital model for decisions about colorectal cancer surveillance intervals achieves a high degree of compliance with guideline recommendations, which should relieve burdening of colonoscopy resources.

  18. Effects of Goal-Setting Instruction on Academic Engagement for Students at Risk

    ERIC Educational Resources Information Center

    Rowe, Dawn A.; Mazzotti, Valerie L.; Ingram, Angela; Lee, Seunghee

    2017-01-01

    Research indicates teachers feel teaching goal-setting is an effective way to enhance academic engagement. However, teachers ultimately feel unprepared to embed goal-setting instruction into academic content to support active student engagement. Given the importance teachers place on goal-setting skills, there is a need to identify strategies to…

  19. Developing an effective lung cancer program in a community hospital setting.

    PubMed

    Fischel, Richard J; Dillman, Robert O

    2009-07-01

    Lung cancer remains the number one cause of cancer-based mortality in men and women. The importance of proper lung cancer care outside of major academic centers cannot be overemphasized because the vast majority of lung cancer care occurs in community hospital settings. We have had the opportunity to develop a highly successful community hospital-based lung cancer program. Utilizing a multidisciplinary approach, we have achieved steadily improving survival rates that are much higher than those observed nationally for patients diagnosed with lung cancer. Key components of this successful program include: (1) a weekly multidisciplinary lung cancer case conference with medical doctor representatives from medical oncology, thoracic surgery, pulmonary medicine, radiology, radiation oncology, and nuclear medicine who discuss patient presentation, test results, treatment history, and plans for therapy; (2) thoracic surgeons skilled in minimally invasive video-assisted thoracoscopic surgery; (3) nurse navigator/coordinators to help patients through the process from detection to recovery and provide a personal bond that greatly improves patient satisfaction; (4) utilization of treatment guidelines for patient-specific treatment strategies; (5) formal continuing medical education; (6) an emphasis on early detection that includes consideration of computed tomography screening of former smokers; (6) a cancer center that allows for many services to be offered at a single location for patient convenience and to promote interdisciplinary care; and (7) access to research protocols. These components have helped us provide a quality lung cancer program in a community hospital setting that is associated with excellent clinical outcomes.

  20. Identifying and communicating the contributions of library and information services in hospitals and academic health sciences centers.

    PubMed

    Abels, Eileen G; Cogdill, Keith W; Zach, Lisl

    2004-01-01

    This article introduces a systematic approach to identifying and communicating the value of library and information services (LIS) from the perspective of their contributions to achieving organizational goals. The contributions of library and information services (CLIS) approach for identifying and communicating the value of LIS draws on findings from a multimethod study of hospitals and academic health sciences centers. The CLIS approach is based on the concept that an individual unit's value to an organization can be demonstrated by identifying and measuring its contributions to organizational goals. The CLIS approach involves seven steps: (1) selecting appropriate organizational goals that are meaningful in a specific setting; (2) linking LIS contributions to organizational goals; (3) obtaining data from users on the correspondence between LIS contributions and LIS services; (4) selecting measures for LIS services; (5) collecting and analyzing data for the selected measures; (6) planning and sustaining communication with administrators about LIS contributions; and (7) evaluating findings and revising selected goals, contributions, and services as necessary. The taxonomy of LIS contributions and the CLIS approach emerged from research conducted in hospitals and academic health sciences centers and reflect the mission and goals common in these organizations. However, both the taxonomy and the CLIS approach may be adapted for communicating the value of LIS in other settings.

  1. The contributions of library and information services to hospitals and academic health sciences centers: a preliminary taxonomy

    PubMed Central

    Abels, Eileen G.; Cogdill, Keith W.; Zach, Lisl

    2002-01-01

    Objectives: This article presents a taxonomy of the contributions of library and information services (LIS) in hospitals and academic health sciences centers. The taxonomy emerges from a study with three objectives: to articulate the value of LIS for hospitals and academic health sciences centers in terms of contributions to organizational missions and goals, to identify measures and measurable surrogates associated with each LIS contribution, and to document best practices for communicating the value of LIS to institutional administrators. Methods: The preliminary taxonomy of LIS contributions in hospitals and academic health sciences centers is based on a review of the literature, twelve semi-structured interviews with LIS directors and institutional administrators, and a focus group of administrators from five academic, teaching, and nonteaching hospitals. Results: Derived from the balanced scorecard approach, the taxonomy of LIS contributions is organized on the basis of five mission-level concepts and fifteen organizational goals. LIS contributions are included only if they have measurable surrogates. Conclusions: The taxonomy of LIS contributions offers a framework for the collection of both quantitative and qualitative data in support of communicating the value of LIS in hospitals and academic health sciences centers. PMID:12113510

  2. Academic Progress of Students across Inclusive and Traditional Settings

    ERIC Educational Resources Information Center

    Cole, Cassandra M.; Waldron, Nancy; Majd, Massoumeh

    2004-01-01

    Effects of inclusive school settings for students in six Indiana school corporations were investigated. Results reveal that students without disabilities educated in inclusive settings made significantly greater academic progress in mathematics and reading. For students with disabilities, there were no significant differences in reading and math…

  3. Proposed Terminology for Anal Squamous Lesions: Its Application and Interobserver Agreement Among Pathologists in Academic and Community Hospitals.

    PubMed

    Roma, Andres A; Liu, Xiuli; Patil, Deepa T; Xie, Hao; Allende, Daniela

    2017-07-01

    To analyze interobserver reproducibility and compare practice patterns between academic and community settings of Lower Anogenital Squamous Terminology (LAST). In total, 132 anal biopsy slides were revised as well as p16 immunostains. LAST was used in 49% of cases (academic center, 68%; satellite hospitals [community practice setting], 32%). After pathology review and consensus interpretation, 23 (17%) case diagnoses were reclassified: eight (34.8%) cases (benign or low-grade squamous intraepithelial lesion [LSIL]) were upgraded to high-grade squamous intraepithelial lesion (HSIL) (p16 confirmed ordered during review); four (17.4%) cases originally classified as HSIL were downgraded to LSIL (p16 originally ordered in one case). There was no significant difference in discrepancies between original and consensus diagnosis in the community vs academic setting or by subspecialty (gynecological vs gastrointestinal). Overall interobserver agreement among reviewers was substantial (κ = 0.63) and improved with the use of p16 immunostain in challenging cases (κ = 0.71; P < .001). This new terminology is not yet uniformly used by pathologists in anal/perianal biopsy specimens; this two-tier system has a good interobserver agreement and is further improved with p16 use in appropriate cases. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  4. Teaching Quality, Learning Satisfaction, and Academic Performance among Hospitality Students in Taiwan

    ERIC Educational Resources Information Center

    Ko, Wen-Hwa; Chung, Feng-Ming

    2014-01-01

    The purpose of this study is to examine the effect of the teaching quality of culinary arts teachers and student learning satisfaction on the academic performance of hospitality students. This study surveys the students in hospitality departments at universities in Taiwan. A total of 406 (81.2%) valid questionnaires were received. Research results…

  5. Factors affecting nurse retention at an academic Magnet® hospital.

    PubMed

    Buffington, Annsley; Zwink, Jennifer; Fink, Regina; Devine, Deborah; Sanders, Carolyn

    2012-05-01

    : The aim of this study was to examine the factors affecting the retention of registered nurses (RNs) and validate the revised Casey-Fink Nurse Retention Survey (2009). : Creating an organizational culture of retention may reduce nurse turnover. Focusing on why nurses leave and identifying factors why nurses stay are essential. : A descriptive survey design gathered data from RNs with 1 or more years of experience providing direct patient care and employed in inpatient/ambulatory settings in an acute care, academic, Magnet hospital. : There were no statistically significant relationships between nurse respondents' perceptions of work environment/support/encouragement and age or years of experience. However, there were significant differences between inpatient and ambulatory nurse responses in several key areas including job satisfaction, mentorship, and educational support. Overall, nurses reported feeling a lack of support and recognition from managers. Results provide evidence to support improved strategies to foster nurse retention.

  6. Cost-Analysis of Seven Nosocomial Outbreaks in an Academic Hospital.

    PubMed

    Dik, Jan-Willem H; Dinkelacker, Ariane G; Vemer, Pepijn; Lo-Ten-Foe, Jerome R; Lokate, Mariëtte; Sinha, Bhanu; Friedrich, Alex W; Postma, Maarten J

    2016-01-01

    Nosocomial outbreaks, especially with (multi-)resistant microorganisms, are a major problem for health care institutions. They can cause morbidity and mortality for patients and controlling these costs substantial amounts of funds and resources. However, how much is unclear. This study sets out to provide a comparable overview of the costs of multiple outbreaks in a single academic hospital in the Netherlands. Based on interviews with the involved staff, multiple databases and stored records from the Infection Prevention Division all actions undertaken, extra staff employment, use of resources, bed-occupancy rates, and other miscellaneous cost drivers during different outbreaks were scored and quantified into Euros. This led to total costs per outbreak and an estimated average cost per positive patient per outbreak day. Seven outbreaks that occurred between 2012 and 2014 in the hospital were evaluated. Total costs for the hospital ranged between €10,778 and €356,754. Costs per positive patient per outbreak day, ranged between €10 and €1,369 (95% CI: €49-€1,042), with a mean of €546 and a median of €519. Majority of the costs (50%) were made because of closed beds. This analysis is the first to give a comparable overview of various outbreaks, caused by different microorganisms, in the same hospital and all analyzed with the same method. It shows a large variation within the average costs due to different factors (e.g. closure of wards, type of ward). All outbreaks however cost considerable amounts of efforts and money (up to €356,754), including missed revenue and control measures.

  7. Family Environment, Educational Aspirations, and Academic Achievement in Two Cultural Settings.

    ERIC Educational Resources Information Center

    Seginer, Rachel; Vermulst, Ad

    2002-01-01

    Tested a four-step model involving family background parental support and demandingness, educational aspirations, and academic achievement. Data came from Israeli eighth graders within two cultural settings: transition to modernity (Arabs) and Western (Jews). Family background directly and indirectly affected academic achievement among Arabs but…

  8. Patient awareness of breast density and interest in supplemental screening tests: comparison of an academic facility and a county hospital.

    PubMed

    Trinh, Long; Ikeda, Debra M; Miyake, Kanae K; Trinh, Jennifer; Lee, Kevin K; Dave, Haatal; Hanafusa, Kei; Lipson, Jafi

    2015-03-01

    The aim of this study was to measure women's knowledge of breast density and their attitudes toward supplemental screening tests in the setting of the California Breast Density Notification Law at an academic facility and a county hospital, serving women with higher and lower socioeconomic status, respectively. Institutional review board exemptions were obtained. A survey was administered during screening mammography at two facilities, assessing women's awareness of and interest in knowing their breast density and interest in and willingness to pay for supplemental whole breast ultrasound and contrast-enhanced spectral mammography (CEMG). The results were compared by using Fisher exact tests between groups. A total of 105 of 130 and 132 of 153 women responded to the survey at the academic and county facilities, respectively. Among respondents at the academic and county facilities, 23% and 5% were aware of their breast density, and 94% and 79% wanted to know their density. A majority were interested in supplemental ultrasonography and CEMG at both sites; however, fewer women had a willingness to pay for the supplemental tests at the county hospital compared with those at the academic facility (22% and 70%, respectively, for ultrasound, P < .0001; 20% and 65%, respectively, for CEMG, P < .0001). Both groups of women were interested in knowing their breast density and in supplemental screening tests. However, women at the county hospital were less willing to incur out-of-pocket expenses, suggesting a potential for a disparity in health care access for women of lower socioeconomic status after the enactment of breast density notification legislation. Published by Elsevier Inc.

  9. Variations in costs for the care of low-birth-weight infants among academic hospitals.

    PubMed

    Herrod, Henry G; Chang, Cyril F; Steinberg, Stephanie S

    2010-05-01

    To determine the relative role that academic hospitals (AHs) play in providing neonatal care for low-birth-weight infants within a single state and to determine if there are variations in inpatient costs for neonatal services among AHs. Retrospective analysis of hospital costs for low-birth-weight infants. Cases were identified using 2003-2005 data from the Tennessee Hospital Discharge Data System. A specific focus was discharge data from the 5 AHs that support obstetrical residencies and have a neonatal intensive care unit. Cases included all discharged infants with a birth weight of <2500 grams. The 5 AHs discharged 18% of the total normal-birth-weight infants and 30% of the low-birth-weight infants for the entire state. AHs had higher costs associated with these infants than did other hospitals, with a single exception The difference in costs at this hospital was consistent with the finding of lower utilization rates of hospital services, a shorter average length of stay, and lower costs for infants insured by the state Medicaid program. Academic obstetrical hospitals discharged a disproportionately high percentage of low-birth-weight infants compared with other Tennessee hospitals. The lower costs observed in the Shelby County hospital indicates that other hospitals could potentially lower their costs for the care of low-birth-weight infants.

  10. Improving operating room efficiency in academic children's hospital using Lean Six Sigma methodology.

    PubMed

    Tagge, Edward P; Thirumoorthi, Arul S; Lenart, John; Garberoglio, Carlos; Mitchell, Kenneth W

    2017-06-01

    Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital. In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves. Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001). These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology. Prospective comparative study, Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Mind-set interventions are a scalable treatment for academic underachievement.

    PubMed

    Paunesku, David; Walton, Gregory M; Romero, Carissa; Smith, Eric N; Yeager, David S; Dweck, Carol S

    2015-06-01

    The efficacy of academic-mind-set interventions has been demonstrated by small-scale, proof-of-concept interventions, generally delivered in person in one school at a time. Whether this approach could be a practical way to raise school achievement on a large scale remains unknown. We therefore delivered brief growth-mind-set and sense-of-purpose interventions through online modules to 1,594 students in 13 geographically diverse high schools. Both interventions were intended to help students persist when they experienced academic difficulty; thus, both were predicted to be most beneficial for poorly performing students. This was the case. Among students at risk of dropping out of high school (one third of the sample), each intervention raised students' semester grade point averages in core academic courses and increased the rate at which students performed satisfactorily in core courses by 6.4 percentage points. We discuss implications for the pipeline from theory to practice and for education reform. © The Author(s) 2015.

  12. Clinical Development of Cell Therapies: Setting the Stage for Academic Success.

    PubMed

    Abou-El-Enein, M; Volk, H-D; Reinke, P

    2017-01-01

    Cellular therapies have potential to treat a wide range of diseases with autologous immunotherapies showing unprecedented therapeutic promise in clinical trials. Such therapies are mainly developed by academic researchers applying small-scale production, targeting rare and unmet medical needs. Here, we highlight the clinical translation of immunotherapy product in an academic setting, which may serve as a success model for early academic development of cell-based therapeutics. © 2016 American Society for Clinical Pharmacology and Therapeutics.

  13. Total quality management in the hospital setting.

    PubMed

    Ernst, D F

    1994-01-01

    With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance (QA) programs. Hospitals have been faced with customer dissatisfaction with services, escalating costs, intense competition, and reduced reimbursement for services. As a result, many hospitals have incorporated total quality management (TQM), also known as continuous quality improvement (CQI) and quality improvement (QI), to improve quality care and decrease costs. This article examines the concept of TQM, its rationale, and how it can be implemented in a hospital. A comparison of TQM and QA is made. Examples of hospital implementation of TQM and problems and issues associated with TQM in the hospital setting are explored.

  14. Scheduling, revenue management, and fairness in an academic-hospital radiology division.

    PubMed

    Baum, Richard; Bertsimas, Dimitris; Kallus, Nathan

    2014-10-01

    Physician staff of academic hospitals today practice in several geographic locations including their main hospital. This is referred to as the extended campus. With extended campuses expanding, the growing complexity of a single division's schedule means that a naive approach to scheduling compromises revenue. Moreover, it may provide an unfair allocation of individual revenue, desirable or burdensome assignments, and the extent to which the preferences of each individual are met. This has adverse consequences on incentivization and employee satisfaction and is simply against business policy. We identify the daily scheduling of physicians in this context as an operational problem that incorporates scheduling, revenue management, and fairness. Noting previous success of operations research and optimization in each of these disciplines, we propose a simple unified optimization formulation of this scheduling problem using mixed-integer optimization. Through a study of implementing the approach at the Division of Angiography and Interventional Radiology at the Brigham and Women's Hospital, which is directed by one of the authors, we exemplify the flexibility of the model to adapt to specific applications, the tractability of solving the model in practical settings, and the significant impact of the approach, most notably in increasing revenue by 8.2% over previous operating revenue while adhering strictly to a codified fairness and objectivity. We found that the investment in implementing such a system is far outweighed by the large potential revenue increase and the other benefits outlined. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  15. Leadership and priority setting: the perspective of hospital CEOs.

    PubMed

    Reeleder, David; Goel, Vivek; Singer, Peter A; Martin, Douglas K

    2006-11-01

    The role of leadership in health care priority setting remains largely unexplored. While the management leadership literature has grown rapidly, the growing literature on priority setting in health care has looked in other directions to improve priority setting practices--to health economics and ethical approaches. Consequently, potential for improvement in hospital priority setting practices may be overlooked. A qualitative study involving interviews with 46 Ontario hospital CEOs was done to describe the role of leadership in priority setting through the perspective of hospital leaders. For the first time, we report a framework of leadership domains including vision, alignment, relationships, values and process to facilitate priority setting practices in health services' organizations. We believe this fledgling framework forms the basis for the sharing of good leadership practices for health reform. It also provides a leadership guide for decision makers to improve the quality of their leadership, and in so doing, we believe, the fairness of their priority setting.

  16. [State of development of the role of academic nursing staff at German university hospitals in 2015].

    PubMed

    Tannen, Antje; Feuchtinger, Johanna; Strohbücker, Barbara; Kocks, Andreas

    2017-02-01

    In order to meet the requirements of the increasing complexity of patient care it is recommended to promote more differentiated nursing staff structures and to integrate academic nurses, which is international standard and recommended by the German Science Council. The implementation level is unclear. What is the percentage of nurses with an academic degree at German university hospitals, and what are their task profiles? Standardised written survey by nursing directors of all 32 German university hospitals and medical universities in 2015. The response rate was 75 %. The ratio of nurses with an academic degree amounted to 1.7 % overall, and to 1.0 % in direct patient care. The activities of nurses with an academic degree correspond to international Advanced Nursing Practice approaches including conceptual development (76 %), support of evidence-based care (72 %), practice projects (64 %) and patient counselling (56 %). There were significant variations among hospitals nationwide concerning pay rates with a current lack of reliable pay structures. This is the first national survey to determine the quota of nurses with an academic degree in direct patient care. The ratio of 1 % is well below the 10 to 20 % recommended by the German Science Council - hence the need for immediate action and comprehensive reforms. A follow-up survey is planned for 2017. Copyright © 2016. Published by Elsevier GmbH.

  17. Setting healthcare priorities in hospitals: a review of empirical studies

    PubMed Central

    Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan

    2015-01-01

    Priority setting research has focused on the macro (national) and micro (bedside) level, leaving the meso (institutional, hospital) level relatively neglected. This is surprising given the key role that hospitals play in the delivery of healthcare services and the large proportion of health systems resources that they absorb. To explore the factors that impact upon priority setting at the hospital level, we conducted a thematic review of empirical studies. A systematic search of PubMed, EBSCOHOST, Econlit databases and Google scholar was supplemented by a search of key websites and a manual search of relevant papers’ reference lists. A total of 24 papers were identified from developed and developing countries. We applied a policy analysis framework to examine and synthesize the findings of the selected papers. Findings suggest that priority setting practice in hospitals was influenced by (1) contextual factors such as decision space, resource availability, financing arrangements, availability and use of information, organizational culture and leadership, (2) priority setting processes that depend on the type of priority setting activity, (3) content factors such as priority setting criteria and (4) actors, their interests and power relations. We observe that there is need for studies to examine these issues and the interplay between them in greater depth and propose a conceptual framework that might be useful in examining priority setting practices in hospitals. PMID:24604831

  18. WJG sets an example of internationalization for other Chinese academic journals.

    PubMed

    Zu, Guang-An

    2010-06-14

    Supported by the "Special Fund for Key Academic Journals" of the National Natural Science Foundation of China, World Journal of Gastroenterology (WJG) has become a high-impact international clinical medical journal due to the great efforts of Professor Lian-Sheng Ma, Editor-in-Chief, and his team over several years. Now, WJG has successfully achieved a high degree of internationalization and sets a good example for other Chinese academic journals.

  19. [GPs' self-perception of their own role compared with hospital, ambulatory, academic, and health organisation physicians].

    PubMed

    Daghio, Maria Monica; Gaglianò, Giuseppe; Bevini, Massimo; Cadioli, Tiziano; Delvecchio, Carlo; Guidetti, Patrizia; Lorenzetti, Manuela; Fattori, Giuseppe; Ciardullo, Anna Vittoria

    2005-05-01

    Aim of the present study was to explore how the 76 general practitioners (GPs) - serving Carpi district (90,000 residents) - value their own role compared with the hospital, ambulatory, academic, and health organisation physicians'. GPs had a positive self-image only in comparison with health organisation doctors (7 vs 7 grades). GPs disappointed with themselves when comparing their role with ambulatory (-1.6 grades), academic (-1.9 grades) and hospital doctors (-2.2 grades). Secondarily, GPs perceived patients' valuing their professional role mostly 'subordinate' to the other physicians', except health organisation colleagues'.

  20. Combining clinical practice and academic work in nursing: A qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals.

    PubMed

    van Oostveen, Catharina J; Goedhart, Nicole S; Francke, Anneke L; Vermeulen, Hester

    2017-12-01

    To obtain in-depth insight into the perceptions of nurse academics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Combining clinical practice and academic work facilitates the use of research findings for high-quality patient care. However, nurse academics move away from the bedside because clinical academic careers for nurses have not yet been established in the Netherlands. This qualitative study was conducted in two Dutch university hospitals and their affiliated medical faculties and universities of applied sciences. Data were collected between May 2015 and August 2016. We used purposive sampling for 24 interviews. We asked 14 participants in two focus groups for their perceptions of importance, facilitators and barriers in nurses' combined clinical and academic work in education and research. We audiotaped, transcribed and thematically analysed the interviews and focus groups. Three themes related to perceived importance, facilitators and barriers: culture, leadership and infrastructure. These themes represent deficiencies in facilitating clinical academic careers for nurses. The current nursing culture emphasises direct patient care, which is perceived as an academic misfit. Leadership is lacking at all levels, resulting in the underuse of nurse academics and the absence of supporting structures for nurses who combine clinical and academic work. The present nursing culture appears to be the root cause of the dearth of academic positions and established clinical academic posts. A culture change would require a show of leadership that would promote and enable combined research, teaching and clinical practice and that would introduce clinical academic career pathways for nurses. Meanwhile, nurse academics should collaborate with established medical academics for whom combined roles are mainstream, and they should take advantage of their established infrastructure

  1. To What Extent and Under Which Circumstances Are Growth Mind-Sets Important to Academic Achievement? Two Meta-Analyses.

    PubMed

    Sisk, Victoria F; Burgoyne, Alexander P; Sun, Jingze; Butler, Jennifer L; Macnamara, Brooke N

    2018-04-01

    Mind-sets (aka implicit theories) are beliefs about the nature of human attributes (e.g., intelligence). The theory holds that individuals with growth mind-sets (beliefs that attributes are malleable with effort) enjoy many positive outcomes-including higher academic achievement-while their peers who have fixed mind-sets experience negative outcomes. Given this relationship, interventions designed to increase students' growth mind-sets-thereby increasing their academic achievement-have been implemented in schools around the world. In our first meta-analysis ( k = 273, N = 365,915), we examined the strength of the relationship between mind-set and academic achievement and potential moderating factors. In our second meta-analysis ( k = 43, N = 57,155), we examined the effectiveness of mind-set interventions on academic achievement and potential moderating factors. Overall effects were weak for both meta-analyses. However, some results supported specific tenets of the theory, namely, that students with low socioeconomic status or who are academically at risk might benefit from mind-set interventions.

  2. WJG sets an example of internationalization for other Chinese academic journals

    PubMed Central

    Zu, Guang-An

    2010-01-01

    Supported by the “Special Fund for Key Academic Journals” of the National Natural Science Foundation of China, World Journal of Gastroenterology (WJG) has become a high-impact international clinical medical journal due to the great efforts of Professor Lian-Sheng Ma, Editor-in-Chief, and his team over several years. Now, WJG has successfully achieved a high degree of internationalization and sets a good example for other Chinese academic journals. PMID:20533589

  3. Do Changes in Hospital Outpatient Payments Affect the Setting of Care?

    PubMed Central

    He, Daifeng; Mellor, Jennifer M

    2013-01-01

    Objective To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting. Data Sources/Study Setting Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008. Study Design This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States. We estimate multivariate regressions of inguinal hernia surgery counts in the outpatient setting and in the inpatient setting. The key explanatory variable is the time-varying Medicare payment rate specific to the procedure and hospital. Control variables include time-varying hospital and county characteristics and hospital and year-fixed effects. Principal Findings Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate. Conclusions Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare's efforts to contain hospital outpatient costs. PMID:23701048

  4. Setting healthcare priorities in hospitals: a review of empirical studies.

    PubMed

    Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan

    2015-04-01

    Priority setting research has focused on the macro (national) and micro (bedside) level, leaving the meso (institutional, hospital) level relatively neglected. This is surprising given the key role that hospitals play in the delivery of healthcare services and the large proportion of health systems resources that they absorb. To explore the factors that impact upon priority setting at the hospital level, we conducted a thematic review of empirical studies. A systematic search of PubMed, EBSCOHOST, Econlit databases and Google scholar was supplemented by a search of key websites and a manual search of relevant papers' reference lists. A total of 24 papers were identified from developed and developing countries. We applied a policy analysis framework to examine and synthesize the findings of the selected papers. Findings suggest that priority setting practice in hospitals was influenced by (1) contextual factors such as decision space, resource availability, financing arrangements, availability and use of information, organizational culture and leadership, (2) priority setting processes that depend on the type of priority setting activity, (3) content factors such as priority setting criteria and (4) actors, their interests and power relations. We observe that there is need for studies to examine these issues and the interplay between them in greater depth and propose a conceptual framework that might be useful in examining priority setting practices in hospitals. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  5. The Evolution of the Council of Academic Hospitals of Ontario Statement of Principles--A Successful Harmonization Initiative

    ERIC Educational Resources Information Center

    Porter, Katie; Lampson, Sarah

    2011-01-01

    To improve efficiency, consistency and transparency in clinical trial contract negotiations with industry sponsors, a Council of Academic Hospitals of Ontario (CAHO) committee facilitated the development of standard principles for member hospitals to follow during contract negotiation. Hospitals were encouraged to provide a link to the CAHO…

  6. A networking approach to reduce academic and social isolation for junior doctors working in rural hospitals in India.

    PubMed

    Vyas, R; Zachariah, A; Swamidasan, I; Doris, P; Harris, I

    2012-07-01

    Graduates from Christian Medical College (CMC) Vellore face many challenges while doing their service obligation in smaller hospitals, including academic and social isolation. To overcome these challenges, CMC aspired through its Fellowship in Secondary Hospital Medicine (FSHM), a 1-year blended on-site and distance-learning program, to provide academic and social support through networking for junior doctors working in rural areas. The purpose of this paper is to report the evaluation of the networking components of the FSHM program, with a focus on whether it succeeded in providing academic and social support for these junior doctors. A mixed method evaluation was done using written surveys for students and faculty and telephone interviews for students. Evidence for validity was gathered for the written survey. Criteria for validity were also applied for the qualitative data analysis. The major strengths of networking with faculty and peers identified were that it provided social support,, academic support through discussion about patient management problems and a variety of cases seen in the hospital, guidance on projects and reminders about deadlines. Recommendations for improvement included use of videoconferencing and Yahoo Groups. It is useful to incorporate networking into distance-learning educational programs for providing support to junior doctors working in rural hospitals.

  7. Priority-setting and hospital strategic planning: a qualitative case study.

    PubMed

    Martin, Douglas; Shulman, Ken; Santiago-Sorrell, Patricia; Singer, Peter

    2003-10-01

    To describe and evaluate the priority-setting element of a hospital's strategic planning process. Qualitative case study and evaluation against the conditions of 'accountability for reasonableness' of a strategic planning process at a large urban university-affiliated hospital. The hospital's strategic planning process met the conditions of 'accountability for reasonableness' in large part. Specifically: the hospital based its decisions on reasons (both information and criteria) that the participants felt were relevant to the hospital; the number and type of participants were very extensive; the process, decisions and reasons were well communicated throughout the organization, using multiple communication vehicles; and the process included an ethical framework linked to an effort to evaluate and improve the process. However, there were opportunities to improve the process, particularly by giving participants more time to absorb the information relevant to priority-setting decisions, more time to take difficult decisions and some means to appeal or revise decisions. A case study linked to an evaluation using 'accountability for reasonableness' can serve to improve priority-setting in the context of hospital strategic planning.

  8. Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review.

    PubMed

    Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley

    2015-12-01

    Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings. A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes. In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice. The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings. © 2015 Occupational Therapy Australia.

  9. Factors Influencing Adoption of Hospital-Acquired Pressure Ulcer Prevention Programs in US Academic Medical Centers.

    PubMed

    Padula, William V; Valuck, Robert J; Makic, Mary Beth F; Wald, Heidi L

    2015-01-01

    Recent data show a decrease in hospital-acquired pressure ulcers (PUs) throughout US hospitals; these changes may be associated with increased success in implementing evidence-based practices for PU prevention. The purpose of this study was to identify wound care nurse perceptions of the primary factors that influenced the overall reduction of PUs. Cross-sectional descriptive survey. Surveys were sent to wound care nurses at 98 University HealthSystem Consortium (UHC) hospitals. The UHC consists of more than 120 academic medical centers and affiliated facilities across the United States. Responses solicited from this survey represented a geographically diverse set of hospitals from less than 200 beds to more than 1000 beds. The survey questionnaire used a framework of 7 internal and 5 external influential factors for implementing evidence-based practices for PU prevention. Internal influential factors queried included availability of nurse specialists, high nursing job turnover, high PU rates, and prevention campaigns. External influential factors included data sharing, Medicare nonpayment policy, and applications for Magnet recognition. Hospital-acquired PU prevention experts at UHC hospitals were contacted through the Wound, Ostomy and Continence Nurses Society membership directory to complete the questionnaire. Consenting participants were e-mailed a disclosure and online questionnaire; they were also sent monthly reminders until they either responded to the survey or declined participation. Fifty-five respondents (59% response rate) indicated several internal factors that influenced evidence-based practice: hospital prevention campaigns; the availability of nursing specialists; and the level of preventive knowledge among hospital staff. External influential factors included financial concerns; application for Magnet recognition; data sharing among peer institutions; and regulatory issues. These findings suggest that the Centers for Medicare & Medicaid Services

  10. SARS and hospital priority setting: a qualitative case study and evaluation.

    PubMed

    Bell, Jennifer A H; Hyland, Sylvia; DePellegrin, Tania; Upshur, Ross E G; Bernstein, Mark; Martin, Douglas K

    2004-12-19

    Priority setting is one of the most difficult issues facing hospitals because of funding restrictions and changing patient need. A deadly communicable disease outbreak, such as the Severe Acute Respiratory Syndrome (SARS) in Toronto in 2003, amplifies the difficulties of hospital priority setting. The purpose of this study is to describe and evaluate priority setting in a hospital in response to SARS using the ethical framework 'accountability for reasonableness'. This study was conducted at a large tertiary hospital in Toronto, Canada. There were two data sources: 1) over 200 key documents (e.g. emails, bulletins), and 2) 35 interviews with key informants. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Participants described the types of priority setting decisions, the decision making process and the reasoning used. Although the hospital leadership made an effort to meet the conditions of 'accountability for reasonableness', they acknowledged that the decision making was not ideal. We described good practices and opportunities for improvement. 'Accountability for reasonableness' is a framework that can be used to guide fair priority setting in health care organizations, such as hospitals. In the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain, and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less.

  11. A Sustained Partnership between a Haitian Children’s Hospital and North American Academic Medical Centers

    PubMed Central

    Koster, Michael P.; Williams, Jackson H.; Gautier, Jacqueline; Alce, Renee; Trappey, Bernard E.

    2017-01-01

    Global health initiatives from academic medical centers have rapidly proliferated over the last decade. This paper endeavors to describe our 5-year experience as an academic medical collaborative supporting healthcare delivery, medical training, and research at Hôpital Saint Damien-Nos Petits Frères et Soeurs, the only freestanding children’s hospital in Haiti. Descriptions of the history and current activities of our academic medical collaborative, its partnership and communication structure, its evolution to fill the expressed needs of our host site, its funding mechanisms, and its challenges and opportunities for the future are included. PMID:28611976

  12. A hospital discharge summary quality improvement program featuring individual and team-based feedback and academic detailing.

    PubMed

    Axon, Robert N; Penney, Fletcher T; Kyle, Thomas R; Zapka, Jane; Marsden, Justin; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

    2014-06-01

    Discharge summaries are an important component of hospital care transitions typically completed by interns in teaching hospitals. However, these documents are often not completed in a timely fashion or do not include pertinent details of hospitalization. This report outlines the development and impact of a curriculum intervention to improve the quality of discharge summaries by interns and residents in Internal Medicine. A previous study demonstrated that a discharge summary curriculum featuring individualized feedback was associated with improved summary quality, but few subsequent studies have described implementation of similar curricula. No information exists on the utility of other strategies such as team-based feedback or academic detailing. Study participants were 96 Internal Medicine intern and resident physicians at an academic medical center-based training program. A comprehensive evidence-based discharge summary quality improvement program was developed and implemented that featured a discharge summary template to facilitate summary preparation, individual feedback, team-based feedback, academic detailing and an objective discharge summary evaluation instrument. The discharge summary evaluation instrument had moderate interrater reliability (κ = 0.72). Discharge summary scores improved from mean score of 70% to 82% (P = 0.05). Interns and residents participating in this program also reported increased confidence in producing and critiquing summaries. A comprehensive discharge summary curriculum can be feasibly implemented within the context of a residency program. Team-based feedback and academic detailing may serve to reinforce individual feedback and extend program reach.

  13. Academic-Community Hospital Comparison of Vulnerabilities in Door-to-Needle Process for Acute Ischemic Stroke.

    PubMed

    Prabhakaran, Shyam; Khorzad, Rebeca; Brown, Alexandra; Nannicelli, Anna P; Khare, Rahul; Holl, Jane L

    2015-10-01

    Although best practices have been developed for achieving door-to-needle (DTN) times ≤60 minutes for stroke thrombolysis, critical DTN process failures persist. We sought to compare these failures in the Emergency Department at an academic medical center and a community hospital. Failure modes effects and criticality analysis was used to identify system and process failures. Multidisciplinary teams involved in DTN care participated in moderated sessions at each site. As a result, DTN process maps were created and potential failures and their causes, frequency, severity, and existing safeguards were identified. For each failure, a risk priority number and criticality score were calculated; failures were then ranked, with the highest scores representing the most critical failures and targets for intervention. We detected a total of 70 failures in 50 process steps and 76 failures in 42 process steps at the community hospital and academic medical center, respectively. At the community hospital, critical failures included (1) delay in registration because of Emergency Department overcrowding, (2) incorrect triage diagnosis among walk-in patients, and (3) delay in obtaining consent for thrombolytic treatment. At the academic medical center, critical failures included (1) incorrect triage diagnosis among walk-in patients, (2) delay in stroke team activation, and (3) delay in obtaining computed tomographic imaging. Although the identification of common critical failures suggests opportunities for a generalizable process redesign, differences in the criticality and nature of failures must be addressed at the individual hospital level, to develop robust and sustainable solutions to reduce DTN time. © 2015 American Heart Association, Inc.

  14. Physician clinical alignment and integration: a community-academic hospital approach.

    PubMed

    Salas-Lopez, Debbie; Weiss, Sandra Jarva; Nester, Brian; Whalen, Thomas

    2014-01-01

    An overwhelming need for change in the U.S. healthcare delivery system, coupled with the need to improve clinical and financial outcomes, has prompted hospitals to direct renewed efforts toward achieving high quality and cost-effectiveness. Additionally, with the dawn of accountable care organizations and increasing focus on patient expectations, hospitals have begun to seek physician partners through clinical alignment. Contrary to the unsuccessful alignment strategies of the 1990s, today's efforts are more mutually beneficial, driven by the need to achieve better care coordination, increased access to infrastructure, improved quality, and lower costs. In this article, we describe a large, academic, tertiary care hospital's approach to developing and implementing alignment and integration models with its collaboration-ready physicians and physician groups. We developed four models--short of physicians' employment with the organization--tailored to meet the needs of both the physician group and the hospital: (1) medical directorship (group physicians are appointed to serve as medical directors of a clinical area), (2) professional services agreement (specific clinical services, such as overnight admissions help, are contracted), (3) co-management services agreement (one specialty group co-manages all services within the specialty service lines), and (4) lease arrangement (closest in scope to employment, in which the hospital pays all expenses and receives all revenue). Successful hospital-physician alignment requires careful planning and the early engagement of legal counsel to ensure compliance with federal statutes. Establishing an integrated system with mutually identified goals better positions hospitals to deliver cost-effective and high-quality care under the new paradigm of healthcare reform.

  15. A task analysis of emergency physician activities in academic and community settings.

    PubMed

    Chisholm, Carey D; Weaver, Christopher S; Whenmouth, Laura; Giles, Beverly

    2011-08-01

    We characterize and compare the work activities, including peak patient loads, associated with the workplace in the academic and community emergency department (ED) settings. This allows assessment of the effect of future ED system operational changes and identifies potential sources contributing to medical error. This was an observational, time-motion study. Trained observers shadowed physicians, recording activities. Data included total interactions, distances walked, time sitting, patients concurrently treated, interruptions, break in tasks, physical contact with patients, hand washing, diagnostic tests ordered, and therapies rendered. Activities were classified as direct patient care, indirect patient care, or personal time with a priori definitions. There were 203 2-hour observation periods of 85 physicians at 2 academic EDs with 100,000 visits per year at each (N=160) and 2 community EDs with annual visits of 19,000 and 21,000 (N=43). Reported data present the median and minimum-maximum values per 2-hour period. Emergency physicians spent the majority of time on indirect care activities (academic 64 minutes, 29 to 91 minutes; community 55 min, 25 to 95 minutes), followed by direct care activities (academic 36 minutes, 6 to 79 minutes; community 41 minutes, 5 to 60 minutes). Personal time differed by location type (academic 6 minutes, 0 to 66 minutes; community 13 minutes, 0 to 69 minutes). All physicians simultaneously cared for multiple patients, with a median number of patients greater than 5 (academic 7 patients, 2 to 16 patients; community 6 patients, 2 to 12 patients). Emergency physicians spend the majority of their time involved in indirect patient care activities. They are frequently interrupted and interact with a large number of individuals. They care for a wide range of patients simultaneously, with surges in multiple patient care responsibilities. Physicians working in academic settings are interrupted at twice the rate of their community

  16. Drug discovery in an academic setting: playing to the strengths.

    PubMed

    Huryn, Donna M

    2013-03-14

    Drug discovery and medicinal chemistry initiatives in academia provide an opportunity to create a unique environment that is distinct from the traditional industrial model. Two characteristics of a university setting that are not usually associated with pharma are the ability to pursue high-risk projects and a depth of expertise, infrastructure, and capabilities in focused areas. Encouraging, supporting, and fostering drug discovery efforts that take advantage of these and other distinguishing characteristics of an academic setting can lead to novel and innovative therapies that might not be discovered otherwise.

  17. Setting limits through global budgeting: hospital cost containment in Rhode Island.

    PubMed

    Hackey, R B

    1996-01-01

    In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.

  18. Predictors of Situational Disengagement in the Academic Setting: The Contribution of Grades, Perceived Competence, and Academic Motivation

    ERIC Educational Resources Information Center

    Stephan, Yannick; Caudroit, Johan; Boiche, Julie; Sarrazin, Philippe

    2011-01-01

    Background: Although psychological disengagement is a well-documented phenomenon in the academic setting, the attempts to identify its predictors are scarce. In addition, existing research has mainly focused on chronic disengagement and less is known on the determinants of situational disengagement. Aims: The purpose of the present study was to…

  19. Exploring Shared Governance for an Academic Nursing Setting.

    PubMed

    Boswell, Carol; Opton, Laura; Owen, Donna C

    2017-04-01

    A beneficial work environment influences staff and employee satisfaction and contributes to enhanced organizational execution. This article communicates a literature review of the existing knowledge to describe the potential influence of job satisfaction, empowerment, and work engagement on a faculty and staff academic shared governance model and impact on the improvement of a healthy work environment. References from PubMed (from 1975 to 2014) and ERIC (from 2006 to 2016), along with manuscripts included in the reference lists of the selected articles, served as the basis of the review. Definitions and descriptions of shared governance in academic settings suggested the potential influence on the development of a faculty and staff shared governance model within a school of nursing on job satisfaction, empowerment, and work engagement, resulting in the maintenance of a healthy work environment. This shift is essential for the resilience of nursing academia and the building of novel, more inclusive approaches to innovation that tap into the talent and skill of all organizational members. [J Nurs Educ. 2017;56(4):197-203.]. Copyright 2017, SLACK Incorporated.

  20. What is the role of general internists in the tertiary or academic setting?

    PubMed

    Tanriover, Mine Durusu; Rigby, Shirley; van Hulsteijn, L Harry; Ferreira, Faustino; Oliveira, Narcisso; Schumm-Draeger, Petra-Maria; Weidanz, Frauke; Kramer, Mark H H

    2015-01-01

    The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research. In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As 'internal medicine is the cornerstone of every national healthcare system', academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  1. Cultural Diversity in the Curriculum: Perceptions and Attitudes of Irish Hospitality and Tourism Academics

    ERIC Educational Resources Information Center

    Devine, Frances; Hearns, Niamh; Baum, Tom; Murray, Anna

    2008-01-01

    Academics are facing significant challenges in preparing indigenous students for employment in the multicultural working environment of hospitality and tourism organisations. In dealing with the impact of the new skills and flexibilities demanded by increasing globalisation, the indigenous workforce needs to possess a multicultural perspective and…

  2. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature.

    PubMed

    Goodwin, Nicholas S; Spinks, Anneliese; Wasiak, Jason

    2016-08-01

    The aim of this systematic review was to determine the supporting evidence for the clinical use of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting. Two authors searched three databases (Ovid Medline, Ovid Embase and The Cochrane Library) for relevant English language articles published through September 2014. Reference lists, conference proceedings and non-indexed academic journals were manually searched. A separate search was conducted using the Internet search engine Google to source additional studies from burns advisory agencies, first aid bodies, military institutions, manufacturer and paramedic websites. Two authors independently assessed study eligibility and relevance of non-traditional data forms for inclusion. Studies were independently assessed and included if Hydrogel-based burn dressings (HBD) were examined in first aid practices in the pre-hospital setting. A total of 129 studies were considered for inclusion, of which no pre-hospital studies were identified. The review highlights that current use of HBD in the pre-hospital setting appears to be driven by sources of information that do not reflect the paramedic environment. We recommend researchers in the pre-hospital settings undertake clinical trials in this field. More so, the review supports the need for expert consensus to identify key demographic, clinical and injury outcomes for clinicians and researchers undertaking further research into the use of dressings as a first aid measure. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  3. Cognitive workload reduction in hospital information systems : Decision support for order set optimization.

    PubMed

    Gartner, Daniel; Zhang, Yiye; Padman, Rema

    2018-06-01

    Order sets are a critical component in hospital information systems that are expected to substantially reduce physicians' physical and cognitive workload and improve patient safety. Order sets represent time interval-clustered order items, such as medications prescribed at hospital admission, that are administered to patients during their hospital stay. In this paper, we develop a mathematical programming model and an exact and a heuristic solution procedure with the objective of minimizing physicians' cognitive workload associated with prescribing order sets. Furthermore, we provide structural insights into the problem which lead us to a valid lower bound on the order set size. In a case study using order data on Asthma patients with moderate complexity from a major pediatric hospital, we compare the hospital's current solution with the exact and heuristic solutions on a variety of performance metrics. Our computational results confirm our lower bound and reveal that using a time interval decomposition approach substantially reduces computation times for the mathematical program, as does a K -means clustering based decomposition approach which, however, does not guarantee optimality because it violates the lower bound. The results of comparing the mathematical program with the current order set configuration in the hospital indicates that cognitive workload can be reduced by about 20.2% by allowing 1 to 5 order sets, respectively. The comparison of the K -means based decomposition with the hospital's current configuration reveals a cognitive workload reduction of about 19.5%, also by allowing 1 to 5 order sets, respectively. We finally provide a decision support system to help practitioners analyze the current order set configuration, the results of the mathematical program and the heuristic approach.

  4. Acidosis in the hospital setting: is metformin a common precipitant?

    PubMed

    Scott, K A; Martin, J H; Inder, W J

    2010-05-01

    Acidosis is commonly seen in the acute hospital setting, and carries a high mortality. Metformin has been associated with lactic acidosis, but it is unclear how frequently this is a cause of acidosis in hospitalized inpatients. The aim of this study is to explore the underlying comorbidities and acute precipitants of acidosis in the hospital setting, including the relationship between type 2 diabetes (T2DM) and metformin use. Retrospective review. Cases of acidosis were identified using the hospital discharge code for acidosis for a 3-month period: October-December 2005. A total of 101 episodes of acidosis were identified: 29% had isolated respiratory acidosis, 31% had metabolic acidosis and 40% had a mixed respiratory and metabolic acidosis. There were 28 cases of confirmed lactic acidosis. Twenty-nine patients had T2DM, but only five of the subjects with T2DM had lactic acidosis; two were on metformin. The major risk factors for development of lactic acidosis were hepatic impairment (OR 33.8, P = 0.01), severe left ventricular dysfunction (OR 25.3, P = 0.074) and impaired renal function (OR 9.7, P = 0.09), but not metformin use. Most cases of metabolic and lactic acidosis in the hospital setting occur in patients not taking metformin. Hepatic, renal and cardiac dysfunction are more important predictors for the development of acidosis.

  5. The Interdisciplinary Geriatric/Gerontological Team in the Academic Setting.

    PubMed

    Mellor, M Joanna; Solomon, Renee

    1992-01-01

    Geriatric health care requires the services of an interdisciplinary health care team to assess, treat and order the social service needs of the older person, and this concept needs to be included in geriatric social work education. But while the necessity of interdisciplinary team care is recognized, little focus has been placed on the actual process of developing a functional team. The issues that arise-disparate terminologies, organizational and administrative differentials, turf-and the steps needed for a team to become viable are described, using an interdisciplinary team based in academia as a case model. The academic interdisciplinary team may easily become a forum for 'hot air' rather than a catalyst for good practice. This danger is reviewed with reference to stages in the interdisciplinary team development-- goal development group affiliation; team awareness; and goal evaluation. The chapter concludes with a discussion on the impact of the interdisciplinary team on faculty, students and the academic setting.

  6. Student Affairs and Academic Affairs Collaborations in the Community College Setting

    ERIC Educational Resources Information Center

    Gulley, Needham Yancey; Mullendore, Richard H.

    2014-01-01

    The relationship between academic affairs and student affairs units in higher education settings has traditionally and historically been troubled by the divergent understandings of each other's institutional role and the systematic division of labor between the two. However, for a variety of reasons, not the least of which is a desire to…

  7. Improving Exclusive Breastfeeding in an Urban Academic Hospital.

    PubMed

    Ward, Laura P; Williamson, Susan; Burke, Stephanie; Crawford-Hemphill, Ruby; Thompson, Amy M

    2017-02-01

    Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project. Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding. We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility. This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates. Copyright © 2017 by the American Academy of Pediatrics.

  8. The Relationship between Black Racial Identity and Academic Achievement in Urban Settings

    ERIC Educational Resources Information Center

    Harper, Brian E.

    2007-01-01

    This article examines the relationship between Black racial identity and academic achievement in urban settings. Using Mary Shelley's Frankenstein (1918) as a comparative framework, the author describes current practices and suggests practical applications of empirical findings for practicing classroom teachers of African American students.…

  9. Impact of State hospital rate setting on capital formation

    PubMed Central

    Cromwell, Jerry

    1987-01-01

    For this article, a new national data base of Medicare cost reports on more than 2,000 hospitals is used to measure the impact of State prospective rate setting on capital formation. Several investment measures are analyzed, both in nominal and real terms, using a combination of descriptive and multivariate techniques. Results indicate that, over the last decade, State hospital rate-setting programs have had little demonstrable effect on capital formation and they have not caused any significant aging of plant assets. Programs in both New York and Massachusetts were found to be associated with a slowing in the rate of bed growth, however, resulting in significant long-term cost savings. PMID:10312117

  10. Positioning academic medical centers and teaching hospitals to thrive in the next decade.

    PubMed

    Morris, D E

    1985-06-01

    Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification.

  11. The Prediction of College Student Academic Performance and Retention: Application of Expectancy and Goal Setting Theories

    ERIC Educational Resources Information Center

    Friedman, Barry A.; Mandel, Rhonda G.

    2010-01-01

    Student retention and performance in higher education are important issues for educators, students, and the nation facing critical professional labor shortages. Expectancy and goal setting theories were used to predict academic performance and college student retention. Students' academic expectancy motivation at the start of the college…

  12. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting.

    PubMed

    Scheepers, Renée A; Lases, Lenny S S; Arah, Onyebuchi A; Heineman, Maas Jan; Lombarts, Kiki M J M H

    2017-10-01

    Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.

  13. Nursing students' perceptions of their clinical learning environment in placements outside traditional hospital settings.

    PubMed

    Bjørk, Ida T; Berntsen, Karin; Brynildsen, Grethe; Hestetun, Margrete

    2014-10-01

    To explore students' opinions of the learning environment during clinical placement in settings outside traditional hospital settings. Clinical placement experiences may influence positively on nursing students attitudes towards the clinical setting in question. Most studies exploring the quality of clinical placements have targeted students' experience in hospital settings. The number of studies exploring students' experiences of the learning environment in healthcare settings outside of the hospital venue does not match the growing importance of such settings in the delivery of health care, nor the growing number of nurses needed in these venues. A survey design was used. The Clinical Learning Environment Inventory was administered to two cohorts of undergraduate nursing students (n = 184) after clinical placement in mental health care, home care and nursing home care. Nursing students' overall contentment with the learning environment was quite similar across all three placement areas. Students in mental health care had significantly higher scores on the subscale individualisation, and older students had significantly higher scores on the total scale. Compared with other studies where the Clinical Learning Environment Inventory has been used, the students' total scores in this study are similar or higher than scores in studies including students from hospital settings. Results from this study negate the negative views on clinical placements outside the hospital setting, especially those related to placements in nursing homes and mental healthcare settings. Students' experience of the learning environment during placements in mental health care, home care and nursing homes indicates the relevance of clinical education in settings outside the hospital setting. © 2014 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.

  14. Nursing students' perceptions of their clinical learning environment in placements outside traditional hospital settings

    PubMed Central

    Bjørk, Ida T; Berntsen, Karin; Brynildsen, Grethe; Hestetun, Margrete

    2014-01-01

    Aims and objectives To explore students' opinions of the learning environment during clinical placement in settings outside traditional hospital settings. Background Clinical placement experiences may influence positively on nursing students attitudes towards the clinical setting in question. Most studies exploring the quality of clinical placements have targeted students' experience in hospital settings. The number of studies exploring students' experiences of the learning environment in healthcare settings outside of the hospital venue does not match the growing importance of such settings in the delivery of health care, nor the growing number of nurses needed in these venues. Design A survey design was used. Method The Clinical Learning Environment Inventory was administered to two cohorts of undergraduate nursing students (n = 184) after clinical placement in mental health care, home care and nursing home care. Results Nursing students' overall contentment with the learning environment was quite similar across all three placement areas. Students in mental health care had significantly higher scores on the subscale individualisation, and older students had significantly higher scores on the total scale. Compared with other studies where the Clinical Learning Environment Inventory has been used, the students' total scores in this study are similar or higher than scores in studies including students from hospital settings. Conclusion Results from this study negate the negative views on clinical placements outside the hospital setting, especially those related to placements in nursing homes and mental healthcare settings. Relevance to clinical practice Students' experience of the learning environment during placements in mental health care, home care and nursing homes indicates the relevance of clinical education in settings outside the hospital setting. PMID:24460862

  15. The impact of the board's strategy-setting role on board-management relations and hospital performance.

    PubMed

    Büchner, Vera Antonia; Schreyögg, Jonas; Schultz, Carsten

    2014-01-01

    The appropriate governance of hospitals largely depends on effective cooperation between governing boards and hospital management. Governing boards play an important role in strategy-setting as part of their support for hospital management. However, in certain situations, this active strategic role may also generate discord within this relationship. The objective of this study is to investigate the impact of the roles, attributes, and processes of governing boards on hospital performance. We examine the impact of the governing board's strategy-setting role on board-management collaboration quality and on financial performance while also analyzing the interaction effects of board diversity and board activity level. The data are derived from a survey that was sent simultaneously to German hospitals and their associated governing board, combined with objective performance information from annual financial statements and quality reports. We use a structural equation modeling approach to test the model. The results indicate that different board characteristics have a significant impact on hospital performance (R = .37). The strategy-setting role and board-management collaboration quality have a positive effect on hospital performance, whereas the impact of strategy-setting on collaboration quality is negative. We find that the positive effect of strategy-setting on performance increases with decreasing board diversity. When board members have more homogeneous backgrounds and exhibit higher board activity levels, the negative effect of the strategy-setting on collaboration quality also increases. Active strategy-setting by a governing board may generally improve hospital performance. Diverse members of governing boards should be involved in strategy-setting for hospitals. However, high board-management collaboration quality may be compromised if managerial autonomy is too highly restricted. Consequently, hospitals should support board-management collaboration about

  16. An Elder Abuse Assessment Team in an Acute Hospital Setting.

    ERIC Educational Resources Information Center

    The Beth Israel Hospital Elder Assessment Team

    1986-01-01

    Describes a hospital-based multidisciplinary team designed to assess and respond to cases of suspected abuse or neglect of elders from both institutional and community settings. Presence of the team has increased the hospital staff's awareness of elder abuse and neglect, as well as their willingness to refer suspected cases for further assessment.…

  17. Pathways to Advancing Aging Policy-Relevant Research in Academic Settings

    PubMed Central

    KIETZMAN, KATHRYN G.; TROY, LISA M.; GREEN, CARMEN R.; WALLACE, STEVEN P.

    2016-01-01

    Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research. PMID:26849290

  18. Pathways to Advancing Aging Policy-Relevant Research in Academic Settings.

    PubMed

    Kietzman, Kathryn G; Troy, Lisa M; Green, Carmen R; Wallace, Steven P

    2016-01-01

    Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research.

  19. Exploring Rural High School Learners' Experience of Mathematics Anxiety in Academic Settings

    ERIC Educational Resources Information Center

    Hlalele, Dipane

    2012-01-01

    The purpose of the study was to explore rural high school learners' experience of mathematics anxiety in academic settings. Mathematics anxiety has been found to have an adverse effect on confidence, motivation and achievement. This quantitative study is exploratory and descriptive in nature. The participants were 403 learners doing mathematics in…

  20. [A paradigm change in German academic medicine. Merger and privatization as exemplified with the university hospitals in Marburg and Giessen].

    PubMed

    Maisch, Bernhard

    2005-03-01

    1. The intended fusion of the university hospitals Marburg and Giessen in the state of Hessia is "a marriage under pressure with uncalculated risk" (Spiegel 2005). In the present political and financial situation it hardly appears to be avoidable. From the point of the view of the faculty of medicine in Marburg it is difficult to understand, that the profits of this well guided university hospital with a positive yearly budget should go to the neighboring university hospital which still had a fair amount of deficit spending in the last years.2. Both medical faculties suffer from a very low budget from the state of Hessia for research and teaching. Giessen much more than Marburg, have a substantial need for investments in buildings and infrastructure. Both institutions have a similar need for investments in costly medical apparatuses. This is a problem, which many university hospitals face nowadays.3. The intended privatisation of one or both university hospitals will need sound answers to several fundamental questions and problems:a) A privatisation potentially endangers the freedom of research and teaching garanteed by the German constitution. A private company will undoubtedly influence by active or missing additional support the direction of research in the respective academic institution. An example is the priorisation of clinical in contrast to basic research.b) With the privatisation practical absurdities in the separation of research and teaching on one side and hospital care on the other will become obvious with respect to the status of the academic employees, the obligatory taxation (16%) when a transfer of labor from one institution to the other is taken into account. The use of rooms for seminars, lectures and bedside with a double function for both teaching, research and hospital care has to be clarified with a convincing solution in everyday practice.c) The potential additional acquisition of patients, which has been advocated by the Hessian state

  1. Academic health center teaching hospitals in transition: a perspective from the field.

    PubMed

    Cyphert, S T; Colloton, J W; Levey, S

    1997-01-01

    A study of 11 Academic Health Center Teaching Hospitals (ATHs) in 11 states found that cost reduction programs, internal reorganizations, reengineering, benchmarking, and broadened entrepreneurial activity were prominent among the strategic initiatives reported in dealing with an increasingly turbulent environment. Although none of the ATHs had experienced negative net margins, we conclude that today's competitive healthcare system requires ATHs be reimbursed separately for their educational and other societally related costs to assist them in competing on a level playing fields.

  2. Between Two Advisors: Interconnecting Academic and Workplace Settings in an Emerging Field

    ERIC Educational Resources Information Center

    Hytönen, Kaisa; Palonen, Tuire; Lehtinen, Erno; Hakkarainen, Kai

    2016-01-01

    This article examines a new training design for continuing professional development that aims to support the learning of the novel knowledge and skills needed in emerging professional fields by interconnecting academic and workplace settings. The training design is based on using two advisors, one from working life and the other from an academic…

  3. Nurses' knowledge of inhaler technique in the inpatient hospital setting.

    PubMed

    De Tratto, Katie; Gomez, Christy; Ryan, Catherine J; Bracken, Nina; Steffen, Alana; Corbridge, Susan J

    2014-01-01

    High rates of inhaler misuse in patients with chronic obstructive pulmonary disease and asthma contribute to hospital readmissions and increased healthcare cost. The purpose of this study was to examine inpatient staff nurses' self-perception of their knowledge of proper inhaler technique compared with demonstrated technique and frequency of providing patients with inhaler technique teaching during hospitalization and at discharge. A prospective, descriptive study. A 495-bed urban academic medical center in the Midwest United States. A convenience sample of 100 nurses working on inpatient medical units. Participants completed a 5-item, 4-point Likert-scale survey evaluating self-perception of inhaler technique knowledge, frequency of providing patient education, and responsibility for providing education. Participants demonstrated inhaler technique to the investigators using both a metered dose inhaler (MDI) and Diskus device inhaler, and performance was measured via a validated checklist. Overall misuse rates were high for both MDI and Diskus devices. There was poor correlation between perceived ability and investigator-measured performance of inhaler technique. Frequency of education during hospitalization and at discharge was related to measured level of performance for the Diskus device but not for the MDI. Nurses are a key component of patient education in the hospital; however, nursing staff lack adequate knowledge of inhaler technique. Identifying gaps in nursing knowledge regarding proper inhaler technique and patient education about proper inhaler technique is important to design interventions that may positively impact patient outcomes. Interventions could include one-on-one education, Web-based education, unit-based education, or hospital-wide competency-based education. All should include return demonstration of appropriate technique.

  4. The effect of health care reform on academic medicine in Canada. Editorial Committee of the Canadian Institute for Academic Medicine.

    PubMed

    Hollenberg, C H

    1996-05-15

    Although Canadian health care reform has constrained costs and improved efficiency, it has had a profound and mixed effect on Canadian academic medicine. Teaching hospitals have been reduced in number and size, and in patient programs have shifted to ambulatory and community settings. Specialized care programs are now multi-institutional and multidisciplinary. Furthermore, the influence of regional planning bodies has grown markedly. Although these changes have likely improved clinical service, their impact on the quality of clinical education is uncertain. Within the academic clinical department, recruitment of young faculty has been greatly complicated by constraints on licensing, billing numbers, fee-for-service income and research funding. The departmental practice plan based on university funds and fee-for-service income is being replaced by less favourable funding arrangements. However, emphasis on multidisciplinary programs has rendered these departments more flexible in structure. The future of Canadian academic medicine depends on an effective alliance with government. Academia and government must agree, particularly on human-resource requirements, research objectives and the delivery of clinical and academic programs in regional and community settings. The establishment of focal points for academic health sciences planning within academic health sciences centres and within governments would assist in these developments. Finally, government and the academic health sciences sector must work together to remove the current impediments to the recruitment of highly qualified young faculty.

  5. Community-Academic Partnerships: Developing a Service-Learning Framework.

    PubMed

    Voss, Heather C; Mathews, Launa Rae; Fossen, Traci; Scott, Ginger; Schaefer, Michele

    2015-01-01

    Academic partnerships with hospitals and health care agencies for authentic clinical learning have become a major focus of schools of nursing and professional nursing organizations. Formal academic partnerships in community settings are less common despite evolving models of care delivery outside of inpatient settings. Community-Academic partnerships are commonly developed as a means to engage nursing students in service-learning experiences with an emphasis on student outcomes. The benefit of service-learning projects on community partners and populations receiving the service is largely unknown primarily due to the lack of structure for identifying and measuring outcomes specific to service-learning. Nursing students and their faculty engaged in service-learning have a unique opportunity to collaborate with community partners to evaluate benefits of service-learning projects on those receiving the service. This article describes the development of a service-learning framework as a first step toward successful measurement of the benefits of undergraduate nursing students' service-learning projects on community agencies and the people they serve through a collaborative community-academic partnership. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Immediate Symptom Relief After a First Session of Massage Therapy or Reiki in Hospitalized Patients: A 5-year Clinical Experience from a Rural Academic Medical Center.

    PubMed

    Vergo, Maxwell T; Pinkson, Briane M; Broglio, Kathleen; Li, Zhongze; Tosteson, Tor D

    2018-04-05

    There is an increasing demand for and use of alternative and complementary therapies, such as reiki and massage therapy, in hospital-based settings. Most controlled studies and practice-based reports include oncology and surgical patient populations; thus the effect in a more heterogeneous hospitalized patient population is hard to estimate. We examined the immediate symptom relief from a single reiki or massage session in a hospitalized population at a rural academic medical center. Retrospective analysis of prospectively collected data on demographic, clinical, process, and quality of life for hospitalized patients receiving massage therapy or reiki. A 396-bed rural academic and tertiary medical center in the United States. Hospitalized patients requesting or referred to the healing arts team who received either a massage or reiki session and completed both a pre- and post-therapy symptom questionnaire. First session of routine reiki or massage therapy during a hospital stay. Differences between pre- and postsession patient-reported scores in pain, nausea, fatigue, anxiety, depression, and overall well-being using an 11-point Likert scale. Patients reported symptom relief with both reiki and massage therapy. Analysis of the reported data showed reiki improved fatigue (-2.06 vs. -1.55 p < 0.0001) and anxiety (-2.21 vs. -1.84 p < 0.001) statistically more than massage. Pain, nausea, depression, and well being changes were not statistically different between reiki and massage encounters. Immediate symptom relief was similar for cancer and noncancer patients for both reiki and massage therapy and did not vary based on age, gender, length of session, and baseline symptoms. Reiki and massage clinically provide similar improvements in pain, nausea, fatigue, anxiety, depression, and overall well-being while reiki improved fatigue and anxiety more than massage therapy in a heterogeneous hospitalized patient population. Controlled trials should be considered to

  7. Tracking the demise of state hospital rate setting.

    PubMed

    McDonough, J E

    1997-01-01

    From its once preeminent position in state health policy, prospective hospital rate setting has declined in use from more than thirty states in 1980 to two today. This essay tracks the trend toward deregulation in various states--especially Massachusetts, New Jersey, and New York-- and examines the continuation of rate setting in Maryland. Principally, the decline reflects the development of managed care and capitation as alternative means to control health spending growth. This trend represents both an evolution in prospective payment methodology and a renewed preference for private over public-sector price controls.

  8. Setting quality and safety priorities in a target-rich environment: an academic medical center's challenge.

    PubMed

    Mort, Elizabeth A; Demehin, Akinluwa A; Marple, Keith B; McCullough, Kathryn Y; Meyer, Gregg S

    2013-08-01

    Hospitals are continually challenged to provide safer and higher-quality patient care despite resource constraints. With an ever-increasing range of quality and safety targets at the national, state, and local levels, prioritization is crucial in effective institutional quality goal setting and resource allocation.Organizational goal-setting theory is a performance improvement methodology with strong results across many industries. The authors describe a structured goal-setting process they have established at Massachusetts General Hospital for setting annual institutional quality and safety goals. Begun in 2008, this process has been conducted on an annual basis. Quality and safety data are gathered from many sources, both internal and external to the hospital. These data are collated and classified, and multiple approaches are used to identify the most pressing quality issues facing the institution. The conclusions are subject to stringent internal review, and then the top quality goals of the institution are chosen. Specific tactical initiatives and executive owners are assigned to each goal, and metrics are selected to track performance. A reporting tool based on these tactics and metrics is used to deliver progress updates to senior hospital leadership.The hospital has experienced excellent results and strong organizational buy-in using this effective, low-cost, and replicable goal-setting process. It has led to improvements in structural, process, and outcomes aspects of quality.

  9. Pediatric nurse staffing and quality of care in the hospital setting.

    PubMed

    Stratton, Karen M

    2008-01-01

    Indicators of quality and nurse staffing in pediatrics are distinct from adults. A retrospective, correlational, linear mixed model design was used to describe relationships between pediatric nurse staffing and 5 indicators of quality care from a convenience sample of 7 academic children's hospitals. Key findings supported a strong inverse relationship between the proportion of hours of pediatric nursing care delivered by registered nurses and the rate of occurrence of central line (P < .001) and bloodstream infections (P < .05). Supplemental nurse staffing hours also demonstrated relationships between bloodstream infections and parent/family complaints.

  10. Assessment of Oropharyngeal and Laryngeal Cancer Treatment Delay in a Private and Safety Net Hospital System.

    PubMed

    Perlow, Haley K; Ramey, Stephen J; Silver, Ben; Kwon, Deukwoo; Chinea, Felix M; Samuels, Stuart E; Samuels, Michael A; Elsayyad, Nagy; Yechieli, Raphael

    2018-04-01

    Objective To examine the impact of treatment setting and demographic factors on oropharyngeal and laryngeal cancer time to treatment initiation (TTI). Study Design Retrospective case series. Setting Safety net hospital and adjacent private academic hospital. Subjects and Methods Demographic, staging, and treatment details were retrospectively collected for 239 patients treated from January 1, 2014, to June 30, 2016. TTI was defined as days between diagnostic biopsy and initiation of curative treatment (defined as first day of radiotherapy [RT], surgery, or chemotherapy). Results On multivariable analysis, safety net hospital treatment (vs private academic hospital treatment), initial diagnosis at outside hospital, and oropharyngeal cancer (vs laryngeal cancer) were all associated with increased TTI. Surgical treatment, severe comorbidity, and both N1 and N2 status were associated with decreased TTI. Conclusion Safety net hospital treatment was associated with increased TTI. No differences in TTI were found when language spoken and socioeconomic status were examined in the overall cohort.

  11. Music in a Hospital Setting: A Multifaceted Experience

    ERIC Educational Resources Information Center

    Preti, Costanza; Welch, Graham F.

    2004-01-01

    The article offers an explanation of the effects of music on children within a hospital setting and points up the multifaceted nature of this experience. The nature of the client group allows the musical experience to work on many different levels, such as modifying the child's perception of pain and reducing stress, whilst at the same time having…

  12. Modifying the Toyota Production System for continuous performance improvement in an academic children's hospital.

    PubMed

    Stapleton, F Bruder; Hendricks, James; Hagan, Patrick; DelBeccaro, Mark

    2009-08-01

    The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

  13. Academic season does not influence cardiac surgical outcomes at US Academic Medical Centers.

    PubMed

    Lapar, Damien J; Bhamidipati, Castigliano M; Mery, Carlos M; Stukenborg, George J; Lau, Christine L; Kron, Irving L; Ailawadi, Gorav

    2011-06-01

    Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals and non-cardiothoracic teaching hospitals nationwide. From 2003 to 2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample database. Patients undergoing cardiac operations at cardiothoracic teaching and non-cardiothoracic teaching hospitals were identified using the Association of American Medical College's Graduate Medical Education Tracking System. Hierarchic multivariable logistic regression analyses were used to estimate the effect of academic quarter on risk-adjusted outcomes. Mean patient age was 65.9 ± 10.9 years. Women accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%), followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate were 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p = 0.12) or morbidity (p = 0.24) at academic medical centers. Risk-adjusted mortality and morbidity for cardiac operations were not associated with time of year in the US at teaching and nonteaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Comparing Academic Library Spending with Public Libraries, Public K-12 Schools, Higher Education Public Institutions, and Public Hospitals between 1998-2008

    ERIC Educational Resources Information Center

    Regazzi, John J.

    2012-01-01

    This study compares the overall spending trends and patterns of growth of Academic Libraries with Public Libraries, K-12 schools, higher education institutions, and hospitals in the period of 1998 to 2008. Academic Libraries, while showing a growth of 13% over inflation for the period, far underperformed the growth of the other public institutions…

  15. Variables Affecting University Academic Achievement in a Distance- versus a Conventional Education Setting.

    ERIC Educational Resources Information Center

    Darwazeh, Afnan N.

    The aim of this study was to investigate some of the learner variables that may have an influence on university academic achievement in a distance versus a conventional education setting. Descriptive and analytical statistics were used to analyze data by using "Pearson r," and "F-test." Results revealed that the university…

  16. IAIMS and JCAHO: implications for hospital librarians. Integrated Academic Information Management Systems. Joint Commission on Accreditation of Healthcare Organizations.

    PubMed Central

    Doyle, J D

    1999-01-01

    The roles of hospital librarians have evolved from keeping print materials to serving as a focal point for information services and structures within the hospital. Concepts that emerged from the Integrated Academic Information Management Systems (IAIMS) as described in the Matheson Report and the 1994 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards have combined to propel hospital libraries into many new roles and functions. This paper will review the relationship of the two frameworks, provide a view of their commonalities, and establish the advantages of both for hospital librarianship as a profession. PMID:10550022

  17. The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized?

    PubMed

    Lau, Christine; Stilos, Kalli; Nowell, Allyson; Lau, Fanchea; Moore, Jennifer; Wynnychuk, Lesia

    2018-04-01

    Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital. We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not. A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016. Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P < .05. The use of CMOS resulted in 1.7 adjustments to symptom management per patient by palliative care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P < .05. However, initiating CMOS did not result in a signficant difference in patient distress around the time of death ( P = .11). Dyspnea was the most frequently identified symptom causing distress in actively dying patients. Implementation of the CMOS is helpful in providing a foundation to a comfort approach in imminently dying patients. However, more education on its utility as a framework for EOL care and assessment across the organization is still required.

  18. Job Stress and Burnout among Academic Career Anaesthesiologists at an Egyptian University Hospital.

    PubMed

    Shams, Tarek; El-Masry, Ragaa

    2013-05-01

    There is compelling evidence that anaesthesiology is a stressful occupation and, when this stressful occupation is associated with an academic career, the burnout level is high. This study aimed to assess the predictors and prevalence of stress and burnout, associated sociodemographic characteristics, and job-related features. A cross-sectional survey study was carried out at Mansoura University Hospital in Egypt among 98 anaesthesiologists who had academic careers. The English version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale and the Workplace Stress Scale of the American Institute of Stress were used to measure job stress and burnout. Data were analysed according to the guidelines for data processing and an analysis of the scales used. The participation rate of this study was 73.1%, where 69.4% were encountering job stress, while 62.2% experienced emotional exhaustion, 56.1% depersonalisation, and 58.2% reduced personal capacity. There was a significant positive correlation between job stress and MBI-HSS subscales. Residents and assistant lecturers were the most affected group. The strongest significant single predictor of all burnout dimensions was a lack of job support. Stress and burnout among academic anaesthesiologists were caused by the lack of job support; this was especially true among residents and assistant lecturers. We can conclude that a well-organised institutional strategy to mitigate the heavy professional demands of academic anaesthesiologists' will relieve their stress and burnout.

  19. Job Stress and Burnout among Academic Career Anaesthesiologists at an Egyptian University Hospital

    PubMed Central

    Shams, Tarek; El-Masry, Ragaa

    2013-01-01

    Objectives: There is compelling evidence that anaesthesiology is a stressful occupation and, when this stressful occupation is associated with an academic career, the burnout level is high. This study aimed to assess the predictors and prevalence of stress and burnout, associated sociodemographic characteristics, and job-related features. Methods: A cross-sectional survey study was carried out at Mansoura University Hospital in Egypt among 98 anaesthesiologists who had academic careers. The English version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale and the Workplace Stress Scale of the American Institute of Stress were used to measure job stress and burnout. Data were analysed according to the guidelines for data processing and an analysis of the scales used. Results: The participation rate of this study was 73.1%, where 69.4% were encountering job stress, while 62.2% experienced emotional exhaustion, 56.1% depersonalisation, and 58.2% reduced personal capacity. There was a significant positive correlation between job stress and MBI-HSS subscales. Residents and assistant lecturers were the most affected group. The strongest significant single predictor of all burnout dimensions was a lack of job support. Conclusion: Stress and burnout among academic anaesthesiologists were caused by the lack of job support; this was especially true among residents and assistant lecturers. We can conclude that a well-organised institutional strategy to mitigate the heavy professional demands of academic anaesthesiologists’ will relieve their stress and burnout. PMID:23862036

  20. The implementation and evaluation of therapeutic touch in burn patients: an instructive experience of conducting a scientific study within a non-academic nursing setting.

    PubMed

    Busch, Martine; Visser, Adriaan; Eybrechts, Maggie; van Komen, Rob; Oen, Irma; Olff, Miranda; Dokter, Jan; Boxma, Han

    2012-12-01

    Evaluation of therapeutic touch (TT) in the nursing of burn patients; post hoc evaluation of the research process in a non-academic nursing setting. 38 burn patients received either TT or nursing presence. On admission, days 2, 5 and 10 of hospitalization, data were collected on anxiety for pain, salivary cortisol, and pain medication. Interviews with nurses were held concerning research in a non-academic setting. Anxiety for pain was more reduced on day 10 in the TT-group. The TT-group was prescribed less morphine on day 1 and 2. On day 2 cortisol level before dressing changes was higher in the TT-group. The situational challenges of this study led to inconsistencies in data collection and a high patient attrition rate, weakening its statistical power. Conducting an effect study within daily nursing practice should not be done with a nursing staff inexperienced in research. Analysis of the remaining data justifies further research on TT for burn patients with pain, anxiety for pain, and cortisol levels as outcomes. Administering and evaluating TT during daily care requires nurses experienced both in TT and research, thus leading to less attrition and missing data, increasing the power of future studies. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Learning Patient Safety in Academic Settings: A Comparative Study of Finnish and British Nursing Students' Perceptions.

    PubMed

    Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

    2015-06-01

    Globalization of health care demands nursing education programs that equip students with evidence-based patient safety competences in the global context. Nursing students' entrance into clinical placements requires professional readiness. Thus, evidence-based learning activities about patient safety must be provided in academic settings prior to students' clinical placements. To explore and compare Finnish and British nursing students' perceptions of learning about patient safety in academic settings to inform nursing educators about designing future education curriculum. A purpose-designed instrument, Patient Safety in Nursing Education Questionnaire (PaSNEQ) was used to examine the perceptions of Finnish (n = 195) and British (n = 158) nursing students prior to their final year of registration. Data were collected in two Finnish and two English nursing schools in 2012. Logistic regressions were used to analyze the differences. British students reported more inclusion (p < .001) of "gaining knowledge," "training skills," and "highlighting affirmative attitudes and motivation" related to patient safety in their programs. Both student groups considered patient safety education to be more valuable for their own learning than what their programs had provided. Training patient safety skills in the academic settings were the strongest predictors for differences (odds ratio [OR] = 34.69, 95% confidence interval [CI] 7.39-162.83), along with work experience in the healthcare sector (OR = 3.02, 95% CI 1.39-6.58). To prepare nursing students for practical work, training related to clear communication, reporting errors, systems-based approaches, interprofessional teamwork, and use of simulation in academic settings requires comprehensive attention, especially in Finland. Overall, designing patient safety-affirming nursing curricula in collaboration with students may enhance their positive experiences on teaching and learning about patient safety. An international

  2. Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya.

    PubMed

    Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan

    2017-02-01

    There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system 'hardware' (resource scarcity) and 'software' (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  3. Implementing Medical Teaching Policy in University Hospitals

    ERIC Educational Resources Information Center

    Engbers, Rik; Fluit, Cornelia Cornelia R. M. G.; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F. J. M.

    2017-01-01

    Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have…

  4. The Concept of Happiness and Moral Development of "Filipinas" in the Academic Setting

    ERIC Educational Resources Information Center

    Mallari, Shedy Dee C.; Ebreo, Edleen P.; Pelayo, Jose Maria G., III.

    2015-01-01

    This study determined salient themes of female individuals who are inside the academic setting on their concept of happiness and moral development. The idea of studying the Filipina Female Concept of Happiness came from two areas of study--Female Psychology and Positive Psychology. The researchers were intrigued by the idea that since the female…

  5. Dual Enrollment Programs: A Comparative Study of High School Students' College Academic Achievement at Different Settings

    ERIC Educational Resources Information Center

    Flores, Agnes L. Acker

    2012-01-01

    The "ex post facto" causal-comparative study examined the academic achievement of high school students who took their dual credit English or mathematics college credit-bearing course in two different environments, namely, the college setting and the high school setting. Due to non-experimental nature of the study, no causal inferences…

  6. Historical evidence for the origin of teaching hospital, medical school and the rise of academic medicine.

    PubMed

    Modanlou, H D

    2011-04-01

    Historical progression and the development of current teaching hospitals, medical schools and biomedical research originated from the people of many civilizations and cultures. Greeks, Indians, Syriacs, Persians and Jews, assembled first in Gondi-Shapur during the Sasanian empire in Persia, and later in Baghdad during the Golden Age of Islam, ushering the birth of current academic medicine.

  7. Opportunities and Design Considerations for Peer Support in a Hospital Setting.

    PubMed

    Haldar, Shefali; Mishra, Sonali R; Khelifi, Maher; Pollack, Ari H; Pratt, Wanda

    2017-05-01

    Although research has demonstrated improved outcomes for outpatients who receive peer support-such as through online health communities, support groups, and mentoring systems-hospitalized patients have few mechanisms to receive such valuable support. To explore the opportunities for a hospital-based peer support system, we administered a survey to 146 pediatric patients and caregivers, and conducted semi-structured interviews with twelve patients and three caregivers in a children's hospital. Our analysis revealed that hospitalized individuals need peer support for five key purposes: (1) to ask about medical details-such as procedures, treatments, and medications; (2) to learn about healthcare providers; (3) to report and prevent medical errors; (4) to exchange emotional support; and (5) to manage their time in the hospital. In this paper, we examine these themes and describe potential barriers to using a hospital-based peer support system. We then discuss the unique opportunities and challenges that the hospital environment presents when designing for peer support in this setting.

  8. Mergers involving academic health centers: a formidable challenge.

    PubMed

    Pellegrini, V D

    2001-10-01

    Escalating economic pressures on the clinical enterprise threaten the missions of education and research in many of the most prestigious academic health centers. Following the model of industry, mergers of the healthcare delivery systems of teaching hospitals and clinics held promise for economies of scale and an improved operating margin. Failure to follow business principles in constructing the merged entity, differences in organizational governance and culture, and inability of physician leadership to prioritize, downsize, and consolidate clinical programs to optimize operational efficiencies all compromise the success of such mergers in academic medicine. Academic institutions and their respective governing boards need to exercise greater discipline in financial analysis and a willingness to make difficult decisions that show favor to one parent institution over another if mergers are to be effective in this setting. To date, an example of a vibrant and successful merger of academic health centers remains to be found.

  9. Paraprofessional-Delivered Video Prompting to Teach Academics to Students with Severe Disabilities in Inclusive Settings.

    PubMed

    Knight, Victoria F; Kuntz, Emily M; Brown, Melissa

    2018-06-01

    Video prompting is effective for teaching a variety of skills (e.g., daily living, communication) to students with autism and intellectual disability; yet, little research exists on the efficacy of these strategies on academic skills, in inclusive settings, and with typical intervention agents. Authors collaborated with paraprofessionals to select socially important academic skills (i.e., literacy, social studies, science, and math) aligned with students' IEPs and content taught in their inclusive classes. Results from the multiple probe across participants and skills design indicated a functional relation between the paraprofessional-delivered video prompting and correct responding to academic tasks for all three elementary students with autism and intellectual disability. Implications for practitioners, study limitations, and recommendations for future research are discussed.

  10. Priority setting in developing countries health care institutions: the case of a Ugandan hospital

    PubMed Central

    Kapiriri, Lydia; Martin, Douglas K

    2006-01-01

    Background Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. However, there is lack of literature that describes and evaluates priority setting in these contexts. The objective of this paper is to describe priority setting in a teaching hospital in Uganda and evaluate the description against an ethical framework for fair priority setting processes – Accountability for Reasonableness. Methods A case study in a 1,500 bed national referral hospital receiving 1,320 out patients per day and an average budget of US$ 13.5 million per year. We reviewed documents and carried out 70 in-depth interviews (14 health planners, 40 doctors, and 16 nurses working at the hospital). Interviews were recorded and transcribed. Data analysis employed the modified thematic approach to describe priority setting, and the description was evaluated using the four conditions of Accountability for Reasonableness: relevance, publicity, revisions and enforcement. Results Senior managers, guided by the hospital strategic plan make the hospital budget allocation decisions. Frontline practitioners expressed lack of knowledge of the process. Relevance: Priority is given according to a cluster of factors including need, emergencies and patient volume. However, surgical departments and departments whose leaders "make a lot of noise" are also prioritized. Publicity: Decisions, but not reasons, are publicized through general meetings and circulars, but this information does not always reach the frontline practitioners. Publicity to the general public was through ad hoc radio programs and to patients who directly ask. Revisions: There were no formal mechanisms for challenging the reasoning. Enforcement: There were no mechanisms to ensure adherence to the four conditions of a fair process. Conclusion Priority setting decisions at this hospital do not

  11. A Successful US Academic Collaborative Supporting Medical Education in a Postconflict Setting.

    PubMed

    McQuilkin, Patricia; Marshall, Roseda E; Niescierenko, Michelle; Tubman, Venée N; Olson, Bradley G; Staton, Donna; Williams, Jackson H; Graham, Elinor A

    2014-01-01

    This article describes a model employed by the Academic Collaborative to Support Medical Education in Liberia to augment medical education in a postconflict setting where the health and educational structures and funding are very limited. We effectively utilized a cohort of visiting US pediatric faculty and trainees for short-term but recurrent clinical work and teaching. This model allows US academic medical centers, especially those with smaller residency programs, to provide global health experiences for faculty and trainees while contributing to the strengthening of medical education in the host country. Those involved can work toward a goal of sustainable training with a strengthened host country specialty education system. Partnerships such as ours evolve over time and succeed by meeting the needs of the host country, even during unanticipated challenges, such as the Ebola virus outbreak in West Africa.

  12. Diabetes quality of care in academic endocrinology practice: a descriptive study.

    PubMed

    Shah, Baiju R; James, Jacqueline E; Lawton, Carolyn; Montada-Atin, Tess; Sigmond, Marianne; Cauch-Dudek, Karen; Booth, Gillian L

    2009-01-01

    To describe the quality of diabetes care delivered by academic endocrinologists practicing at 4 teaching hospitals affiliated with a single medical school. Up to 30 patients who first saw an endocrinologist for an ambulatory consultation for diabetes between January 2004 and December 2005 were randomly selected for chart review. Process and intermediate measures of quality of care were abstracted. There were 417 patient charts available for analysis. Quality of care was generally high, with 61% of patients achieving a glycated hemoglobin of ≤7.0%, 77% achieving blood pressure ≤130/80 mm Hg and 73% achieving a low-density lipoprotein cholesterol level of ≤2.5 mmol/L. More than 80% of patients had had eye examinations, microalbuminuria screening and foot examinations. There were no significant differences in quality between hospitals. The quality of diabetes care delivered by academic endocrinologists in this setting was high and approached the "ideal" levels of care recommended by practice guidelines. Compared to past studies in both the primary and specialist care settings, the results show that high-quality care can be delivered in routine academic clinical practice without having previously instituted a specific quality improvement program. Copyright © 2009 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  13. An Academic Approach to Stress Management for College Students in a Conventional Classroom Setting.

    ERIC Educational Resources Information Center

    Carnahan, Robert E.; And Others

    Since the identification of stress and the relationship of individual stress responses to physical and mental health, medical and behavioral professionals have been training individuals in coping strategies. To investigate the possibility of teaching cognitive coping skills to a nonclinical population in an academic setting, 41 college students…

  14. Hypodermoclysis therapy. In a chronic care hospital setting.

    PubMed

    Worobec, G; Brown, M K

    1997-06-01

    Occasionally, elderly patients experience acute, episodic incidents of illness that result in dehydration or a high potential for dehydration (e.g., flu, diarrhea). At times, patients may be unable, or refuse, to take fluids orally. Enteral routes via a nasogastric tube or enteral stomach tube may also not be available. In the past, these patients often had to be transferred from home or long-term care facilities to an acute care hospital for intravenous therapy. A transfer of the acutely ill elderly patient to an acute care hospital is often very stressful to the patient and his/her family and is costly to the health care delivery system. Hypodermoclysis, the process of rehydrating a patient by providing isotonic fluids into the subcutaneous tissues over a short time period, provides an alternative method to deal with acute, short-term fluid deficit problems in the elderly. Hypodermoclysis therapy can be administered in a chronic care setting thus potentially decreasing the need to transfer the elderly client to an acute care hospital. The purpose of this study was to investigate the use of hypodermoclysis therapy in solving acute, or potentially acute fluid deficit problems, that were anticipated to be both reversible and short term in nature. This was carried out in an elderly population that resided in a 284-bed chronic care hospital in southern Ontario.

  15. The development of hospital-based palliative care services in public hospitals in the Western Cape, South Africa.

    PubMed

    Gwyther, L; Krause, R; Cupido, C; Stanford, J; Grey, H; Credé, T; De Vos, A; Arendse, J; Raubenheimer, P

    2018-02-01

    With the recent approval of a South African (SA) National Policy Framework and Strategy for Palliative Care by the National Health Council, it is pertinent to reflect on initiatives to develop palliative care services in public hospitals. This article reviews the development of hospital-based palliative care services in the Western Cape, SA. Palliative care services in SA started in the non-governmental sector in the 1980s. The first SA hospital-based palliative care team was established in Charlotte Maxeke Johannesburg Academic Hospital in 2001. The awareness of the benefit of palliative care in the hospital setting led to the development of isolated pockets of excellence providing palliative care in the public health sector in SA. This article describes models for palliative care at tertiary, provincial and district hospital level, which could inform development of hospital-based palliative care as the national policy for palliative care is implemented in SA.

  16. Is Treating Oral and Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center.

    PubMed

    DeLuke, Dean M; Agarwal, Vickas; Holleman, Trevor; Carrico, Caroline K; Laskin, Daniel M

    2017-02-01

    During the past 2 decades, there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. Although many factors can influence the decision not to take trauma call, 1 primary disincentive is the perception that managing facial trauma might be profitable for the hospital, but not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the Virginia Commonwealth University (VCU) Medical Center (Richmond, VA). In this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery at VCU (VCUOMS) from June 2011 through July 2014. Cost and reimbursement data were analyzed for these patients from the VCU Health System (VCUHS) and the VCUOMS. For the hospital, actual cost data were provided; for the surgeon, cost was calculated based on an average overhead of 50%. For uniformity, patients were excluded if they remained in the hospital for longer than a 23-hour observation period. Patients younger than 18 years also were excluded. In total, 169 patients met the inclusion criteria. There was a statistically relevant difference in the percentage of costs recouped and the actual profit. The average percentage of costs recouped was 230% for the VCUHS versus 47% for the VCUOMS. This amounts to an average profit per case of $3,461 for the hospital versus a loss of $1,162 for the surgeon. The results of this study indicate that in the VCU Medical Center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. Although the results are limited to outpatient management at 1 academic institution, they suggest that hospitals in some settings might be in a position to incentivize surgeons for trauma management. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons

  17. 25 CFR 36.83 - How many hours can a student be taken out of the academic setting to receive behavioral health...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true How many hours can a student be taken out of the academic..., DEPARTMENT OF THE INTERIOR EDUCATION MINIMUM ACADEMIC STANDARDS FOR THE BASIC EDUCATION OF INDIAN CHILDREN... a student be taken out of the academic setting to receive behavioral health services? A student may...

  18. 25 CFR 36.83 - How many hours can a student be taken out of the academic setting to receive behavioral health...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false How many hours can a student be taken out of the academic..., DEPARTMENT OF THE INTERIOR EDUCATION MINIMUM ACADEMIC STANDARDS FOR THE BASIC EDUCATION OF INDIAN CHILDREN... a student be taken out of the academic setting to receive behavioral health services? A student may...

  19. 25 CFR 36.83 - How many hours can a student be taken out of the academic setting to receive behavioral health...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false How many hours can a student be taken out of the academic..., DEPARTMENT OF THE INTERIOR EDUCATION MINIMUM ACADEMIC STANDARDS FOR THE BASIC EDUCATION OF INDIAN CHILDREN... a student be taken out of the academic setting to receive behavioral health services? A student may...

  20. 25 CFR 36.83 - How many hours can a student be taken out of the academic setting to receive behavioral health...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false How many hours can a student be taken out of the academic..., DEPARTMENT OF THE INTERIOR EDUCATION MINIMUM ACADEMIC STANDARDS FOR THE BASIC EDUCATION OF INDIAN CHILDREN... a student be taken out of the academic setting to receive behavioral health services? A student may...

  1. Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service.

    PubMed

    Fung, Russell; Hyde, Jensen Hart; Davis, Mike

    2018-01-01

    The process of admitting patients from the emergency department (ED) to an academic internal medicine (AIM) service in a community teaching hospital is one fraught with variability and disorder. This results in an inconsistent volume of patients admitted to academic versus private hospitalist services and results in frustration of both ED and AIM clinicians. We postulated that implementation of a mobile application (app) would improve provider satisfaction and increase admissions to the academic service. The app was designed and implemented to be easily accessible to ED physicians, regularly updated by academic residents on call, and a real-time source of the number of open AIM admission spots. We found a significant improvement in ED and AIM provider satisfaction with the admission process. There was also a significant increase in admissions to the AIM service after implementation of the app. We submit that the implementation of a mobile app is a viable, cost-efficient, and effective method to streamline the admission process from the ED to AIM services at community-based hospitals.

  2. Strategic Planning for Information Systems: The Evidence from a Successful Implementation in an Academic Setting.

    ERIC Educational Resources Information Center

    Carter, Richard B.; And Others

    1991-01-01

    Demonstrates how an information systems plan can be successfully developed and implemented within an academic setting. Six guidelines for information systems planning are provided; problems are identified and recommendations to address the problems are suggested; and information systems objectives are discussed, including business communications,…

  3. [The Health Technology Assessment Engine of the Academic Hospital of Udine: first appraisal].

    PubMed

    Vidale, Claudia

    2014-01-01

    The Health Technology Assessment Engine (HTAE) of the Academic Hospital of Udine aggregates about one hundred of health technology assessment websites. It was born thanks to Google technology in 2008 and after about four years of testing it became public for everybody from the Homepage of the Italian Society of Health Technology Assessment (SIHTA). In this paper the first results obtained with this resource are reported. The role of the scientific librarian is examined not only as a support specialist in bibliographic search but also as a creative expert in managing new technologies for the community.

  4. Computerized Testing in a Hospital Setting: Psychometric and Psychological Effects.

    ERIC Educational Resources Information Center

    Peterson, Leif; And Others

    1996-01-01

    This Swedish study sought to evaluate a touch-screen computer-based (CB) test administration system in a hospital setting in comparison with paper-and-pencil administrative routine. Patients were given psychometric tests (involving depression, mood, and intelligence measurement) in both formats. Patient pleasantness, activation, and calmness were…

  5. Data linkage of inpatient hospitalization and workers' claims data sets to characterize occupational falls.

    PubMed

    Bunn, Terry L; Slavova, Svetla; Bathke, Arne

    2007-07-01

    The identification of industry, occupation, and associated injury costs for worker falls in Kentucky have not been fully examined. The purpose of this study was to determine the associations between industry and occupation and 1) hospitalization length of stay; 2) hospitalization charges; and 3) workers' claims costs in workers suffering falls, using linked inpatient hospitalization discharge and workers' claims data sets. Hospitalization cases were selected with ICD-9-CM external cause of injury codes for falls and payer code of workers' claims for years 2000-2004. Selection criteria for workers'claims cases were International Association of Industrial Accident Boards and Commissions Electronic Data Interchange Nature (IAIABCEDIN) injuries coded as falls and/or slips. Common data variables between the two data sets such as date of birth, gender, date of injury, and hospital admission date were used to perform probabilistic data linkage using LinkSolv software. Statistical analysis was performed with non-parametric tests. Construction falls were the most prevalent for male workers and incurred the highest hospitalization and workers' compensation costs, whereas most female worker falls occurred in the services industry. The largest percentage of male worker falls was from one level to another, while the largest percentage of females experienced a fall, slip, or trip (not otherwise classified). When male construction worker falls were further analyzed, laborers and helpers had longer hospital stays as well as higher total charges when the worker fell from one level to another. Data linkage of hospitalization and workers' claims falls data provides additional information on industry, occupation, and costs that are not available when examining either data set alone.

  6. Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for Parkinson's disease: a United States Nationwide Inpatient Sample analysis from 2006 to 2010.

    PubMed

    Sharma, Mayur; Ambekar, Sudheer; Guthikonda, Bharat; Wilden, Jessica; Nanda, Anil

    2013-11-01

    The aim of this study was to analyze the incidence of adverse outcomes, complications, inpatient mortality, length of hospital stay, and the factors affecting them between academic and nonacademic centers after deep brain stimulation (DBS) surgery for Parkinson's disease (PD). The authors also analyzed the impact of various factors on the total hospitalization charges after this procedure. This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2006 to 2010. Various patient and hospital variables were analyzed from the database. The adverse discharge disposition and the higher cost of hospitalization were taken as the dependent variables. A total of 2244 patients who underwent surgical treatment for PD were identified from the database. The mean age was 64.22 ± 9.8 years and 68.7% (n = 1523) of the patients were male. The majority of the patients was discharged to home or self-care (87.9%, n = 1972). The majority of the procedures was performed at high-volume centers (64.8%, n = 1453), at academic institutions (85.33%, n = 1915), in urban areas (n = 2158, 96.16%), and at hospitals with a large bedsize (86.6%, n = 1907) in the West or South. Adverse discharge disposition was more likely in elderly patients (OR > 1, p = 0.011) with high comorbidity index (OR 1.508 [95% CI 1.148-1.98], p = 0.004) and those with complications (OR 3.155 [95% CI 1.202-8.279], p = 0.033). A hospital with a larger annual caseload was an independent predictor of adverse discharge disposition (OR 3.543 [95% CI 1.781-7.048], p < 0.001), whereas patients treated by physicians with high case volumes had significantly better outcomes (p = 0.006). The median total cost of hospitalization had increased by 6% from 2006 through 2010. Hospitals with a smaller case volume (OR 0.093, p < 0.001), private hospitals (OR 11.027, p < 0.001), nonteaching hospitals (OR 3.139, p = 0.003), and hospitals in the West compared with hospitals in Northeast and the Midwest (OR 1.885 [p

  7. Are Australasian academic physicians an endangered species?

    PubMed

    Wilson, A

    2007-11-01

    It has been stated that academic medicine is in a worldwide crisis. Is this decline in hospital academic practice a predictable consequence of modern clinical practice with its emphasis on community and outpatient-based services as well as a corporate health-care ethos or does it relate to innate problems in the training process and career structure for academic clinicians? A better understanding of the barriers to involvement in academic practice, including the effect of gender, the role and effect of overseas training, expectation of further research degrees and issues pertaining to the Australian academic workplace will facilitate recruitment and retention of the next generation of academic clinicians. Physician-scientists remain highly relevant as medical practice and education evolves in the 21st century. Hospital-based academics carry out a critical role in the ongoing mentoring of trainees and junior colleagues, whose training is still largely hospital based in most specialty programmes. Academic clinicians are uniquely placed to translate the rapid advances in medical biology into the clinical sphere, by guiding and carrying out translational research as well as leading clinical studies. Academic physicians also play key leadership in relations with government and industry, in professional groups and medical colleges. Thus, there is a strong case to assess the problems facing recruitment and retention of physician-scientists in academic practice and to develop workable solutions.

  8. Making Sense of Clinical Practice: Order Set Design Strategies in CPOE

    PubMed Central

    Novak, Laurie L.

    2007-01-01

    A case study was conducted during the customization phase of a commercial CPOE system at a multi-hospital, academic health system. The study focused on the development of order sets. Three distinct approaches to order set development were observed: Empirical, Local Consensus and Departmental. The three approaches are first described and then examined using the framework of sensemaking. Different approaches to sensemaking in the context of order set development reflect variations in sources of knowledge related to the standardization of care. PMID:18693900

  9. What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions?

    PubMed Central

    Reeleder, David; Martin, Douglas K; Keresztes, Christian; Singer, Peter A

    2005-01-01

    Background Priority setting, also known as rationing or resource allocation, occurs at all levels of every health care system. Daniels and Sabin have proposed a framework for priority setting in health care institutions called 'accountability for reasonableness', which links priority setting to theories of democratic deliberation. Fairness is a key goal of priority setting. According to 'accountability for reasonableness', health care institutions engaged in priority setting have a claim to fairness if they satisfy four conditions of relevance, publicity, appeals/revision, and enforcement. This is the first study which has surveyed the views of hospital decision makers throughout an entire health system about the fairness of priority setting in their institutions. The purpose of this study is to elicit hospital decision-makers' self-report of the fairness of priority setting in their hospitals using an explicit conceptual framework, 'accountability for reasonableness'. Methods 160 Ontario hospital Chief Executive Officers, or their designates, were asked to complete a survey questionnaire concerning priority setting in their publicly funded institutions. Eight-six Ontario hospitals completed this survey, for a response rate of 54%. Six close-ended rating scale questions (e.g. Overall, how fair is priority setting at your hospital?), and 3 open-ended questions (e.g. What do you see as the goal(s) of priority setting in your hospital?) were used. Results Overall, 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to the 'accountability for reasonableness' conditions, respondents indicated their hospitals performed best for the relevance (75.0%) condition, followed by appeals/revision (56.6%), publicity (56.0%), and enforcement (39.5%). Conclusions For the first time hospital Chief Executive Officers within an entire health system were surveyed about the fairness of priority setting practices in their institutions using the

  10. Hospital agenda to prioritize. Interview by Donald E. Johnson..

    PubMed

    Forsyth, J D

    1991-09-01

    How does a teaching hospital balance the needs of patient care with its educational mission? What changes in focus must the CEO make to accommodate reductions in federal funding while maintaining academic excellence? In the following interview with Health Care Strategic Management's Donald E. L. Johnson, John D. Forsyth, executive director of the University of Michigan Hospitals, discusses the challenges facing his institution. The interview focuses on many topics including setting priorities, funding researchers and countering any "anti-science" perceptions.

  11. Translational science and the hidden research system in universities and academic hospitals: a case study.

    PubMed

    Lander, Bryn; Atkinson-Grosjean, Janet

    2011-02-01

    Innovation systems (IS) and science policy scholarship predominantly focus on linkages between universities and industry, and the commercial translation of academic discoveries. Overlooked in such analyses are important connections between universities and academic hospitals, and the non-commercial aspects of translational science. The two types of institutions tend to be collapsed into a single entity-'the university'-and relational flows are lost. Yet the distinctions and flows between the two are crucial elements of translational science and the biomedical innovation system. This paper explores what has been called the 'hidden research system' that connects hospitals, universities, and their resources, with the clinical and scientific actors who make the linkages possible. Then, using a novel conceptual model of translational science, we examine the individual interactions and dynamics involved in a particular example of the biomedical innovation system at work: the diagnosis of IRAK-4 deficiency, a rare immunological disorder, and the translational flows that result. Contra to conventional IS analyses, we are able to point to the strong role of public-sector institutions, and the weak role of the private-sector, in the translational processes described here. Our research was conducted within a Canadian network of scientists and clinician-scientists studying the pathogenomics of immunological disorders and innate immunity. Copyright © 2010 Elsevier Ltd. All rights reserved.

  12. Experience in Strategic Networking to Promote Palliative Care in a Clinical Academic Setting in India

    PubMed Central

    Nair, Shoba; Tarey, SD; Barathi, B; Mary, Thiophin Regina; Mathew, Lovely; Daniel, Sudha Pauline

    2016-01-01

    Background: Palliative care in low and middle-income countries is a new discipline, responding to a greater patient need, than in high-income countries. By its very nature, palliative as a specialty has to network with other specialties to provide quality care to patients. For any medical discipline to grow as a specialty, it should be well established in the teaching medical institutions of that country. Data show that palliative care is more likely to establish and grow in an academic health care institution. It is a necessity that multiple networking strategies are adopted to reach this goal. Objectives: (1) To describe a strategic approach to palliative care service development and integration into clinical academic setting. (2) To present the change in metrics to evaluate progress. Design and Setting: This is a descriptive study wherein, the different strategies that are adopted by the Department of Palliative Medicine for networking in an academic health care institution and outside the institution are scrutinized. Measurement: The impact of this networking was assessed, one, at the level of academics and the other, at the level of service. The number of people who attended various training programs conducted by the department and the number of patients who availed palliative care service over the years were assessed. Results: Ten different strategies were identified that helped with networking of palliative care in the institution. During this time, the referrals to the department increased both for malignant diseases (52–395) and nonmalignant diseases (5–353) from 2000 to 2013. The academic sessions conducted by the department for undergraduates also saw an increase in the number of hours from 6 to 12, apart from the increase in a number of courses conducted by the department for doctors and nurses. Conclusion: Networking is an essential strategy for the establishment of a relatively new medical discipline like palliative care in a developing and

  13. Effects of Goal-Setting Skills on Students'academic Performance in English Language in Enugu Nigeria

    ERIC Educational Resources Information Center

    Abe, Iyabo Idowu; Ilogu, Guy Chibuzoh; Madueke, Ify Louisa

    2014-01-01

    The study investigated the effectiveness of goal-setting skills among Senior Secondary II students' academic performance in English language in Enugu Metropolis, Enugu state, Nigeria. Quasi-experimental pre-test, post-test control group design was adopted for the study. The initial sample was 147 participants (male and female) Senior Secondary…

  14. Exploring Students' Perceptions of Academic Disengagement and Reengagement in a Dropout Recovery Charter School Setting

    ERIC Educational Resources Information Center

    Iachini, Aidyn L.; Buettner, Cynthia; Anderson-Butcher, Dawn; Reno, Rebecca

    2013-01-01

    The purpose of this exploratory case study was to understand the academic disengagement and reengagement process from the perspective of students enrolled in a dropout recovery charter school. Specifically, this study focused on students' perceptions of the factors that influenced their lack of success in the traditional school setting, the…

  15. Royal london hospital set P28 plans 30th anniversary reunion.

    PubMed

    Sibthorpe, Fran

    2013-04-03

    Members of Set P28 at the Royal London Hospital who began their training in February 1980 are planning a reunion on July 27 in London. The venue will be announced later. Email fran-joy@hotmail.com for details.

  16. Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

    PubMed

    Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

    2009-02-01

    The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.

  17. An academic-based hospital donor site: do physicians donate blood?

    PubMed

    Kanner, William A; Jeffus, Susanne; Wehrli, Gay

    2009-01-01

    The objectives of this prospective, cross-sectional study were to characterize blood donors in an academic-based hospital donor center, to determine whether physicians donate, and to elucidate the donation impetus. A confidential survey was issued to presenting, potential donors over 200 weekdays. Three questions were asked: their role at the institution, if and when they had previously donated blood, and what prompted the current donation. The majority of the 687 respondents were institution-affiliated (73.5%) and 79.3% had previously donated, with a median of 3 mo since the prior donation. Only 21 (3.1%) respondents were physicians. The predominant reasons for donor presentation were an appointment, knowing it had been 8 wk since the last donation, and contact by the blood center to donate. This study shows the dearth of physician blood donors and a strong cohort of institution-affiliated repeat donors. Physicians represent a potential, stable, and sustainable donor pool; further studies are needed to establish physician recruitment programs.

  18. NEEDLE KNIFE SPHINCTEROTOMY - THE CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL EXPERIENCE.

    PubMed

    Thomson, J T; Smith, M D; Omoshoro-Jones, J A O; Devar, J D; Khan, Z K; Jugmohan, B J

    2017-06-01

    Deep biliary cannulation is essential in performing a therapeutic ERCP. Cannulation can be enhanced through the utilization of a pre-cut by means of a needle knife sphincterotomy. Retrospective analysis of the Chris Hani Baragwanath Academic Hospital's ERCP database was performed. All ERCPs performed with the aid of a needle knife were identified and analysed for successful and unsuccessful deep biliary cannulation. 2830 ERCPs were performed during the study period. 369 (13%) required needle knife sphincterotomies and successful deep biliary cannulation was achieved in 229 (62%) of these patients. Repeat ERCPs were performed on 125 (34%) patients. 61 (49%) of the repeat ERCPs were performed because of previously failed cannulation. 34 (56%) of these repeat ERCPs resulted in successful deep biliary cannulation at re-attempt. 99% of successful cannulations at repeat ERCP had had a needle knife sphincterotomy at the first ERCP. Needle knife sphincterotomy improves deep biliary cannulation at initial ERCP and subsequent ERCPs with low incidences of complications.

  19. Patients transferred to academic medical centers and other hospitals: characteristics, resource use, and outcomes.

    PubMed

    Wyatt, S M; Moy, E; Levin, R J; Lawton, K B; Witter, D M; Valente, E; Lala, R; Griner, P F

    1997-10-01

    As purchasers of health care increasingly rely on hospital resource use and outcomes profiles to guide quality improvement efforts and contract decisions, a better understanding of the contribution of the most severely ill patients to aggregate resource use and outcomes is needed to develop measures that make fair comparisons between hospitals. In this article, the authors examine the distribution, resource utilization, and outcomes of transferred patients ("transfers"), a group known to be highly complex. The study examines the contributions to resource use and outcomes of these patients at academic medical centers (AMCs) and non-teaching hospitals. The authors go beyond previous work by comparing AMCs with non-teaching hospitals, and by using a nationally representative sample for the year 1992. The detailed findings demonstrated that AMCs provided a disproportionate share of care to transfers in 1992, and that transfers to AMCs are more complex and require more specialized care than do transfers to non-teaching hospitals. The study also determined that, during the time studied, AMCs received a disproportionate share of Medicaid and indigentcare transfers. Finally, the findings demonstrated that transfers increased in absolute numbers and as a percentage of total patient volumes for all hospitals from 1988 to 1994. The rate of increase was greatest for AMCs. The authors explain why they believe that their findings are applicable today, although they caution that study of more recent data should be made. The authors comment that purchasers of health care may find the study useful in better understanding benchmarking tools used to evaluate hospitals. This study may also help those involved in health policy to more fully understand the magnitude of the contribution to transfer patient care provided by AMCs. Finally, health policymakers and planners may find this work useful as they prepare for increasing numbers of transfers in the future, particularly at AMCs.

  20. Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

    PubMed

    Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

    2017-08-01

    Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  1. Neighborhood poverty rate and mortality in patients receiving critical care in the academic medical center setting.

    PubMed

    Zager, Sam; Mendu, Mallika L; Chang, Domingo; Bazick, Heidi S; Braun, Andrea B; Gibbons, Fiona K; Christopher, Kenneth B

    2011-06-01

    Poverty is associated with increased risk of chronic illness but its contribution to critical care outcome is not well defined. We performed a multicenter observational study of 38,917 patients, aged ≥ 18 years, who received critical care between 1997 and 2007. The patients were treated in two academic medical centers in Boston, Massachusetts. Data sources included 1990 US census and hospital administrative data. The exposure of interest was neighborhood poverty rate, categorized as < 5%, 5% to 10%, 10% to 20%, 20% to 40% and > 40%. Neighborhood poverty rate is the percentage of residents below the federal poverty line. Census tracts were used as the geographic units of analysis. Logistic regression examined death by days 30, 90, and 365 post-critical care initiation and in-hospital mortality. Adjusted ORs were estimated by multivariable logistic regression models. Sensitivity analysis was performed for 1-year postdischarge mortality among patients discharged to home. Following multivariable adjustment, neighborhood poverty rate was not associated with all-cause 30-day mortality: 5% to 10% OR, 1.05 (95% CI, 0.98-1.14; P = .2); 10% to 20% OR, 0.96 (95% CI, 0.87-1.06; P = .5); 20% to 40% OR, 1.08 (95% CI, 0.96-1.22; P = .2); > 40% OR, 1.20 (95% CI, 0.90-1.60; P = .2); referent in each is < 5%. Similar nonsignificant associations were noted at 90-day and 365-day mortality post-critical care initiation and in-hospital mortality. Among patients discharged to home, neighborhood poverty rate was not associated with 1-year-postdischarge mortality. Our study suggests that there is no relationship between the neighborhood poverty rate and mortality up to 1 year following critical care at academic medical centers.

  2. Developing Socially Responsible Leaders in Academic Settings

    ERIC Educational Resources Information Center

    Cauthen, T. W., III

    2016-01-01

    This chapter begins the exploration of what leadership education is through examining the relationship between educational involvement and academic autonomy in the development of socially responsible leaders.

  3. Gender Differences in the Relationship between Academic Procrastination, Satisfaction with Academic Life and Academic Performance

    ERIC Educational Resources Information Center

    Balkis, Murat; Duru, Erdinç

    2017-01-01

    Introduction: Procrastination has become one of the most researched topics due its adverse effects on the both general and student population in social sciences. The general tendency toward delaying academic tasks has been conceptualized as academic procrastination in academic setting. It is a prevalent issue among students and a numerous students…

  4. Cognitive and academic achievement changes associated with day hospital rehabilitation in children with acquired brain injury.

    PubMed

    Goldstein, Gerald; Mayfield, Joan; Thaler, Nicholas S; Walker, Jon; Allen, Daniel N

    2018-01-01

    An evaluation was made of the outcome of a day hospital rehabilitation program for children who experienced an acquired neurological illness, mainly traumatic brain injury. Participants were administered neuropsychological and academic evaluations upon entry to the program, immediately upon discharge and several months after discharge Repeated measures ANOVA results for variables selected from the Reynolds Intellectual Assessment and the Delis-Kaplan Executive Function System found that comparisons showed significant (≥p < .01) improvement occurred between the first and second assessment, generally with large effect sizes. There were some nonsignificant decrements in performance between the discharge and follow-up assessments. A correlational analysis showed that while the association between cognitive function and academic achievement was robust, correlation coefficients did not differ in strength before and following rehabilitation. The study demonstrates significant improvement in children with acquired neurological disorders following rehabilitation.

  5. Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review.

    PubMed

    Vieira, Edgar Ramos; Freund-Heritage, Rosalie; da Costa, Bruno R

    2011-09-01

    To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings. Eligible studies were systematically searched on 16 databases from inception to December 2010. The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded. A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified. Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings.

  6. Severe Idiopathic Dysphagia in an Acute Hospital Setting: Assessment, Management, and Outcome

    PubMed Central

    Simning, Inga; Simning, Adam

    2014-01-01

    This case describes the course of a patient who was admitted to an acute care hospital with pneumonia and odynophagia and found to have severe, idiopathic oropharyngeal dysphagia. The assessment, treatment, and outcome are reported alongside suggestions for best practice in the treatment of dysphagia in hospital settings. Timely instrumental assessment, interdisciplinary management, and post-discharge follow-up were needed to provide optimum care and to achieve a positive outcome for this patient with life-threatening dysphagia. PMID:25705102

  7. Hypophosphataemia at a large academic hospital in South Africa.

    PubMed

    Hoffmann, M; Zemlin, A E; Meyer, W P; Erasmus, R T

    2008-10-01

    The aim of this study was to determine the most common causes of hypophosphataemia (hospital population in order to identify patient groups at risk of developing the condition. The study was conducted at Tygerberg Hospital, a tertiary care centre in the Western Cape, South Africa. All patients identified with a phosphate level hospital stay. Most (45%; n = 278) of the patients with low phosphate levels occurred in an intensive care setting, whereas 10% (n = 63) were most likely due to refeeding, and 6% (n = 35) had neoplastic disease. Sepsis was implicated as a contributing factor in 26% (n = 162). Severe hypophosphataemia is associated with a very high mortality (30%, n = 189). Patients with a high risk of developing hypophosphataemia include those in an intensive care unit (ICU), patients suffering from neoplastic diseases, possible refeeding syndrome and septic patients. Regular phosphate determination is recommended in these patients to facilitate early diagnosis of hypophosphataemia.

  8. Athletic Trainers' Roles and Responsibilities Regarding Academic Adjustments as Part of the Concussion-Management Process in the Secondary School Setting.

    PubMed

    Bacon, Cailee E Welch; Kay, Melissa C; McLeod, Tamara C Valovich

    2017-10-01

      Athletic trainers (ATs) play a vital role in managing the care of student-athletes after a sport-related concussion, yet little is known about their specific involvement in the implementation of academic adjustments as part of the concussion-management plan.   To explore ATs' perceived roles and responsibilities regarding the implementation of academic adjustments for concussed student-athletes.   Qualitative study.   Individual telephone interviews.   Sixteen ATs employed in the secondary school setting (8 women, 8 men; age = 39.6 ± 7.9 years; athletic training experience = 15.1 ± 5.6 years), representing 12 states, were interviewed.   One telephone interview was conducted with each participant. After the interviews were transcribed, the data were analyzed and coded into themes and categories, which were determined via consensus of a 4-person research team. To decrease researcher bias, triangulation occurred through participant member checking, the inclusion of multiple researchers, and an internal auditor.   Several categories related to participants' perceptions regarding their roles and responsibilities within the academic-adjustments process emerged from data analysis: (1) understanding of academic adjustments, (2) perceptions of their roles in academic adjustments, (3) initiation of academic adjustments, (4) facilitation of academic adjustments, and (5) lack of a role in the academic-adjustments process. Although most ATs perceived that they had a role in the initiation and facilitation of academic adjustments for concussed student-athletes, some reported they did not want a role in the process. Regardless, participants frequently suggested the need for further education.   These findings highlight that ATs either wanted to be involved in the implementation of academic adjustments but felt further education was needed or they did not want to be involved because they felt that it was not in their area of expertise. To create a cohesive

  9. Mobile Phones as a Potential Vehicle of Infection in a Hospital Setting.

    PubMed

    Chao Foong, Yi; Green, Mark; Zargari, Ahmad; Siddique, Romana; Tan, Vanessa; Brain, Terry; Ogden, Kathryn

    2015-01-01

    The objective of this article is to investigate the potential role of mobile phones as a reservoir for bacterial colonization and the risk factors for bacterial colonization in a hospital setting. We screened 226 staff members at a regional Australian hospital (146 doctors and 80 medical students) between January 2013 and March 2014. The main outcomes of interest were the types of microorganisms and the amount of contamination of the mobile phones. This study found a high level of bacterial contamination (n = 168/226, 74%) on the mobile phones of staff members in a tertiary hospital, with similar organisms isolated from the staff member's dominant hand and mobile phones. While most of the isolated organisms were normal skin flora, a small percentage were potentially pathogenic (n = 12/226, 5%). Being a junior medical staff was found to be a risk factor for heavy microbial growth (OR 4.00, 95% CI 1.54, 10.37). Only 31% (70/226) of our participants reported cleaning their phones routinely, and only 21% (47/226) reported using alcohol containing wipes on their phones. This study demonstrates that mobile phones are potentially vehicles for pathogenic bacteria in a hospital setting. Only a minority of our participants reported cleaning their phones routinely. Disinfection guidelines utilizing alcohol wipes should be developed and implemented.

  10. Becoming tobacco-free: Changes in staff and patient attitudes and incident reports in a large academic mental health and addictions hospital

    PubMed Central

    Riad-Allen, Lilian; Dermody, Sarah S.; Herman, Yarissa; Bellissimo, Kim; Selby, Peter; George, Tony P.

    2017-01-01

    Background and Objective Complete tobacco bans in mental health facilities are thought to have the potential for adverse consequences. We evaluated staff and patient attitudes and adverse events associated with implementing Canada's largest, multi-site academic psychiatric hospital tobacco ban. Methods A total of 1,173 staff and 422 patients completed an anonymous attitudes survey at prior to implementation (baseline), and 4-6 months and 10-12 months post-implementation. The tobacco-free initiative was implemented in a phased approach, allowing the prospective measurement of changes in attitudes and adverse outcomes such as agitation over a 1-year period. Results We observed positive changes in staff and patient attitudes towards the tobacco-free policy for both staff and patients. Moreover, there was also a statistically significant decrease in patient agitation F (2,99) = 3.25, p=0.04, but no change F (2, 21) = 1.09, p=0.35 in fire-related incidents. Discussion and Conclusions We observed positive changes in staff and patients attitudes and significant decrease in patient agitation during the first year of this tobacco-free hospital initiative. Scientific Significance During the first year of this tobacco-free psychiatric hospital policy, implementation of a tobacco-free environment in a large mental health and addictions setting was feasible and perceived as desirable by the majority of staff and patients surveyed and a decrease in incidents related to patient agitation was also observed. Further well-controlled studies with longer study durations are warranted. PMID:28211960

  11. ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2003.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2004-03-01

    Results of the 2003 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. The response rate was 47.1%. Virtually all hospitals (95.3%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2000; fewer respondents reported monitoring less than 25% of patients in the hospital, and most hospitals reported an increase in the amount of time pharmacists devoted to monitoring activities. Pharmacists were provided computer access to laboratory information in 78% of hospitals to facilitate this function. Detection and reporting of adverse drug events (ADEs) have substantially increased since 1999, with an increase of 42% in events reported internally. Strategies to improve ADE reporting were in place in 84% of hospitals, indicating that pharmacists are adopting the widely recommended philosophy of learning from errors. Errors were less widely reported externally, limiting the value of aggregated data for improving the medication-use process. Most hospitals (85.5%) had an interprofessional infrastructure in place to discuss and learn from voluntary reports of ADEs. Medication counseling continued to be relatively infrequent, with nearly three fourths of hospitals reporting fewer than 26% of inpatients received medication education. Pharmacist staffing in hospitals has risen significantly, from an average of 8.6 full-time equivalents (FTEs) in 2002 to 9.4 FTEs per hospital. Vacancy rates for pharmacists decreased from 7.3% in 2002 to 43%. It is now estimated that there are 1846 vacancies in hospital pharmacies. Notable improvements in hospital pharmacy practice have been

  12. Academic health centers in competitive markets.

    PubMed

    Reuter, J; Gaskin, D

    1997-01-01

    Academic health center (AHC) hospitals and other major teaching hospitals have funded a portion of their academic missions through patient care revenues. Using all-payer state discharge data, this DataWatch presents information on how these institutions are being affected by market changes. Although AHCs are not as successful as other hospitals are in attracting managed care patients, competitive pressures had not eroded AHCs' financial status as of 1994. However, increasing enrollment in managed care and potential changes in both Medicare and Medicaid suggest that pressure on the financing of these institutions' social missions will continue to grow over time.

  13. Determining the composition and benefit of the pre-hospital medical response team in the conflict setting.

    PubMed

    Davis, P R; Rickards, A C; Ollerton, J E

    2007-12-01

    To determine the optimal composition o f the pre-hospital medical response team (MERT) and the value of pre-hospital critical care interventions in a military setting, and specifically to determine both the benefit of including a doctor in the pre-hospital response team and the relevance of the time and distance to definitive care. A comprehensive review of the literature incorporating a range of electronic search engines and hand searches of key journals. There was no level 1 evidence on which to base conclusions. The 15 most relevant articles were analysed in detail. There was one randomized controlled trial (level 2 evidence) that supports the inclusion of a doctor on MERT. Several cohort studies were identified that analysed the benefits of specific critical care interventions in the pre-hospital setting. A doctor with critical care skills deployed on the MERT is associated with improved survival in victims of major trauma. Specific critical care interventions including emergency endotracheal intubation and ventilation, and intercostal drainage are associated with improved survival and functional recovery in certain patients. These benefits appear to be more easily demonstrated for the rural and remote setting than for the urban setting.

  14. Psychometric properties of the Postgraduate Hospital Educational Environment Measure in an Iranian hospital setting.

    PubMed

    Shokoohi, Shahrzad; Emami, Amir Hossein; Mohammadi, Aeen; Ahmadi, Soleiman; Mojtahedzadeh, Rita

    2014-01-01

    Background Students' perceptions of the educational environment are an important construct in assessing and enhancing the quality of medical training programs. Reliable and valid measurement, however, can be problematic - especially as instruments developed and tested in one culture are translated for use in another. Materials and method This study sought to explore the psychometric properties of the Postgraduate Hospital Educational Environment Measure (PHEEM) for use in an Iranian hospital training setting. We translated the instrument into Persian and ensured its content validity by back translation and expert review prior to administering it to 127 residents of Urmia University of Medical Science. Results Overall internal consistency of the translated measure was good (a=0.94). Principal components analysis revealed five factors accounting for 52.8% of the variance. Conclusion The Persian version of the PHEEM appears to be a reliable and potentially valid instrument for use in Iranian medical schools and may find favor in evaluating the educational environments of residency programs nationwide.

  15. Psychometric properties of the postgraduate hospital educational environment measure in an Iranian hospital setting.

    PubMed

    Shokoohi, Shahrzad; Hossein Emami, Amir; Mohammadi, Aeen; Ahmadi, Soleiman; Mojtahedzadeh, Rita

    2014-01-01

    Students' perceptions of the educational environment are an important construct in assessing and enhancing the quality of medical training programs. Reliable and valid measurement, however, can be problematic - especially as instruments developed and tested in one culture are translated for use in another. This study sought to explore the psychometric properties of the Postgraduate Hospital Educational Environment Measure (PHEEM) for use in an Iranian hospital training setting. We translated the instrument into Persian and ensured its content validity by back translation and expert review prior to administering it to 127 residents of Urmia University of Medical Science. Overall internal consistency of the translated measure was good (a=0.94). Principal components analysis revealed five factors accounting for 52.8% of the variance. The Persian version of the PHEEM appears to be a reliable and potentially valid instrument for use in Iranian medical schools and may find favor in evaluating the educational environments of residency programs nationwide.

  16. Plastic surgeons’ self-reported operative infection rates at a Canadian academic hospital

    PubMed Central

    Ng, Wendy KY; Kaur, Manraj Nirmal; Thoma, Achilleas

    2014-01-01

    BACKGROUND: Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature. OBJECTIVE: To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada. METHODS: A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates. RESULTS: A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies. DISCUSSION: The plastic surgery infection rate at the study institution was found to be <1%. This rate was equal to, or somewhat less than, surgical site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted. PMID:25535460

  17. Healthy Settings in Hospital - How to Prevent Burnout Syndrome in Nurses: Literature Review.

    PubMed

    Friganović, Adriano; Kovačević, Irena; Ilić, Boris; Žulec, Mirna; Krikšić, Valentina; Grgas Bile, Cecilija

    2017-06-01

    Healthy settings involve a holistic and multidisciplinary method that integrates actions towards risk factors. In hospital settings, a high level of stress can lead to depression, anxiety, decreased job satisfaction and lower loyalty to the organization. Burnout syndrome can be defined as physical, psychological and emotional exhaustion, depersonalization, and low sense of personal accomplishment. The aim of this literature review was to make systematic literature analysis to provide scientific evidence for the consequences of constant exposure to high levels of stress and for the methods to be used to prevent burnout syndrome among health care workers. The Medline database was searched to identify relevant studies and articles published during the last 15 years. The key words used in this survey were burnout syndrome, prevention, nurses, and healthy settings. The 6 eligible studies were included in literature review. Evidence showed nurses to be exposed to stress and to have symptoms of burnout syndrome. As a result of burnout syndrome, chronic fatigue and reduced working capacity occur, thus raising the risk of adverse events. In conclusion, the occurrence of burnout syndrome is a major problem for hospitals and healthcare system. Action plan for hospital burnout syndrome prevention would greatly reduce the incidence and improve the quality of health care.

  18. The Relationship Between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers

    PubMed Central

    Nguyen, Ninh T.; Paya, Mahbod; Stevens, C Melinda; Mavandadi, Shahrzad; Zainabadi, Kambiz; Wilson, Samuel E.

    2004-01-01

    Objective: To examine the effect of hospital volume of bariatric surgery on morbidity, mortality, and costs at academic centers. Summary Background Data: The American Society for Bariatric Surgery recently proposed categorization of certain bariatric surgery centers as “Centers of Excellence.” Some of the proposed inclusion criteria were hospital volume and operative outcomes. The volume–outcome relationship has been well established in several complex abdominal operations; however, few studies have examined this relationship in patients undergoing bariatric surgery. Methods: Using the International Classification of Diseases, 9th edition, diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all patients who underwent Roux-en-Y gastric bypass for the treatment of morbid obesity between 1999 and 2002 (n = 24,166). Outcomes of bariatric surgery, including length of hospital stay, 30-day readmission, morbidity, observed and expected (risk-adjusted) mortality, and costs were compared between high-volume (>100 cases/year), medium-volume (50–100 cases/year), and low-volume hospitals (<50 cases/year). Results: There were 22 high-volume (n = 13,810), 27 medium-volume (n = 7634), and 44 low-volume (n = 2722) hospitals included in our study. Compared with low-volume hospitals, patients who underwent gastric bypass at high-volume hospitals had a shorter length of hospital stay (3.8 versus 5.1 days, P < 0.01), lower overall complications (10.2% versus 14.5%, P < 0.01), lower complications of medical care (7.8% versus 10.8%, P < 0.01), and lower costs ($10,292 versus $13,908, P < 0.01). The expected mortality rate was similar between high- and low-volume hospitals (0.6% versus 0.6%), demonstrating similarities in characteristics and severity of illness between groups. The observed mortality, however, was significantly lower at high-volume hospitals (0.3% versus 1.2%, P < 0.01). In a subset of patients older

  19. [University clinics in the competitive hospital market].

    PubMed

    Schmidt, C E; Möller, J; Hesslau, U; Bauer, M; Gabbert, T; Kremer, B

    2005-07-01

    In recent years Germany has faced a growing economization and competition among hospitals. To protect their interests hospitals have to operate similarly to other commercial businesses. Academic hospitals face difficult circumstances in this competition. They have to facilitate research and education activities which require additional financial and personnel resources but also provide maximum acute care treatment at all times. This causes additional disadvantages in terms of financial resources, compared to private hospital chains. Such examples of financial shortcomings have led to the privatization of academic research centres in Germany. An alternative strategy to privatization of academic acute care hospitals is the change of their legal status into a capital company or into a foundation, according to US experiences. Public private partnerships (PPPs) may also represent a potential alternative, as they have already produced a growing number of successful examples in the public sector in Germany. Academic acute care hospitals can also choose a strategic reorganization of their targets, similar to their privately held competitors in the market. Potential economies in scale may be achieved in areas such as medical treatment, research and personnel planning.However, it is vital that academic acute care hospitals start to act productively and also individually. This article provides a number of managerial pathways and options to maintain and strengthen operational competitiveness.

  20. Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

    PubMed Central

    Zwicker, Jeffrey I.; Rojan, Adam; Campigotto, Federico; Rehman, Nadia; Funches, Renee; Connolly, Gregory; Webster, Jonathan; Aggarwal, Anita; Mobarek, Dalia; Faselis, Charles; Neuberg, Donna; Rickles, Frederick R.; Wun, Ted; Streiff, Michael B.; Khorana, Alok A.

    2014-01-01

    Purpose Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. Conclusion We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in

  1. Evaluating the performance of PI-RADS v2 in the non-academic setting.

    PubMed

    Jordan, Eric J; Fiske, Charles; Zagoria, Ronald J; Westphalen, Antonio C

    2017-11-01

    To evaluate the utility of PI-RADS v2 to diagnose clinically significant prostate cancer (CS-PCa) with magnetic resonance ultrasound (MR/US) fusion-guided prostate biopsies in the non-academic setting. Retrospective analysis of men whom underwent prostate multiparametric MRI and subsequent MR/US fusion biopsies at a single non-academic center from 11/2014 to 3/2016. Prostate MRIs were performed on a 3-Tesla scanner with a surface body coil. The Prostate Imaging Reporting and Data System (PI-RADS) v2 scoring algorithm was utilized and MR/US fusion biopsies were performed in selected cases. Mixed effect logistic regression analyses and receiver-operating characteristic (ROC) curves were performed on PI-RADS v2 alone and combined with PSA density (PSAD) to predict CS-PCa. 170 patients underwent prostate MRI with 282 PI-RADS lesions. MR/US fusion diagnosed 71 CS-PCa, 33 Gleason score 3+3, and 168 negative. PI-RADS v2 score is a statistically significant predictor of CS-PCa (P < 0.001). For each one-point increase in the overall PI-RADS v2 score, the odds of having CS-PCa increases by 4.2 (95% CI 2.2-8.3). The area under the ROC curve for PI-RADS v2 is 0.69 (95% CI 0.63-0.76) and for PI-RADS v2 + PSAD is 0.76 (95% CI 0.69-0.82), statistically higher than PI-RADS v2 alone (P < 0.001). The rate of CS-PCa was about twice higher in men with high PSAD (≥0.15) compared to men with low PSAD (<0.15) when a PI-RADS 4 or 5 lesion was detected (P = 0.005). PI-RADS v2 is a strong predictor of CS-PCa in the non-academic setting and can be further strengthened when utilized with PSA density.

  2. Retail food reform: How to effectively bridge what we say and what we do in our hospital settings.

    PubMed

    Dojeiji, Laurie; Taylor, Andra; Boland, Cholly; Brennan, Carolyn; Penney, Randy

    2017-03-01

    Hospital leaders in Eastern Ontario, Canada, have acknowledged the critical role of food to health and the need for progressive change that goes beyond personal responsibility paradigms. The Healthy Foods in Champlain Hospitals program aims to create supportive, healthy nutrition environments in hospital retail food settings. Twenty independent hospital corporations have collectively initiated a plan to transition cafeteria, vending, franchise, and volunteer operations towards healthier offerings. Hospitals are actively implementing a set of progressively phased, evidence-based nutrition criteria, which cover food and beverage categories, preparation methods, product placement, and provision of nutrition information. Implementation strategies and successes, as well as challenges and limitations, are discussed.

  3. Hospital and Community Characteristics Associated With Pediatric Direct Admission to Hospital.

    PubMed

    Leyenaar, JoAnna K; Shieh, Meng-Shiou; Lagu, Tara; Pekow, Penelope S; Lindenauer, Peter K

    2017-10-27

    One quarter of pediatric hospitalizations begin as direct admissions, defined as hospitalization without receiving care in the hospital's emergency department (ED). Direct admission rates are highly variable across hospitals, yet previous studies have not examined reasons for this variation. We aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates. We conducted a cross-sectional study of the Healthcare Cost and Utilization Project's Kids Inpatient Database, American Hospital Association Database, and Area Health Resource File, including children <18 years of age who were admitted for a medical hospitalization in states contributing data to all data sets. Using hierarchical generalized linear modeling, we generated risk-adjusted direct admission rates and used generalized linear models to assess the association of hospital and community characteristics with these risk-adjusted rates. We included 211,458 children discharged from 933 hospitals and 26 states; 20.2% were admitted directly. One-fifth of the variance in risk-adjusted direct admission rates was attributed to observed hospital and community factors. The greatest proportion of this explained variance was related to ED volume (37%), volume of pediatric hospitalizations (27%), and size of the pediatrician workforce (12%). Direct admission rates were associated with several hospital and community characteristics, but the majority of variation in hospitals' direct admission rates was not explained by these factors. These findings suggest opportunities for diverse hospital types to develop the infrastructure and communication systems necessary to support pediatric direct admissions. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  4. Tackling the climate targets set by the Paris Agreement (COP 21): Green leadership empowers public hospitals to overcome obstacles and challenges in a resource-constrained environment.

    PubMed

    Weimann, E; Patel, B

    2016-12-21

    The healthcare sector itself contributes to climate change, the creation of hazardous waste, use of toxic metals such as mercury, and water and air pollution. To mitigate the effect of healthcare provision on the deteriorating environment and avoid creating further challenges for already burdened health systems, Global Green Hospitals was formed as a global network. Groote Schuur Hospital (GSH), as the leading academic hospital in Africa, joined the network in 2014. Since then, several projects have been initiated to reduce the amount of general waste, energy consumption and food waste, and create an environmentally friendlier and more sustainable hospital in a resource-constrained public healthcare setting. We outline the various efforts made to reduce the carbon footprint of GSH and reduce waste and hazardous substances such as mercury and polystyrene, and elaborate how obstacles and resistance to change were overcome. The hospital was able to halve the amount of coal and water used, increase recycling by 50% over 6 months, replace polystyrene cups and packaging with Forest Stewardship Council recyclable paper-based products, reduce the effect of food wastage by making use of local farmers, and implement measures to reduce the amount of expired pharmaceutical drugs. To improve commitment from all involved roleplayers, political leadership, supportive government policies and financial funding is mandatory, or public hospitals will be unable to tackle the exponentially increasing costs related to climate change and its effects on healthcare.

  5. Exploratory Use of Microaerosol Decontamination Technology (PAEROSOL) in Enclosed, Unoccupied Hospital Setting

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rainina, Evguenia I.; McCune, D. E.; Luna, Maria L.

    2012-05-31

    The goal of this study was to validate the previously observed high biological kill performance of PAEROSOL, a semi-dry, micro-aerosol decontamination technology, against common HAI in a non-human subject trial within a hospital setting of Madigan Army Medical Center (MAMC) on Joint Base Lewis-McChord in Tacoma, Washington. In addition to validating the disinfecting efficacy of PAEROSOL, the objectives of the trial included a demonstration of PAEROSOL environmental safety, (i.e., impact to hospital interior materials and electronic equipment exposed during testing) and PAEROSOL parameters optimization for future deployment.

  6. Patient goal setting as a method for program improvement/development in partial hospitalization programs.

    PubMed

    Gates, A

    1991-12-01

    Data were collected from a study of 49 patients in 1990 and 106 patients in 1991 admitted into Country View Treatment Center and Green Country Counseling Center. Country View is a 30-bed chemical dependency residential center operating under St. John Medical Center in Tulsa, Oklahoma. Green Country is an evening partial hospital chemical dependency program operating under St. John Medical Center in Tulsa, Oklahoma, The tools used in this study were the Country View Patient Self-Reporting Questionnaire, the global Rating Scale, and the Model of Recovering Alcoholics Behavior Stages and Goal Setting (Wing, 1990). These assessments were specifically designed to measure the patient's perceptions of goal setting and the patient's perspective on treatment outcome. The study outcome resulted in program improvement (Green Country evening partial hospital program) and the development of the Country View Substance Abuse Intermediate Link (SAIL) Program (day partial hospital).

  7. Lessons learned: mobile device encryption in the academic medical center.

    PubMed

    Kusche, Kristopher P

    2009-01-01

    The academic medical center is faced with the unique challenge of meeting the multi-faceted needs of both a modern healthcare organization and an academic institution, The need for security to protect patient information must be balanced by the academic freedoms expected in the college setting. The Albany Medical Center, consisting of the Albany Medical College and the Albany Medical Center Hospital, was challenged with implementing a solution that would preserve the availability, integrity and confidentiality of business, patient and research data stored on mobile devices. To solve this problem, Albany Medical Center implemented a mobile encryption suite across the enterprise. Such an implementation comes with complexities, from performance across multiple generations of computers and operating systems, to diversity of application use mode and end user adoption, all of which requires thoughtful policy and standards creation, understanding of regulations, and a willingness and ability to work through such diverse needs.

  8. Economic impact of electronic prescribing in the hospital setting: A systematic review.

    PubMed

    Ahmed, Zamzam; Barber, Nick; Jani, Yogini; Garfield, Sara; Franklin, Bryony Dean

    2016-04-01

    To examine evidence on the economic impact of electronic prescribing (EP) systems in the hospital setting. We conducted a systematic search of MEDLINE, EMBASE, PsycINFO, International Pharmaceutical Abstracts, the NHS Economic Evaluation Database, the European Network of Health Economic Evaluation Database and Web of Science from inception to October 2013. Full and partial economic evaluations of EP or computerized provider order entry were included. We excluded studies assessing prescribing packages for specific drugs, and monetary outcomes that were not related to medicines. A checklist was used to evaluate risk of bias and evidence quality. The search yielded 1160 articles of which three met the inclusion criteria. Two were full economic evaluations and one a partial economic evaluation. A meta-analysis was not appropriate as studies were heterogeneous in design, economic evaluation method, interventions and outcome measures. Two studies investigated the financial impact of reducing preventable adverse drug events. The third measured savings related to various aspects of the system including those related to medication. Two studies reported positive financial effects. However the overall quality of the economic evidence was low and key details often not reported. There seems to be some evidence of financial benefits of EP in the hospital setting. However, it is not clear if evidence is transferable to other settings. Research is scarce and limited in quality, and reported methods are not always transparent. Further robust, high quality research is required to establish if hospital EP is cost effective and thus inform policy makers' decisions. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Utilization of Portable Radios to Improve Ophthalmology Clinic Efficiency in an Academic Setting.

    PubMed

    Davis, Alexander S; Elkeeb, Ahmed M; Vizzeri, Gianmarco; Godley, Bernard F

    2016-03-01

    Improvement in clinic efficiency in the ambulatory setting is often looked at as an area for development of lean management strategies to deliver a higher quality of healthcare while reducing errors, costs, and delays. To examine the benefits of improving team communication and its impact on clinic flow and efficiency, we describe a time-motion study performed in an academic outpatient Ophthalmology clinic and its objective and subjective results. Compared to clinic encounters without the use of the portable radios, objective data demonstrated an overall significant decreases in mean workup time (15.18 vs. 13.10), room wait (13.10 vs. 10.47), and decreased the total time needed with an MD per encounter (9.45 vs. 6.63). Subjectively, significant improvements were seen in careprovider scores for patient flow (60.78 vs. 84.29), getting assistance (61.89 vs. 88.57), moving patient charts (54.44 vs. 85.71), teamwork (69.56 vs. 91.0), communications (62.33 vs. 90.43), providing quality patient care (76.22 vs. 89.57), and receiving input on the ability to see walk-in patients (80.11 vs. 90.43). For academic purposes, an improvement in engagement in patient care and learning opportunities was noted by the clinic resident-in-training during the pilot study. Portable radios in our pilot study were preferred over the previous method of communication and demonstrates significant improvements in certain areas of clinical efficiency, subjective perception of teamwork and communications, and academic learning.

  10. Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya

    PubMed Central

    Cleary, Susan; Molyneux, Sassy; English, Mike

    2017-01-01

    Abstract This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities

  11. Is MBO Appropriate in the Academic Setting?

    ERIC Educational Resources Information Center

    Lasher, Harry J.

    1978-01-01

    A model for implementing a Management by Objectives (MBO) system in the academic environment is presented and potential problems are explored. Some of the pitfalls discussed include: organizational climate, clarity of objectives, assumption that MBO concepts are readily understood, instant success syndrome, and economic reward myopia. (JMD)

  12. Becoming tobacco-free: Changes in staff and patient attitudes and incident reports in a large academic mental health and addictions hospital.

    PubMed

    Riad-Allen, Lilian; Dermody, Sarah Siodmok; Herman, Yarissa; Bellissimo, Kim; Selby, Peter; George, Tony Peter

    2017-03-01

    Complete tobacco bans in mental health facilities are thought to have the potential for adverse consequences. We evaluated staff and patient attitudes and adverse events associated with implementing Canada's largest, multi-site academic psychiatric hospital tobacco ban. A total of 1,173 staff and 422 patients completed an anonymous attitudes survey at prior to implementation (baseline), and 4-6 months and 10-12 months post-implementation. The tobacco-free initiative was implemented in a phased approach, allowing the prospective measurement of changes in attitudes and adverse outcomes such as agitation over a 1-year period. We observed positive changes in staff and patient attitudes toward the tobacco-free policy for both staff and patients. Moreover, there was also a statistically significant decrease in patient agitation F (2, 99) = 3.25, p = .04, but no change F (2, 21) = 1.09, p = .35 in fire-related incidents. We observed positive changes in staff and patients attitudes and significant decrease in patient agitation during the first year of this tobacco-free hospital initiative. During the first year of this tobacco-free psychiatric hospital policy, implementation of a tobacco-free environment in a large mental health and addictions setting was feasible and perceived as desirable by the majority of staff and patients surveyed and a decrease in incidents related to patient agitation was also observed. Further well-controlled studies with longer study durations are warranted. (Am J Addict 2017;26:183-191). © 2017 American Academy of Addiction Psychiatry.

  13. [A set of quality and safety indicators for hospitals of the "Agencia Valenciana de Salud"].

    PubMed

    Nebot-Marzal, C M; Mira-Solves, J J; Guilabert-Mora, M; Pérez-Jover, V; Pablo-Comeche, D; Quirós-Morató, T; Cuesta Peredo, D

    2014-01-01

    To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud». The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  14. Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models

    PubMed Central

    Eason, Christianne M.; Mazerolle, Stephanie M.; Goodman, Ashley

    2017-01-01

    Context: Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models. Objective: To investigate the perceived benefits of and barriers in the medical and academic models. Design: Qualitative study. Setting: National Collegiate Athletic Association Divisions I, II, and III. Patients or Other Participants: A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models. Data Collection and Analysis: We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility. Results: In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative). Conclusions: The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties. PMID:27977302

  15. Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings.

    PubMed

    Omidvari, Amir-Houshang; Vali, Yasaman; Murray, Susan M; Wonderling, David; Rashidian, Arash

    2013-06-06

    Given the prevalence of under-nutrition and reports of inadequate nutritional management of patients in hospitals and the community, nutritional screening may play a role in reducing the risks of malnutrition. Screening programmes can invoke costs to health systems and patients. It is therefore important to assess the effectiveness of nutritional screening programmes. To examine the effectiveness of nutritional screening in improving quality of care (professional practice) and patient outcomes compared with usual care. We searched the following databases: CENTRAL (The Cochrane Library), MEDLINE, EMBASE and CINAHL up to June 2012 to find relevant studies. Randomised controlled studies, controlled clinical trials, controlled before-after studies and interrupted time series studies assessing the effectiveness of nutritional screening were eligible for inclusion in the review. We considered process outcomes (for example patient identification, referral to dietitian) and patient outcomes (for example mortality, change in body mass index (BMI)). Participants were adult patients aged 16 years or over. We included studies conducted in different settings, including hospitals, out-patient clinics, primary care or long term care settings. We independently assessed the risk of bias and extracted data from the included studies. Meta-analysis was considered but was not conducted due to the discrepancies between the studies. The studies were heterogeneous in their design, setting, intervention and outcomes. We analysed the data using a narrative synthesis approach. After conducting initial searches and screening the titles and abstracts of the identified literature, 77 full text papers were retrieved and read. Ultimately three studies were included. Two controlled before-after studies were conducted in hospital settings (one in the UK and one in the Netherlands) and one cluster randomised controlled trial was conducted in a primary care setting (in the USA).The study conducted in

  16. Development of a medical academic degree system in China.

    PubMed

    Wu, Lijuan; Wang, Youxin; Peng, Xiaoxia; Song, Manshu; Guo, Xiuhua; Nelson, Hugh; Wang, Wei

    2014-01-01

    Context The Chinese government launched a comprehensive healthcare reform to tackle challenges to health equities. Medical education will become the key for successful healthcare reform. Purpose We describe the current status of the Chinese medical degree system and its evolution over the last 80 years. Content Progress has been uneven, historically punctuated most dramatically by the Cultural Revolution. There is a great regional disparity. Doctors with limited tertiary education may be licensed to practice, whereas medical graduates with advanced doctorates may have limited clinical skills. There are undefined relationships between competing tertiary training streams, the academic professional degree, and the clinical residency training programme (RTP). The perceived quality of training in both streams varies widely across China. As the degrees of master or doctor of academic medicine is seen as instrumental in career advancement, including employability in urban hospitals, attainment of this degree is sought after, yet is often unrelated to a role in health care, or is seen as superior to clinical experience. Meanwhile, the practical experience gained in some prestigious academic institutions is deprecated by the RTP and must be repeated before accreditation for clinical practice. This complexity is confusing both for students seeking the most appropriate training, and also for clinics, hospitals and universities seeking to recruit the most appropriate applicants. Conclusion The future education reforms might include: 1) a domestic system of 'credits' that gives weight to quality clinical experience vs. academic publications in career advancement, enhanced harmonisation between the competing streams of the professional degree and the RTP, and promotion of mobility of staff between areas of excellence and areas of need; 2) International - a mutual professional and academic recognition between China and other countries by reference to the Bologna Accord, setting

  17. Development of a medical academic degree system in China.

    PubMed

    Wu, Lijuan; Wang, Youxin; Peng, Xiaoxia; Song, Manshu; Guo, Xiuhua; Nelson, Hugh; Wang, Wei

    2014-01-01

    The Chinese government launched a comprehensive healthcare reform to tackle challenges to health equities. Medical education will become the key for successful healthcare reform. We describe the current status of the Chinese medical degree system and its evolution over the last 80 years. Progress has been uneven, historically punctuated most dramatically by the Cultural Revolution. There is a great regional disparity. Doctors with limited tertiary education may be licensed to practice, whereas medical graduates with advanced doctorates may have limited clinical skills. There are undefined relationships between competing tertiary training streams, the academic professional degree, and the clinical residency training programme (RTP). The perceived quality of training in both streams varies widely across China. As the degrees of master or doctor of academic medicine is seen as instrumental in career advancement, including employability in urban hospitals, attainment of this degree is sought after, yet is often unrelated to a role in health care, or is seen as superior to clinical experience. Meanwhile, the practical experience gained in some prestigious academic institutions is deprecated by the RTP and must be repeated before accreditation for clinical practice. This complexity is confusing both for students seeking the most appropriate training, and also for clinics, hospitals and universities seeking to recruit the most appropriate applicants. The future education reforms might include: 1) a domestic system of 'credits' that gives weight to quality clinical experience vs. academic publications in career advancement, enhanced harmonisation between the competing streams of the professional degree and the RTP, and promotion of mobility of staff between areas of excellence and areas of need; 2) International - a mutual professional and academic recognition between China and other countries by reference to the Bologna Accord, setting up a system of easily comparable and

  18. Development of a medical academic degree system in China

    PubMed Central

    Wu, Lijuan; Wang, Youxin; Peng, Xiaoxia; Song, Manshu; Guo, Xiuhua; Nelson, Hugh; Wang, Wei

    2014-01-01

    Context The Chinese government launched a comprehensive healthcare reform to tackle challenges to health equities. Medical education will become the key for successful healthcare reform. Purpose We describe the current status of the Chinese medical degree system and its evolution over the last 80 years. Content Progress has been uneven, historically punctuated most dramatically by the Cultural Revolution. There is a great regional disparity. Doctors with limited tertiary education may be licensed to practice, whereas medical graduates with advanced doctorates may have limited clinical skills. There are undefined relationships between competing tertiary training streams, the academic professional degree, and the clinical residency training programme (RTP). The perceived quality of training in both streams varies widely across China. As the degrees of master or doctor of academic medicine is seen as instrumental in career advancement, including employability in urban hospitals, attainment of this degree is sought after, yet is often unrelated to a role in health care, or is seen as superior to clinical experience. Meanwhile, the practical experience gained in some prestigious academic institutions is deprecated by the RTP and must be repeated before accreditation for clinical practice. This complexity is confusing both for students seeking the most appropriate training, and also for clinics, hospitals and universities seeking to recruit the most appropriate applicants. Conclusion The future education reforms might include: 1) a domestic system of ‘credits’ that gives weight to quality clinical experience vs. academic publications in career advancement, enhanced harmonisation between the competing streams of the professional degree and the RTP, and promotion of mobility of staff between areas of excellence and areas of need; 2) International – a mutual professional and academic recognition between China and other countries by reference to the Bologna Accord

  19. Acinetobacter baumannii: Epidemiological and Beta-Lactamase Data From Two Tertiary Academic Hospitals in Tshwane, South Africa

    PubMed Central

    Lowe, Michelle; Ehlers, Marthie M.; Ismail, Farzana; Peirano, Gisele; Becker, Piet J.; Pitout, Johann D. D.; Kock, Marleen M.

    2018-01-01

    Acinetobacter baumannii is an opportunistic pathogen that is increasingly responsible for hospital-acquired infections. The increasing prevalence of carbapenem resistant A. baumannii has left clinicians with limited treatment options. Last line antimicrobials (i.e., polymyxins and glycylcyclines) are often used as treatment options. The aim of this study was to determine the prevalence of selected β-lactamase genes from A. baumannii isolates obtained from patients with hospital-acquired infections and to determine the genetic relationship and epidemiological profiles among clinical A. baumannii isolates collected from two tertiary academic hospitals in the Tshwane region, South Africa (SA). Multiplex-PCR (M-PCR) assays were performed to detect selected resistance genes. The collected isolates’ genetic relatedness was determined by using pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The acquired oxacillinase (OXA) genes, notably blaOXA-23-like were prevalent in the A. baumannii isolates. The M-PCR assays showed that the isolates collected from hospital A contained the OXA-23-like (96%; n = 69/72) genes and the isolates collected from hospital B contained the OXA-23-like (91%; n = 63/69) and OXA-58-like (4%; n = 3/69) genes. Colistin resistance was found in 1% of the isolates (n = 2/141) and tigecycline intermediate resistance was found in 6% of the isolates (n = 8/141). The A. baumannii isolates were genetically diverse. Molecular epidemiological data showed that specific sequence types (STs) (ST106, ST229, ST258 and ST208) were established in both hospitals, while ST848 was established in hospital A and ST502, ST339 and the novel ST1552 were established in hospital B. ST848 (established in hospital A) was predominately detected in ICU wards whereas ST208, ST339 and the novel ST1552 (established in hospital B) were detected in ICUs and the general wards. The origin of the A. baumannii isolates in the hospitals may be due to the

  20. Perfectionism Group Treatment for Eating Disorders in an Inpatient, Partial Hospitalization, and Outpatient Setting.

    PubMed

    Levinson, Cheri A; Brosof, Leigh C; Vanzhula, Irina A; Bumberry, Laura; Zerwas, Stephanie; Bulik, Cynthia M

    2017-11-01

    Perfectionism is elevated in individuals with eating disorders and is posited to be a risk factor, maintaining factor, and treatment barrier. However, there has been little literature testing the feasibility and effectiveness of perfectionism interventions in individuals specifically with eating disorders in an open group format. In the current study, we tested the feasibility of (a) a short cognitive behavioural therapy for perfectionism intervention delivered in an inpatient, partial hospitalization, and outpatient for eating disorders setting (combined N = 28; inpatient n = 15; partial hospital n = 9; outpatient n = 4), as well as (b) a training for disseminating the treatment in these settings (N = 9). Overall, we found that it was feasible to implement a perfectionism group in each treatment setting, with both an open and closed group format. This research adds additional support for the implementation of perfectionism group treatment for eating disorders and provides information on the feasibility of implementing such interventions across multiple settings. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  1. Professor in Residence: An Innovative Academic-Practice Partnership.

    PubMed

    Hinic, Katherine; Kowalski, Mildred Ortu; Silverstein, Wendy

    2017-12-01

    This article describes an academic-practice partnership between an American Nurses Credentialing Center Magnet ® -designated hospital and an academic nurse educator that has increased the hospital's capacity for research, evidence-based practice, and support for nurses continuing their education. Through close collaboration with the full-time nurse researcher and members of the nursing education department, the professor in residence consults with clinical staff to support completion of research and evidence-based practice projects. The collaboration also has resulted in the development of a formal year-long mentoring program for clinical nurses in the area of evidence-based practice. Individual support and academic consults are offered to nurses enrolled in school to promote advancement of nurses' educational level. This collaboration has been beneficial for both the hospital and the university, increasing the capacity for scholarly activities for nurses in the hospital and serving as a forum for ongoing faculty practice and scholarship. J Contin Educ Nurs. 2017;48(12):552-556. Copyright 2017, SLACK Incorporated.

  2. Introduction of the conducted electrical weapon into a hospital setting.

    PubMed

    Ho, Jeffrey D; Clinton, Joseph E; Lappe, Mark A; Heegaard, William G; Williams, Martin F; Miner, James R

    2011-09-01

    The TASER(®) X26 Conducted Electrical Weapon (CEW) provides painful stimuli and neuromuscular incapacitation to potentially violent persons. Use by law enforcement in society is common. Presenting a CEW is known to de-escalate some situations. Health care personnel sometimes encounter violent persons within the confines of the hospital. CEW use by health care security personnel has not been described. The objective is to describe results from the introduction of the CEW into a hospital environment. Upon introducing the CEW into an urban hospital campus, standardized reports were made describing all CEW use by hospital security. Reports were retrospectively reviewed for the first 12 months of CEW use. Collected data included force options used, potential injuries avoided, witness comments, outcomes, and whether the CEW required full activation or if inactive presentation was sufficient to control the situation. Rates of security personnel injuries were also gathered. Descriptive analysis was applied. Twenty-seven CEW deployments occurred: four were inactive presentation, 20 were presentation with LASER sight activation, and three were probe deployments with a 5-s delivery of electrical current. Two persons required evaluation for minor injuries not related to CEW use. Witnesses reported that in all incidents, injuries were likely avoided due to CEW presentation or use. CEW use aborted one suicide attempt. Personnel injury rates decreased during the study period. CEW introduction into a health care setting demonstrated the ability to avert and control situations that could result in further injury to subjects, patients, and personnel. This correlates with a decrease in injury for hospital personnel. Further study is recommended for validation. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Health professional perspectives on lifestyle behaviour change in the paediatric hospital setting: a qualitative study.

    PubMed

    Elwell, Laura; Powell, Jane; Wordsworth, Sharon; Cummins, Carole

    2014-03-13

    Research exists examining the challenges of delivering lifestyle behaviour change initiatives in practice. However, at present much of this research has been conducted with primary care health professionals, or in acute adult hospital settings. The purpose of this study was to identify barriers and facilitators associated with implementing routine lifestyle behaviour change brief advice into practice in an acute children's hospital. Thirty-three health professionals (nurses, junior doctors, allied health professionals and clinical support staff) from inpatient and outpatient departments at a UK children's hospital were interviewed about their attitudes and beliefs towards supporting lifestyle behaviour change in hospital patients and their families. Responses were analysed using thematic framework analysis. Health professionals identified a range of barriers and facilitators to supporting lifestyle behaviour change in a children's hospital. These included (1) personal experience of effectiveness, (2) constraints associated with the hospital environment, (3) appropriateness of advice delivery given the patient's condition and care pathway and (4) job role priorities, and (5) perceived benefits of the advice given. Delivery of lifestyle behaviour change advice was often seen as an educational activity, rather than a behaviour change activity. Factors underpinning the successful delivery of routine lifestyle behaviour change support must be understood if this is to be implemented effectively in paediatric acute settings. This study reveals key areas where paediatric health professionals may need further support and training to achieve successful implementation.

  4. Developing academic surgery in a socialized health care system: a 35-year experience.

    PubMed

    Duranceau, Andre; Martin, Jocelyne; Liberman, Moishe; Ferraro, Pasquale

    2012-07-01

    The most important benefit of a socialized health care system is the elimination of the threat of personal financial ruin to pay for medical care. Serious disadvantages of a socialized health care system, particularly in a university hospital setting, include restricted financial resources for education and patient care, limited working facilities, and loss of physician-directed decision making in planning and prioritizing. This article describes how a group practice model has supported clinical and academic activities within the faculty of medicine of our university and offers this model as a possible template for other surgical and medical disciplines working in an academic socialized environment.

  5. The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.

    PubMed

    Barasa, Edwine W; Cleary, Susan; English, Mike; Molyneux, Sassy

    2016-09-30

    Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could

  6. Challenges of implementing routine health behavior change support in a children's hospital setting.

    PubMed

    Elwell, Laura; Powell, Jane; Wordsworth, Sharon; Cummins, Carole

    2014-07-01

    Evidence indicates that health behavior change initiatives are often not implemented successfully. This qualitative study aims to understand the barriers and facilitators to implementation of health behavior change brief advice into routine practice in an acute children's hospital setting. Semi-structured interviews were conducted with health professionals working at a UK children's hospital (n=33). Participants were purposively sampled to incorporate a range of specialties, job roles and training. An inductive thematic framework analysis identified two emergent themes. These capture the challenges of implementing routine health behavior change support in a children's hospital setting: (1) 'health professional knowledge, beliefs and behaviors' and (2) 'patient and family related challenges'. This study enhances findings from previous research by outlining the challenges pediatric health professionals face in relation to supporting health behavior change. Challenges include failure to assume responsibility, low confidence, prioritization of the health provider relationship with patients and families, health provider and patient knowledge, and low patient and family motivation. Skills-based behavior change training is needed for pediatric health professionals to effectively support health behavior change. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Invited Commentary on Wallace and Beange (2008): "On the Need for a Specialist Service within the Generic Hospital Setting"

    ERIC Educational Resources Information Center

    O'Hara, David

    2008-01-01

    In this article, the author comments on the paper "On the need for a specialist service within the generic hospital setting" (Wallace & Beange, 2008), which raises critical issues regarding effective models of healthcare delivery for individuals with intellectual disability (ID), particularly within a hospital setting (but not…

  8. Manual cleaning of hospital mattresses: an observational study comparing high- and low-resource settings.

    PubMed

    Hopman, J; Hakizimana, B; Meintjes, W A J; Nillessen, M; de Both, E; Voss, A; Mehtar, S

    2016-01-01

    Hospital-associated infections (HAIs) are more frequently encountered in low- than in high-resource settings. There is a need to identify and implement feasible and sustainable approaches to strengthen HAI prevention in low-resource settings. To evaluate the biological contamination of routinely cleaned mattresses in both high- and low-resource settings. In this two-stage observational study, routine manual bed cleaning was evaluated at two university hospitals using adenosine triphosphate (ATP). Standardized training of cleaning personnel was achieved in both high- and low-resource settings. Qualitative analysis of the cleaning process was performed to identify predictors of cleaning outcome in low-resource settings. Mattresses in low-resource settings were highly contaminated prior to cleaning. Cleaning significantly reduced biological contamination of mattresses in low-resource settings (P < 0.0001). After training, the contamination observed after cleaning in both the high- and low-resource settings seemed comparable. Cleaning with appropriate type of cleaning materials reduced the contamination of mattresses adequately. Predictors for mattresses that remained contaminated in a low-resource setting included: type of product used, type of ward, training, and the level of contamination prior to cleaning. In low-resource settings mattresses were highly contaminated as noted by ATP levels. Routine manual cleaning by trained staff can be as effective in a low-resource setting as in a high-resource setting. We recommend a multi-modal cleaning strategy that consists of training of domestic services staff, availability of adequate time to clean beds between patients, and application of the correct type of cleaning products. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  9. Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya.

    PubMed

    Barasa, Edwine W; Cleary, Susan; Molyneux, Sassy; English, Mike

    2017-04-01

    This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities

  10. Addition of generic medication vouchers to a pharmacist academic detailing program: effects on the generic dispensing ratio in a physician-hospital organization.

    PubMed

    Bhargava, Vinay; Greg, Mark E; Shields, Mark C

    2010-01-01

    Generic dispensing ratio (GDR) is an important measure of efficiency in pharmacy benefit management. A few studies have examined the effects of academic detailing or generic drug samples on GDR. On July 1, 2007, a physician-hospital organization (PHO) with a pay-for-performance incentive for generic utilization initiated a pilot generic medication voucher program that augmented its existing pharmacist-led academic detailing efforts. No published studies have examined the role of generic medication vouchers in promoting generic drug utilization. To determine if supplementing an existing academic detailing initiative in a PHO with a generic medication voucher program would be more effective in increasing the GDR compared with academic detailing alone. The intervention took place over the 9-month period from July 1, 2007, through March 31, 2008. Vouchers provided patients with the first fill of a 30-day supply of a generic drug at no cost to the patient for 8 specific generic medications obtained through a national community pharmacy chain. The study was conducted in a PHO composed of 7 hospitals and approximately 2,900 physicians (900 primary care providers [PCPs] and 2,000 specialists). Of the approximately 300 PCP practices, 21 practices with at least 2 physicians each were selected on the basis of high prescription volume (more than 500 pharmacy claims for the practice over a 12-month pre-baseline period) and low GDR (practice GDR less than 55% in the 12-month pre-baseline period). These 21 practices were then randomized to a control group of academic detailing alone or the intervention group that received academic detailing plus generic medication vouchers. One of 10 intervention groups declined to participate, and 2 of 11 control groups dropped out of the PHO. GDR was calculated monthly for all pharmacy claims including the 8 voucher medications. GDR was defined as the ratio of the total number of paid generic pharmacy claims divided by the total number of paid

  11. Determining the feasibility of robotic courier medication delivery in a hospital setting.

    PubMed

    Kirschling, Thomas E; Rough, Steve S; Ludwig, Brad C

    2009-10-01

    The feasibility of a robotic courier medication delivery system in a hospital setting was evaluated. Robotic couriers are self-guiding, self-propelling robots that navigate hallways and elevators to pull an attached or integrated cart to a desired destination. A robotic courier medication delivery system was pilot tested in two patient care units at a 471-bed tertiary care academic medical center. Average transit for the existing manual medication delivery system hourly hospitalwide deliveries was 32.6 minutes. Of this, 32.3% was spent at the patient care unit and 67.7% was spent pushing the cart or waiting at an elevator. The robotic courier medication delivery system traveled as fast as 1.65 ft/sec (52% speed of the manual system) in the absence of barriers but moved at an average rate of 0.84 ft/sec (26% speed of the manual system) during the study, primarily due to hallway obstacles. The robotic courier was utilized for 50% of the possible 1750 runs during the 125-day pilot due to technical or situational difficulties. Of the runs that were sent, a total of 79 runs failed, yielding an overall 91% success rate. During the final month of the pilot, the success rate reached 95.6%. Customer satisfaction with the traditional manual delivery system was high. Customer satisfaction with deliveries declined after implementation of the robotic courier medication distribution system. A robotic courier medication delivery system was implemented but was not expanded beyond the two pilot units. Challenges of implementation included ongoing education on how to properly move the robotic courier and keeping the hallway clear of obstacles.

  12. Recent Trends in Imaging Use in Hospital Settings: Implications for Future Planning.

    PubMed

    Levin, David C; Parker, Laurence; Rao, Vijay M

    2017-03-01

    To compare trends in utilization rates of imaging in the three hospital-based settings where imaging is conducted. The nationwide Medicare Part B databases for 2004-2014 were used. All discretionary noninvasive diagnostic imaging (NDI) CPT codes were selected and grouped by modality. Procedure volumes of each code were available from the databases and converted to utilization rates per 1,000 Medicare enrollees. Medicare's place-of-service codes were used to identify imaging examinations done in hospital inpatients, hospital outpatient departments (HOPDs), and emergency departments (EDs). Trends were observed over the life of the study. Trendlines were strongly affected by code bundling in echocardiography in 2009, nuclear imaging in 2010, and CT in 2011. However, even aside from these artifactual effects, important trends could be discerned. Inpatient imaging utilization rates of all modalities are trending downward. In HOPDs, the utilization rate of conventional radiographic examinations (CREs) is declining but rates of CT, MRI, echocardiography, and noncardiac ultrasound (US) are increasing. In EDs, utilization rates of CREs, CT, and US are increasing. In the 3 years after 2011, when no further code bundling occurred, the total inpatient NDI utilization rate dropped 15%, whereas the rate in EDs increased 12% and that in HOPDs increased 1%. The trends in utilization of NDI in the three hospital-based settings where imaging occurs are distinctly different. Radiologists and others who are involved in deciding what kinds of equipment to purchase and where to locate it should be cognizant of these trends in making their decisions. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  13. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2011.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2012-05-01

    Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists. Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic.

  14. Vaginal birth after cesarean in German out-of-hospital settings: maternal and neonatal outcomes of women with their second child.

    PubMed

    Beckmann, Lea; Barger, Mary; Dorin, Lena; Metzing, Sabine; Hellmers, Claudia

    2014-12-01

    To offer vaginal birth after cesarean (VBAC) in a hospital setting is recommended in international guidelines, but offering VBAC in out-of-hospital settings is considered controversial. This study describes neonatal and maternal outcomes in mothers who started labor in German out-of-hospital settings. In a retrospective analysis of German out-of-hospital data from 2005 to 2011, included were 24,545 parae II with a singleton pregnancy in a cephalic presentation at term (1,927 with a prior cesarean and 22,618 with a prior vaginal birth). The overall VBAC rate was 77.8 percent. The intrapartum transfer rate to hospital was 38.3 percent (prior cesarean) versus 4.6 percent (prior vaginal) (p < 0.05), and the 10-minute Apgar < 7 rate was 0.6 versus 0.2 percent (p < 0.05), and the nonemergency intrapartum transfer rate was 91.5 versus 85.0 percent (p < 0.05). Prolonged first stage of labor was the most common reason for intrapartum transfer in both groups. The leading reason for postpartum transfer was retained placenta. There was a high rate of successful VBAC in this study. The high nonemergency transfer rate for women with VBAC might mean that midwives are more cautious when attending women with a prior cesarean in out-of-hospital settings. Further studies are necessary to evaluate which women are suitable for VBAC in out-of-hospital settings. © 2014 Wiley Periodicals, Inc.

  15. [Management accounting in hospital setting].

    PubMed

    Brzović, Z; Richter, D; Simunić, S; Bozić, R; Hadjina, N; Piacun, D; Harcet, B

    1998-12-01

    The periodic income and expenditure accounts produced at the hospital and departmental level enable successful short term management, but, in the long run do not help remove tensions between health care demand and limited resources, nor do they enable optimal medical planning within the limited financial resources. We are trying to estabilish disease category costs based on case mixing according to diagnostic categories (diagnosis related groups, DRG, or health care resource groups, HRG) and calculation of hospital standard product costs, e.g., radiology cost, preoperative nursing cost etc. The average DRG cost is composed of standard product costs plus any costs specific to a diagnostic category. As an example, current costing procedure for hip artheroplasty in the University Hospital Center Zagreb is compared to the management accounting approach based on British Health Care Resource experience. The knowledge of disease category costs based on management accounting requirements facilitates the implementation of medical programs within the given financial resources and devolves managerial responsibility closer to the clinical level where medical decisions take place.

  16. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

    PubMed Central

    2012-01-01

    Background Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. Method We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. Results We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Conclusions Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change. PMID:22682525

  17. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.

    PubMed

    Woodhams, Victoria; de Lusignan, Simon; Mughal, Shakeel; Head, Graham; Debar, Safia; Desombre, Terry; Hilton, Sean; Al Sharifi, Houda

    2012-06-10

    Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change.

  18. Initiating Intrapartum Nitrous Oxide in an Academic Hospital: Considerations and Challenges.

    PubMed

    Migliaccio, Laura; Lawton, Robyn; Leeman, Lawrence; Holbrook, Amanda

    2017-05-01

    A 50%-50% mixture of nitrous oxide and oxygen has long been used for managing pain during labor in many countries, but only recently has this intrapartum analgesic technique become popular in the United States. Nitrous oxide is considered minimal sedation and a safe pain management alternative. Many facilities are now interested in providing laboring women this analgesic option. The process of establishing use of nitrous oxide in a large institution can be complicated and may seem daunting. This brief report describes the challenges that occurred during the process of initiating nitrous oxide for pain management during childbirth at an academic medical center and discusses various committee roles. Nurses at the University of New Mexico Hospital now directly oversee the administration of nitrous oxide to women in labor in accordance to an established guideline. Despite limited available research, the guideline also allows offering nitrous oxide as a pain management technique for women with opioid dependence. Key components of the guideline and specifics related to education, cost, and safety are reviewed. © 2017 by the American College of Nurse-Midwives.

  19. Peri-operative morbidity associated with radical cystectomy in a multicenter database of community and academic hospitals.

    PubMed

    Lavallée, Luke T; Schramm, David; Witiuk, Kelsey; Mallick, Ranjeeta; Fergusson, Dean; Morash, Christopher; Cagiannos, Ilias; Breau, Rodney H

    2014-01-01

    To characterize the frequency and timing of complications following radical cystectomy in a cohort of patients treated at community and academic hospitals. Radical cystectomy patients captured from NSQIP hospitals from January 1 2006 to December 31 2012 were included. Baseline information and complications were abstracted by study surgical clinical reviewers through a validated process of medical record review and direct patient contact. We determined the incidence and timing of each complication and calculated their associations with patient and operative characteristics. 2303 radical cystectomy patients met inclusion criteria. 1115 (48%) patients were over 70 years old and 1819 (79%) were male. Median hospital stay was 8 days (IQR 7-13 days). 1273 (55.3%) patients experienced at least 1 post-operative complication of which 191 (15.6%) occurred after hospital discharge. The most common complication was blood transfusion (n = 875; 38.0%), followed by infectious complications with 218 (9.5%) urinary tract infections, 193 (8.4%) surgical site infections, and 223 (9.7%) sepsis events. 73 (3.2%) patients had fascial dehiscence, 82 (4.0%) developed a deep vein thrombosis, and 67 (2.9%) died. Factors independently associated with the occurrence of any post-operative complication included: age, female gender, ASA class, pre-operative sepsis, COPD, low serum albumin concentration, pre-operative radiotherapy, pre-operative transfusion >4 units, and operative time >6 hours (all p<0.05). Complications remain common following radical cystectomy and a considerable proportion occur after discharge from hospital. This study identifies risk factors for complications and quality improvement needs.

  20. Cost-benefit and effectiveness analysis of rapid testing for MRSA carriage in a hospital setting.

    PubMed

    Henson, Gay; Ghonim, Elham; Swiatlo, Andrea; King, Shelia; Moore, Kimberly S; King, S Travis; Sullivan, Donna

    2014-01-01

    A cost-effectiveness analysis was conducted comparing the polymerase chain reaction assay and traditional microbiological culture as screening tools for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to the pediatric and surgical intensive care units (PICU and SICU) at a 722 bed academic medical center. In addition, the cost benefits of identification of colonized MRSA patients were determined. The cost-effectiveness analysis employed actual hospital and laboratory costs, not patient costs. The actual cost of the PCR assay was higher than the microbiological culture identification of MRSA ($602.95 versus $364.30 per positive carrier identified). However, this did not include the decreased turn-around time of PCR assays compared to traditional culture techniques. Patient costs were determined indirectly in the cost-benefit analysis of clinical outcome. There was a reduction in MRSA hospital-acquired infection (3.5 MRSA HAI/month without screening versus 0.6/month with screening by PCR). A cost-benefit analysis based on differences in length of stay suggests an associated savings in hospitalization costs: MRSA HAI with 29.5 day median LOS at $63,810 versus MRSA identified on admission with 6 day median LOS at $14,561, a difference of $49,249 per hospitalization. Although this pilot study was small and it is not possible to directly relate the cost-effectiveness and cost-benefit analysis due to confounding factors such as patient underlying morbidity and mortality, a reduction of 2.9 MRSA HAI/month associated with PCR screening suggests potential savings in hospitalization costs of $142,822 per month.

  1. Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

    PubMed

    Ocampo, Wrechelle; Geransar, Rose; Clayden, Nancy; Jones, Jessica; de Grood, Jill; Joffe, Mark; Taylor, Geoffrey; Missaghi, Bayan; Pearce, Craig; Ghali, William; Conly, John

    2017-10-01

    Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  2. Scleroderma in hospital settings in Lomé: 50 cases.

    PubMed

    Akakpo, A S; Teclessou, J N; Mouhari-Touré, A; Saka, B; Matakloe, H; Kakpovi, K; Kombate, K; Pitché, P

    2017-11-01

    The aim of this study was to document the epidemiological and clinical profile, treatment used, and outcome of patients with scleroderma in hospital settings in Lomé. This descriptive study examined the records of all patients seen as outpatients or admitted for scleroderma in hospital dermatology and rheumatology departments in Lomé during the 20-year period of 1993-2012. During the study period, 50 (0.04%) of the 121,021 patients seen in these departments had scleroderma. There were 29 cases of localized scleroderma and 21 systemic cases, predominantly women (sex-ratio=0.2). The patients' mean age was 36 years. All patients with systemic scleroderma had speckled achromia (100%), and most (90.48%) had cutaneous sclerosis. After a mean follow-up period of 43.5 days, 71.43% of the patients had been lost to follow-up. All of the patients with localized scleroderma had cutaneous sclerosis, and the rate of loss to follow-up (after a mean of 17 days) was 96.55%. The results of this study confirm the extreme rarity of scleroderma in the teaching hospitals in Lomé and a clear female predominance. It points out the difficulty of management, which both influences and is aggravated by the high rate of loss to follow-up.

  3. State Standard-Setting Processes in Brief. State Academic Standards: Standard-Setting Processes

    ERIC Educational Resources Information Center

    Thomsen, Jennifer

    2014-01-01

    Concerns about academic standards, whether created by states from scratch or adopted by states under the Common Core State Standards (CCSS) banner, have drawn widespread media attention and are at the top of many state policymakers' priority lists. Recently, a number of legislatures have required additional steps, such as waiting periods for…

  4. Suicidal behaviour characteristics and factors associated with mortality in the hospital setting.

    PubMed

    Sendra-Gutiérrez, Juan Manuel; Esteban-Vasallo, María; Domínguez-Berjón, M Felicitas

    2016-04-29

    Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality. A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality. Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women. Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries. Copyright © 2016 SEP y SEPB. Published by Elsevier España. All rights reserved.

  5. Academic interventions for academic procrastination: A review of the literature.

    PubMed

    Zacks, Shlomo; Hen, Meirav

    2018-01-01

    Procrastination is a widespread phenomenon in academic settings. It has been studied from many different theoretical angles, and a variety of causes and consequences have been suggested. Recent studies support the notion that academic procrastination can be seen from a situational perspective and as a failure in learning self-regulation. It suggests that interventions should address situational as well as deficits in self-regulation to help students overcome their procrastinating tendencies. The present review examined the recent literature on causes and consequences of academic procrastination and the limited number of studies of academic interventions for academic procrastination. Findings of this review strengthen the need to further study the topic of academic interventions for academic procrastination and to develop effective interventions. At the end of this review, several suggestions for the development of academic interventions are outlined.

  6. Development of a Self-Report Checklist to Assess Dementia Care by Nurses in Hospital Settings.

    PubMed

    Ikegami, Chikako; Ota, Katsumasa

    2018-03-01

    Nurses working at general hospitals face difficulties in providing dementia care. The current study examined aged care nurses' dementia care practices in the hospital setting and developed a dementia care checklist that nurses can use to review their own care practice. A self-administered questionnaire was given to 676 participants; responses were collected from 595 participants. Exploratory factor analysis identified six factors (e.g., patient understanding prompted by concern and interest for the patient, respect for patients' voluntary behavior, early detection of abnormalities) among the questionnaire's 28 items. This analysis provided a framework for the checklist and verified that it had satisfactory internal consistency and construct validity. The frequency of care practices varied with participants' knowledge of dementia care requirements, satisfaction with their own dementia care practice, confidence in their ability to judge patients' physical condition, and cooperation with colleagues. This checklist might improve dementia care in hospital settings. [Res Gerontol Nurs. 2018; 11(2):91-102.]. © 2018 Ikegami and Ota.

  7. Setting Goals for Achievement in Physical Education Settings

    ERIC Educational Resources Information Center

    Baghurst, Timothy; Tapps, Tyler; Kensinger, Weston

    2015-01-01

    Goal setting has been shown to improve student performance, motivation, and task completion in academic settings. Although goal setting is utilized by many education professionals to help students set realistic and proper goals, physical educators may not be using goal setting effectively. Without incorporating all three types of goals and…

  8. Nurses' meaning of caring with patients in acute psychiatric hospital settings: a grounded theory study.

    PubMed

    Chiovitti, Rosalina F

    2008-02-01

    The concept of caring is described as intangible, abstract, and invisible in nursing practice. This has translated into a view of caring as a personal choice or natural obligation rather than a deliberate process. While there has been movement to delineate caring within nursing in general, the psychiatric nurse's perspective on caring has been absent from theoretical works and measures constructed to describe nurse's work. To develop a substantive grounded theory of caring from the perspective of Registered Nurses working with patients in three Canadian acute psychiatric hospital settings. The qualitative research design of grounded theory methodology was used to develop a theory of caring. Three urban, acute psychiatric hospital settings in Canada. Two were general hospitals and one was a psychiatric hospital. Registered Nurses (N=17) licensed with the College of Nurses of Ontario. In-depth interviews with Registered Nurses were conducted using theoretical sampling. The data were analysed using constant comparative analysis. Protective empowering is the basic social psychological process that represents Registered Nurses' caring with patients in acute psychiatric hospital settings. Nurses accomplish protective empowering through six main categories of: (1) respecting the patient; (2) not taking the patient's behaviour personally; (3) keeping the patient safe; (4) encouraging the patient's health; (5) authentic relating; and (6) interactive teaching. The six main categories were accomplished through 27 subcategories. In the theory of protective empowering, the goal is to help patients participate in activities contributing to convalescence, health, and/or quality of life. The theory of protective empowering provides six main categories and 27 subcategories that can be transferred to funding formulas, patient health record documentation systems, nurse orientation and education programs, nurse role descriptions, and used in guiding discussions about organizational

  9. Goal Setting, Decision-Making Skills and Academic Performance of Undergraduate Distance Learners: Implications for Retention and Support Services

    ERIC Educational Resources Information Center

    Tanglang, Nebath; Ibrahim, Aminu Kazeem

    2015-01-01

    The study adopted an ex-post facto research design. Randomization sampling technique was used to select 346 undergraduate distance learners and the learners were grouped into four, High and Low Goal setter learners and High and Low Decision-making skills learners. The instruments for data collection were Undergraduate Academic Goal Setting Scale…

  10. Preparing rehabilitation healthcare providers in the 21st century: implementation of interprofessional education through an academic-clinical site partnership.

    PubMed

    Sheldon, Michael; Cavanaugh, James T; Croninger, William; Osgood, Wendy; Robnett, Regi; Seigle, Janice; Simonsen, Linda

    2012-01-01

    Health profession education programs often struggle with barriers to implementing interprofesssional educational (IPE) initiatives, limiting early and consistent exposure of students to core IPE competencies. Few published reports are available to guide the implementation of IPE programs into practice. This article describes a successful and evolving partnership between an independent university and a tertiary care hospital. The IPE goals of this partnership were to expose students to roles of other disciplines in the complex hospital environment and integrate acute care exposure throughout the Doctor of Physical Therapy and Master of Science in Occupational Therapy curricula. Faculty and students, patients and families, and occupational and physical therapy clinicians participated in a series of learning activities in an acute care setting involving interprofessional teams of students. Activities included observations of OT and PT clinicians providing standard patient care, practice conducting team patient interviews, and interactive treatment planning sessions conducted live via videoconferencing technology between a patient's hospital room and an academic classroom on the university campus. The activities generally were designed to improve student preparedness for working as part of an interprofessional team in an acute care setting. Student and clinician feedback support the early development of student IPE competencies, including the appreciation and understanding of professional roles in the team approach to patient care and the development of effective communication skills. The partnership between the academic institution and tertiary care hospital is an effective vehicle to deliver and sustain IPE educational initiatives in the acute care setting. Current and planned IPE curriculum integration are discussed along with a preliminary analysis of IPE outcomes.

  11. Recruitment and retention strategies for hospital laboratory personnel in urban and rural settings.

    PubMed

    Slagle, Derek R

    2013-01-01

    Laboratory directors and administrators play vital roles in the recruitment and retention processes of their employees. A total of 71 laboratory directors from hospitals across 51 counties in Tennessee responded to questionnaires regarding recruitment and retention strategies. Respondents reported strategies for recruitment and retention, which were agreed to be effective by management. Overall, these major strategies were consistent regardless of geographic location and limited differences were noted with regard to urban-rural locations. The findings that varied significantly between urban and rural locations included: 1) rural employees needed additional supervision; 2) rural hospitals relied on local residents more so than urban hospitals; 3) rural laboratory administrators noted more limited access to resources; and the 4) lower effectiveness of recruitment agencies and family relocation programs for rural hospitals. This is significant given the disparities often associated with rural areas, and the potential to develop more successful recruitment and retention strategies for those areas. Active managers in clinical laboratory science programs in the hospital setting should note effective strategies for both, recruitment and retention of personnel, and note the potential impact of geography on such processes.

  12. Specialist outreach clinics in primary care and rural hospital settings.

    PubMed

    Gruen, R L; Weeramanthri, T S; Knight, S E; Bailie, R S

    2004-01-01

    Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. Four reviewers working in pairs independently extracted data and assessed study quality. 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients

  13. Roadmap to an effective quality improvement and patient safety program implementation in a rural hospital setting.

    PubMed

    Ingabire, Willy; Reine, Petera M; Hedt-Gauthier, Bethany L; Hirschhorn, Lisa R; Kirk, Catherine M; Nahimana, Evrard; Nepomscene Uwiringiyemungu, Jean; Ndayisaba, Aphrodis; Manzi, Anatole

    2015-12-01

    Implementation lessons: (1) implementation of an effective quality improvement and patient safety program in a rural hospital setting requires collaboration between hospital leadership, Ministry of Health and other stakeholders. (2) Building Quality Improvement (QI) capacity to develop engaged QI teams supported by mentoring can improve quality and patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Demographic and other characteristics of nodal non-Hodgkin's lymphoma managed in academic versus non-academic centers.

    PubMed

    Bhatt, Vijaya Raj; Dhakal, Prajwal; Dahal, Sumit; Giri, Smith; Pathak, Ranjan; Bociek, R Gregory; Silberstein, Peter T; Armitage, James O

    2015-10-01

    Cancer therapy and outcomes are known to be affected by various demographic features and hospital types. We aimed to identify the characteristics of non-Hodgkin's lymphoma (NHL) patients associated with receipt of care at academic centers. This is a retrospective study of all patients diagnosed with nodal NHL between 2000 and 2011 in the National Cancer Database (NCDB), who received the diagnosis, and all or part of their initial therapy in the reporting hospital (n = 243,436). Characteristics of patients receiving care in academic versus nonacademic centers were compared using the Chi-square test. Approximately 27% received care in academic centers. Patients receiving care in nonacademic centers, compared with academic centers, were more likely to be ⩾60 years (69% versus 58%, p < .0001), White (89% versus 80%, p < .0001) and have lower educational attainment (>12% without high school diploma: 72% versus 69%, p < .0001) and economic status (household income <$49,000: 66% versus 61%, p < 0.0001). Patients receiving care in nonacademic centers were less likely to travel ⩾25 miles (21% versus 26%, p < 0.0001). White patients, compared with non-Whites, were more likely to be ⩾60 years (70% versus <50%, p < 0.0001), which probably explains less care in academic centers. Patients ⩾60 years and those with poorer educational attainment and economic status were less likely to receive care in academic centers. Care in academic centers required a longer commute. Elderly patients frequently have inferior outcomes and may benefit from clinical trials with novel agents and expertise at academic centers.

  15. Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals

    PubMed Central

    2017-01-01

    PURPOSE: The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. DESIGN: Retrospective observational cohort. SAMPLE AND SETTING: We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. METHODS: We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. RESULTS: Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (−1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (−1.13 cases/quarter; P = .035). CONCLUSIONS: Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products. PMID:28816929

  16. 'Being a conduit' between hospital and home: stakeholders' views and perceptions of a nurse-led Palliative Care Discharge Facilitator Service in an acute hospital setting.

    PubMed

    Venkatasalu, Munikumar Ramasamy; Clarke, Amanda; Atkinson, Joanne

    2015-06-01

    To explore and critically examine stakeholders' views and perceptions concerning the nurse-led Palliative Care Discharge Service in an acute hospital setting and to inform sustainability, service development and future service configuration. The drive in policy and practice is to enable individuals to achieve their preferred place of care during their last days of life. However, most people in UK die in acute hospital settings against their wishes. To facilitate individuals' preferred place of care, a large acute hospital in northeast England implemented a pilot project to establish a nurse-led Macmillan Palliative Care Discharge Facilitator Service. A pluralistic evaluation design using qualitative methods was used to seek stakeholders' views and perceptions of this service. In total, 12 participants (five bereaved carers and seven health professionals) participated in the evaluation. Semi-structured interviews were conducted with bereaved carers who used this service for their relatives. A focus group and an individual interview were undertaken with health professionals who had used the service since its inception. Individual interviews were also conducted with the Discharge Facilitator and service manager. Analysis of all data was guided by Framework Analysis. Four key themes emerged relating to the role of the Discharge Facilitator Service: achieving preferred place of care; the Discharge Facilitator as the 'conduit' between hospital and community settings; delays in hospital discharge and stakeholders' perceptions of the way forward for the service. The Discharge Facilitator Service acted as a reliable resource and support for facilitating the fast-tracking of end-of-life patients to their preferred place of care. Future planning for hospital-based palliative care discharge facilitating services need to consider incorporating strategies that include: increased profile of the service, expansion of service provision and the Discharge Facilitator's earlier

  17. Learning behaviour and preferences of family medicine residents under a flexible academic curriculum

    PubMed Central

    Sy, Alice; Wong, Eric; Boisvert, Leslie

    2014-01-01

    Abstract Objective To determine family medicine residents’ learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Design Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. Setting London, Ont. Participants All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Main outcome measures Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. Results A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians’ teaching sessions (20%), and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents’ homes (32%), and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Conclusion Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents’ various learning preferences and

  18. Discontinuation of Tocolytics for Preterm Labor in an Academic Safety Net Hospital: Impact on the Duration of Betamethasone Exposure.

    PubMed

    Alston, Meredith J; Alexandrovic, Kara; Stiglich, Norma; Metz, Torri D

    2016-01-01

    To evaluate the impact of discontinuation of tocolytics on the completion of the corticosteroid course among preterm neonates in an academic safety net hospital. Retrospective cohort study of all singleton pregnancies with preterm labor resulting in delivery between 24 and 34 weeks' gestation at Denver Health Medical Center (DHMC) between 1/1/2004 and 5/31/2009. In January 2007 DHMC discontinued the use of tocolytic therapy for preterm labor. Study subjects were grouped based on whether their delivery occurred before or after the change in policy. Multivariable logistic regression was used to determine whether the use of tocolysis increased the odds of completion of the betamethasone while adjusting for cervical examination at admission. Of 169 infant/mother pairs who met inclusion criteria, 102 delivered prior to the discontinuation of tocolytics and 67 delivered after the discontinuation of tocolytics. Treatment with tocolysis increased the odds of completing the 48-hour betamethasone window (OR 2.59, 95% CI 1.16-5.79). Each centimeter increase in cervical dilation at the time of admission decreased the odds of completing the betamethasone window (OR 0.50, 95% CI 0.39-0.62). The use of tocolytics increased the odds of completion of the betamethasone window in an academic safety net hospital among neonates born between 24 and 34 weeks' gestation.

  19. Academic and Family Conditions Associated with Intrinsic Academic Motivation in Japanese Medical Students: A Pilot Study

    ERIC Educational Resources Information Center

    Tanaka, Masaaki; Watanabea, Yasuyoshi

    2012-01-01

    Objective: Intrinsic academic motivation is one of the most important psychological concepts in education, and it is related to academic outcomes in medical students. This study examined the relationships between academic and family conditions and intrinsic academic motivation. Design: Cross-sectional design. Setting: The study group consisted of…

  20. Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting.

    PubMed

    Hammond, Athena; Homer, Caroline S E; Foureur, Maralyn

    2017-07-01

    to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews and a thematic analysis guided by study objectives and the aims of exploratory research was undertaken. the study was set at a recently renovated tertiary hospital in a large Australian city. participants were 16 registered midwives working in a tertiary hospital; seven in delivery suite and nine in birth centre settings. Experience as a midwife ranged from three to 39 years and the sample included midwives in diverse roles such as educator, student support and unit manager. three design characteristics were identified that supported midwifery practice. They were friendliness, functionality and freedom. Friendly rooms reduced stress and increased midwives' feelings of safety. Functional rooms enabled choice and provided options to better meet the needs of labouring women. And freedom allowed for flexible, spontaneous and responsive midwifery practice. hospital birth rooms that possess the characteristics of friendliness, functionality and freedom offer enhanced support for midwives and may therefore increase effective care provision. new and existing birth rooms can be designed or adapted to better support the wellbeing and effectiveness of midwives and may thereby enhance the quality of midwifery care delivered in the hospital. Quality midwifery care is associated with positive outcomes and experiences for labouring women. Further research is required to investigate the benefit that may be transmitted to women by implementing design intended to support and enhance midwifery practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Barriers to antenatal psychosocial assessment and depression screening in private hospital settings.

    PubMed

    Connell, Tanya; Barnett, Bryanne; Waters, Donna

    2017-10-11

    The evidence of benefit for antenatal psychosocial assessment and depression screening has been sufficient to lead the implementation of screening in public hospitals in all states of Australia. Details of the implementation of perinatal screening in private obstetric settings is less well known. As any successful implementation relies on the identification of local barriers, we aimed to determine what perceived or actual barriers may exist for the implementation of evidence-based perinatal screening interventions in private obstetric care, and specifically within small private hospitals. The integrative literature review method offers a structured systematic approach to organise, synthesize and critique research from a range of sources. This method was used to determine what barriers have been identified in implementing psychosocial assessment and depression screening with women receiving obstetric care in private hospital settings. The integrative review findings suggest that barriers to implementing psychosocial screening in the private sector are similar to those experienced in the public sector but may also be influenced by the corporate focus of private services. Barriers were identified among health professionals, within the personal and psychosocial context of women and their families, and at provider or system level. Once identified, barriers can be systematically addressed to enhance the success of implementing psychosocial and depression screening in the private sector. Screening is likely to be influenced by the business models and operating systems of private service providers. Health professionals working within this environment need more support to conduct perinatal assessment within this context. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  2. Gender disparities in leadership and scholarly productivity of academic hospitalists.

    PubMed

    Burden, Marisha; Frank, Maria G; Keniston, Angela; Chadaga, Smitha R; Czernik, Zuzanna; Echaniz, Marisa; Griffith, Jennifer; Mintzer, David; Munoa, Anna; Spence, Jeffrey; Statland, Barbara; Teixeira, Joao Pedro; Zoucha, Jeff; Lones, Jason; Albert, Richard K

    2015-08-01

    Gender disparities still exist for women in academic medicine but may be less evident in younger cohorts. Hospital medicine is a new field, and the majority of hospitalists are <41 years of age. To determine whether gender disparities exist in leadership and scholarly productivity for academic hospitalists and to compare the findings to academic general internists. Prospective and retrospective observational study. University programs in the United States. Gender distribution of (1) academic hospitalists and general internists, (2) division or section heads for both specialties, (3) speakers at the 2 major national meetings of the 2 specialties, and (4) first and last authors of articles from the specialties' 2 major journals We found equal gender representation of hospitalists and general internists who worked in university hospitals. Divisions or sections of hospital medicine and general internal medicine were led by women at 11/69 (16%) and 28/80 (35%) of university hospitals, respectively (P = 0.008). Women hospitalists and general internists were listed as speakers on 146/557 (26%) and 291/580 (50%) of the presentations at national meetings, respectively (P < 0.0001), first authors on 153/464 (33%) and 423/895 (47%) publications, respectively (P < 0.0001), and senior authors on 63/305 (21%) and 265/769 (34%) articles, respectively (P < 0.0001). Despite hospital medicine being a newer field, gender disparities exist in leadership and scholarly productivity. © 2015 Society of Hospital Medicine.

  3. Academic procrastination and academic performance: An initial basis for intervention.

    PubMed

    Goroshit, Marina

    2018-01-01

    Academic procrastination is a prevalent phenomenon with a range of negative outcomes. Many studies focused on causes and correlates of academic procrastination; however, the study of interventions for academic procrastination is scarce. The present study is an initial effort to study the relationship between academic procrastination, online course participation, and achievement, as a basis for developing an intervention for academic procrastination. Findings indicated that studying procrastination was negatively associated with final exam grade as well as with the three online course participation measures. Final exam grade was positively associated with two of the online course participation measures, and they positively correlated with each other. In addition, results indicated that studying procrastination, in combination with online course participation measures, explained about 50% of variance in final exam's grade. Frequency of activities in course Web site had the strongest positive effect on final exam's grade. These findings strengthen the notion that studying procrastination is an impediment to students' academic performance and outcomes and clarifies the need to develop and study academic interventions for academic procrastination as a means to decrease its prevalence in academic settings.

  4. Complementary and Integrative Healthcare for Patients with Mechanical Low Back Pain in a U.S. Hospital Setting

    PubMed Central

    Rhee, Taeho Greg; Leininger, Brent D.; Ghildayal, Neha; Evans, Roni L.; Dusek, Jeffery A.; Johnson, Pamela Jo

    2015-01-01

    Objectives Complementary and integrative healthcare (CIH) is commonly used to treat low back pain (LBP). While the use of CIH within hospitals is increasing, little is known regarding the delivery of these services within inpatient settings. We examine the patterns of CIH services among inpatients with mechanical LBP in a hospital setting. Methods This is a retrospective, practice-based study conducted at Abbot Northwestern hospital in Minnesota. Using electronic health record data from July 2009 to December 2012, 8,095 inpatients with mechanical LBP were identified using ICD-9 codes. We classified patients by reason for hospitalization. We examined demographic and clinical characteristics by receipt of CIH services. Then, we estimated the prevalence of types of CIH delivered and clinical foci for CIH visits among inpatients with mechanical LBP. Results Most inpatients with mechanical LBP (>90%) were hospitalized for surgical procedures. Overall, 14.2% received inpatient CIH services. All demographic and clinical characteristics differed by receipt of CIH (P<0.001), except race/ethnicity. CIH recipients were in poorer health than those who did not. Most commonly delivered CIH services were massage (62.1%), relaxation techniques (42.0%) and acupuncture (25.7%). Pain (45.1%), relaxation (17.5%), and comfort (8.2%) were the top three reasons for CIH visits. Conclusion There are important differences between CIH recipients and non-CIH recipients among patients with mechanical LBP within a hospital setting. The reasons documented for CIH visits included addressing physical, emotional and/or mental conditions of patients. Future studies are needed to determine the effectiveness of CIH services health and wellbeing outcomes in this population. PMID:26860795

  5. Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

    PubMed

    Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

    2006-11-01

    Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway

  6. Adventure Counseling as an Adjunct to Group Counseling in Hospital and Clinical Settings

    ERIC Educational Resources Information Center

    Gillen, Mark C.; Balkin, Richard S.

    2006-01-01

    Adventure counseling has been thought of as a highly specialized application of group counseling skills in a wilderness environment. In fact, adventure counseling is based on a developmental theory of group, can be useful for a variety of clients, and can be thoughtfully integrated into clinical and hospital settings. This article describes the…

  7. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center.

    PubMed

    Dion, Liza J; Cutshall, Susanne M; Rodgers, Nancy J; Hauschulz, Jennifer L; Dreyer, Nikol E; Thomley, Barbara S; Bauer, Brent

    2015-03-01

    Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

  8. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

    PubMed Central

    Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

    2015-01-01

    Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID

  9. Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers.

    PubMed

    Tobert, Conrad M; Mott, Sarah L; Nepple, Kenneth G

    2018-01-01

    Malnutrition is a significant problem for hospitalized patients. However, the true prevalence of reported malnutrition diagnosis in real-world clinical practice is largely unknown. Using a large collaborative multi-institutional database, the rate of malnutrition diagnosis was assessed and used to assess institutional variables associated with higher rates of malnutrition diagnosis. The aim of this study was to define the prevalence of malnutrition diagnosis reported among inpatient hospitalizations. The University Health System Consortium (Vizient) database was retrospectively reviewed for reported rates of malnutrition diagnosis. All adult inpatient hospitalization at 105 member institutions during fiscal years 2014 and 2015 were evaluated. Malnutrition diagnosis based on the presence of an International Classification of Diseases-Ninth Revision diagnosis code. Hospital volume and publicly available hospital rankings and patient satisfaction scores were obtained. Multiple regression analysis was performed to assess the association between these variables and reported rates of malnutrition. A total of 5,896,792 hospitalizations were identified from 105 institutions during the 2-year period. It was found that 292,754 patients (5.0%) had a malnutrition diagnosis during their hospital stay. By institution, median rate of malnutrition diagnosis during hospitalization was 4.0%, whereas the rate of severe malnutrition diagnosis was 0.9%. There was a statistically significant increase in malnutrition diagnosis from 4.0% to 4.9% between 2014 and 2015 (P<0.01). Institutional factors associated with increased diagnosis of malnutrition were higher hospital volume, hospital ranking, and patient satisfaction scores (P<0.01). Missing a malnutrition diagnosis appears to be a universal issue because the rate of malnutrition diagnosis was consistently low across academic medical centers. Institutional variables were associated with the prevalence of malnutrition diagnosis, which

  10. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration--2014.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2015-07-01

    The results of the 2014 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are described. A stratified random sample of pharmacy directors at 1435 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 29.7%. Ninety-seven percent of hospitals used automated dispensing cabinets in their medication distribution systems, 65.7% of which used individually secured lidded pockets as the predominant configuration. Overall, 44.8% of hospitals used some form of machine-readable coding to verify doses before dispensing in the pharmacy. Overall, 65% of hospital pharmacy departments reported having a cleanroom compliant with United States Pharmacopeia chapter 797. Pharmacists reviewed and approved all medication orders before the first dose was administered, either onsite or by remote order view, except in procedure areas and emergency situations, in 81.2% of hospitals. Adoption rates of electronic health information have rapidly increased, with the widespread use of electronic health records, computer prescriber order entry, barcodes, and smart pumps. Overall, 31.4% of hospitals had pharmacists practicing in ambulatory or primary care clinics. Transitions-of-care services offered by the pharmacy department have generally increased since 2012. Discharge prescription services increased from 11.8% of hospitals in 2012 to 21.5% in 2014. Approximately 15% of hospitals outsourced pharmacy management operations to a contract pharmacy services provider, an increase from 8% in 2011. Health-system pharmacists continue to have a positive impact on improving healthcare through programs that improve the efficiency, safety, and clinical outcomes of medication use in health systems. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  11. The Scholarship of Academic Development.

    ERIC Educational Resources Information Center

    Eggins, Heather, Ed.; Macdonald, Ranald, Ed.

    The selections in this book address the concept and nature of academic development and examine research into and within the field. Following an introduction, "Developing a Scholarship of Academic Development: Setting the Context," by Ranald Macdonald, the chapters of part 1, "Conceptualizing Academic Development," are: (2)…

  12. [Attitudes towards patient safety culture in a hospital setting and related variables].

    PubMed

    Mir-Abellán, Ramon; Falcó-Pegueroles, Anna; de la Puente-Martorell, María Luisa

    To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables. The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative. 59% (n=123) of respondents rated safety between 7 and 8. 53% (n=103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was "teamwork in the unit/service" and the opportunity for improvement was "staffing". A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff. This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Palliative care need and management in the acute hospital setting: a census of one New Zealand Hospital

    PubMed Central

    2013-01-01

    Background Improving palliative care management in acute hospital settings has been identified as a priority internationally. The aim of this study was to establish the proportion of inpatients within one acute hospital in New Zealand who meet prognostic criteria for palliative care need and explore key aspects of their management. Methods A prospective survey of adult hospital inpatients (n = 501) was undertaken. Case notes were examined for evidence that the patient might be in their last year of life according to Gold Standards Framework (GSF) prognostic indicator criteria. For patients who met GSF criteria, clinical and socio-demographic information were recorded. Results Ninety-nine inpatients met GSF criteria, representing 19.8% of the total census population. The patients’ average age was 70 years; 47% had a primary diagnosis of cancer. Two thirds had died within 6 months of their admission. Seventy-eight of the 99 cases demonstrated evidence that a palliative approach to care had been adopted; however documentation of discussion about goals of care was very limited and only one patient had evidence of an advance care plan. Conclusion One fifth of hospital inpatients met criteria for palliative care need, the majority of whom were aged >70 years. Whilst over three quarters were concluded to be receiving care in line with a palliative care approach, very little documented evidence of discussion with patients and families regarding end of life issues was evident. Future research needs to explore how best to support ‘generalist’ palliative care providers in initiating, and appropriately recording, such discussions. PMID:23537092

  14. Repetitive Pediatric Anesthesia in a Non-Hospital Setting

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Buchsbaum, Jeffrey C., E-mail: jbuchsba@iupui.edu; Indiana University Health Proton Therapy Center, Bloomington, Indiana; McMullen, Kevin P.

    2013-04-01

    Purpose: Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia. Methods and Materials: The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008,more » and April 12, 2012. Results: A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy. Conclusions: This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers.« less

  15. Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project.

    PubMed

    Stephenson, Matthew; Mcarthur, Alexa; Giles, Kristy; Lockwood, Craig; Aromataris, Edoardo; Pearson, Alan

    2016-02-01

    To assess falls prevention practices in Australian hospitals and implement interventions to promote best practice. A multi-site audit using eight evidence-based audit criteria. Following a baseline audit, barriers to compliance were identified and targeted. Two follow-up audit cycles assessed the sustainability of practice change. Nine acute care hospitals around Australia, including a mix of public and private. One medical ward and one surgical ward from each hospital were involved. A clinical leader from each hospital, trained in evidence implementation, conducted the audits and implementation strategies in their setting. Multi-component falls prevention interventions were utilized, designed to target specific barriers to compliance identified at each hospital. Common interventions involved staff and patient education. Percentage compliance with falls prevention audit criteria and change in compliance between baseline and follow-up audits. Fall rate data were also analysed. Mean overall compliance at baseline across all hospitals was 50.4% (range 30.8-76.6%). At the first follow-up, this had increased to 74.5% (range 59.4-87.4%), which was sustained at the second follow-up (74.1%, range 48.6-84.4%). There were no statistically significant differences between compliance rates in medical versus surgical wards or in private versus public hospitals. Despite sustained practice improvement, reported fall rates remained unchanged. The focus on staff education possibly led to improved reporting of falls, which may explain the apparent lack of effect on fall rates. Clinical audit and feedback is an effective strategy to promote quality improvement in falls prevention practices in acute hospital settings. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  16. Surgery and anesthesia capacity-building in resource-poor settings: description of an ongoing academic partnership in Uganda.

    PubMed

    Lipnick, Michael; Mijumbi, Cephas; Dubowitz, Gerald; Kaggwa, Samuel; Goetz, Laura; Mabweijano, Jacqueline; Jayaraman, Sudha; Kwizera, Arthur; Tindimwebwa, Joseph; Ozgediz, Doruk

    2013-03-01

    Surgery and perioperative care have been neglected in the arena of global health despite evidence of cost-effectiveness and the growing, substantial burden of surgical conditions. Various approaches to address the surgical disease crisis have been reported. This article describes the strategy of Global Partners in Anesthesia and Surgery (GPAS), an academically based, capacity-building collaboration between North American and Ugandan teaching institutions. The collaboration's projects shift away from the trainee exchange, equipment donation, and clinical service delivery models. Instead, it focuses on three locally identified objectives to improve surgical and perioperative care capacity in Uganda: workforce expansion, research, collaboration. Recruitment programs from 2007 to 2011 helped increase the number of surgery and anesthesia trainees at Mulago Hospital (Kampala, Uganda) from 20 to 40 and 2 to 19, respectively. All sponsored trainees successfully graduated and remained in the region. Postgraduate academic positions were created and filled to promote workforce retention. A local research agenda was developed, more than 15 collaborative, peer-reviewed papers have been published, and the first competitive research grant for a principal investigator in the Department of Surgery at Mulago was obtained. A local projects coordinator position and an annual conference were created and jointly funded by partnering international efforts to promote collaboration. Sub-Saharan Africa has profound unmet needs in surgery and perioperative care. This academically based model helped increase recruitment of trainees, expanded local research, and strengthened stakeholder collaboration in Uganda. Further analysis is underway to determine the impact on surgical disease burden and other important outcome measures.

  17. Balancing power: A grounded theory study on partnership of academic service institutes.

    PubMed

    Heshmati Nabavi, Fatemeh; Vanaki, Zohreh; Mohammadi, Eesa; Yazdani, Shahram

    2017-07-01

    Governments and professional organizations have called for new partnerships between health care providers and academics to improve clinical education for the benefit of both students and patients. To develop a substantive grounded theory on the process of forming academic-service partnerships in implementing clinical education, from the perspective of academic and clinical nursing staff members and managers working in Iranian settings. The participants included 15 hospital nurses, nurse managers, nurse educators, and educational managers from two central universities and clinical settings from 2009 to 2012. Data were collected through 30 in-depth, semi-structure interviews with the individual participants and then analyzed using the methodology of Strauss and Corbin's grounded theory. Utilizing "balancing power" as the core variable enabled us to integrate the concepts concerning the partnership processes between clinical and educational institutes. Three distinct and significant categories emerged to explain the process of partnership: 1) divergence, 2) conflict between educational and caring functions, and 3) creation of balance between educational and caring functions. In implementing clinical education, partnerships have been formed within a challenging context in Iran. Conflict between clinical and educational functions was the main concern of both sides of the partnership in forming a collaborative relationship, with our findings emphasizing the importance of nursing educators' role in the establishment of partnership programs.

  18. 'I do the best I can': an in-depth exploration of the aphasia management pathway in the acute hospital setting.

    PubMed

    Foster, Abby M; Worrall, Linda E; Rose, Miranda L; O'Halloran, Robyn

    2016-09-01

    While research has begun to explore the management of aphasia across the continuum of care, to date there is little in-depth, context specific knowledge relating to the speech pathology aphasia management pathway. This research aimed to provide an in-depth understanding of the current aphasia management pathway in the acute hospital setting, from the perspective of speech pathologists. Underpinned by a social constructivist paradigm, the researchers implemented an interpretive phenomenological method when conducting in-depth interviews with 14 Australian speech pathologists working in the acute hospital setting. Interview transcripts and interviewer field notes were subjected to a qualitative content analysis. Analysis identified a single guiding construct and five main categories to describe the management of aphasia in the acute hospital setting. The guiding construct, First contact with the profession, informed the entire management pathway. Five additional main categories were identified: Referral processes; Screening and assessment; Therapeutic intervention; Educational and affective counselling; and Advocacy. Findings suggest significant diversity in the pathways of care for people with aphasia and their families in the acute hospital setting. Additional support mechanisms are required in order to support speech pathologists to minimise the evidence-practice gap. Implications for Rehabilitation Significant diversity exists in the current aphasia management pathway for people with acute post-stroke aphasia and their families in the acute hospital setting. Mechanisms that support speech pathologists to minimise the evidence-practice gap, and consequently reduce their sense of professional dissonance, are required.

  19. An alcohol-focused intervention versus a healthy living intervention for problem drinkers identified in a general hospital setting (ADAPTA): study protocol for a randomized, controlled pilot trial.

    PubMed

    Watson, Judith; Tober, Gillian; Raistrick, Duncan; Mdege, Noreen; Dale, Veronica; Crosby, Helen; Godfrey, Christine; Lloyd, Charlie; Toner, Paul; Parrott, Steve

    2013-04-30

    collaboration between academics, commissioners and clinicians in general hospital and addiction services, made possible by the Collaboration in Leadership in Applied Health Research and Care (CLAHRC) program of research. CLAHRC was a necessary vehicle for overcoming the barriers to answering an important NHS question--how better to engage problem drinkers in a hospital setting. ISRCTN47728072.

  20. Dementia training programmes for staff working in general hospital settings - a systematic review of the literature.

    PubMed

    Scerri, Anthony; Innes, Anthea; Scerri, Charles

    2017-08-01

    Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes. This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals. Literature from five databases were searched, based on a number of inclusion criteria. The selected studies were summarised and data was extracted and compared using narrative synthesis based on a set of pre-defined categories. Methodological quality was assessed. Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning were the most utilised. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients' outcomes. This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. It also highlights measures that could be used to develop and deliver training programmes in hospital settings.

  1. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

    PubMed

    Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

    2016-06-01

    OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

  2. How organizational context affects bioethical decision-making: pharmacists' management of gatekeeping processes in retail and hospital settings.

    PubMed

    Chiarello, Elizabeth

    2013-12-01

    Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions "on the ground." Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals - pharmacists - working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Functional consistency across two behavioural modalities: fire-setting and self-harm in female special hospital patients.

    PubMed

    Miller, Sarah; Fritzon, Katarina

    2007-01-01

    Fire-setting and self-harm behaviours among women in high security special hospitals may be understood using Shye's Action System Theory (AST) in which four functional modes are recognized: 'adaptive', 'expressive', 'integrative', and 'conservative'. To test for relationships between different forms of fire-setting and self-harm behaviours and AST modes among women in special hospital, and for consistency within modes across the two behaviours. Clinical case files evidencing both fire-setting and self-harm behaviours (n = 50) were analysed for content, focusing on incident characteristics. A total of 29 fire-setting and 22 self-harm variables were analysed using Smallest Space Analysis (SSA). Chi-square and Spearman's rho (rho) analyses were used to determine functional consistency across behavioural modes. Most women showed one predominant AST mode in fire-setting (n = 39) and self-harm (n = 35). Significant positive correlations were found between integrative and adaptive modes of functioning. The lack of correlation between conservative and expressive modes reflects the differing behaviours used in each activity. Despite this, significant cross-tabulations revealed that each woman had parallel fire-setting and self-harm styles. Findings suggest that, for some women, setting fires and self harm fulfil a similar underlying function. Support is given to AST as a way of furthering understanding of damaging behaviours, whether self- or other-inflicted. Copyright 2007 John Wiley & Sons, Ltd.

  4. Advocacy for the Provision of Dental Hygiene Services Within the Hospital Setting: Development of a Dental Hygiene Student Rotation.

    PubMed

    Juhl, Jacqueline A; Stedman, Lynn

    2016-06-01

    Educational preparation of dental hygiene students for hospital-based practice, and advocacy efforts promote inclusion of dental hygienists within hospital-based interdisciplinary health care teams. Although the value of attending to the oral care needs of patients in critical care units has been recognized, the potential impact of optimal oral health care for the general hospital population is now gaining attention. This article describes a hospital-based educational experience for dental hygiene students and provides advocacy strategies for inclusion of dental hygienists within the hospital interdisciplinary team. The dental hygienist authors, both educators committed to evidence-based oral health care and the profession of dental hygiene, studied hospital health care and recognized a critical void in oral health care provision within that setting. They collaboratively developed and implemented a hospital-based rotation within the curriculum of a dental hygiene educational program and used advocacy skills to encourage hospital administrators to include a dental hygiene presence within hospital-based care teams. Hospital-based dental hygiene practice, as part of interprofessional health care delivery, has the potential to improve patient well-being, shorten hospital stays, and provide fiscal savings for patients, institutions, and third party payers. Advocacy efforts can promote dental hygienists as members of hospital-based health care teams. Further research is needed to document: (1) patient outcomes resulting from optimal oral care provision in hospitals; (2) best ways to prepare dental hygienists for career opportunities within hospitals and other similar health care settings; and (3) most effective advocacy strategies to promote inclusion of dental hygienists within care teams. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Survey of academic pediatric hospitalist programs in the US: organizational, administrative, and financial factors.

    PubMed

    Gosdin, Craig; Simmons, Jeffrey; Yau, Connie; Sucharew, Heidi; Carlson, Douglas; Paciorkowski, Natalia

    2013-06-01

    Many pediatric academic centers have hospital medicine programs. Anecdotal data suggest that variability exists in program structure. To provide a description of the organizational, administrative, and financial structures of academic pediatric hospital medicine (PHM). This online survey focused on the organizational, administrative, and financial aspects of academic PHM programs, which were defined as hospitalist programs at US institutions associated with accredited pediatric residency program (n = 246) and identified using the Accreditation Council for Graduate Medical Education (ACGME) Fellowship and Residency Electronic Interactive Database. PHM directors and/or residency directors were targeted by both mail and the American Academy of Pediatrics Section on Hospital Medicine LISTSERV. The overall response rate was 48.8% (120/246). 81.7% (98/120) of hospitals reported having an academic PHM program, and 9.1% (2/22) of hospitals without a program reported plans to start a program in the next 3 years. Over a quarter of programs provide coverage at multiple sites. Variability was identified in many program factors, including hospitalist workload and in-house coverage provided. Respondents reported planning increased in-house hospitalist coverage coinciding with the 2011 ACGME work-hour restrictions. Few programs reported having revenues greater than expenses (26% single site, 4% multiple site). PHM programs exist in the majority of academic centers, and there appears to be variability in many program factors. This study provides the most comprehensive data on academic PHM programs and can be used for benchmarking as well as program development. Copyright © 2013 Society of Hospital Medicine.

  6. Management of the Hospital Environment

    ERIC Educational Resources Information Center

    Turner, Alvis G.

    1976-01-01

    Hospital studies indicate the need for an environmental/sanitarian specialist for control of nosocomial infection and maintenance of a quality environment. The author recommends these requirements for certification as a hospital environmentalist: academic studies including toxicology, epidemiology, hygiene, management, and an internship in…

  7. Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital.

    PubMed

    Picard, Matthieu; Bégin, Philippe; Bouchard, Hugues; Cloutier, Jonathan; Lacombe-Barrios, Jonathan; Paradis, Jean; Des Roches, Anne; Laufer, Brian; Paradis, Louis

    2013-01-01

    Prescribing antibiotics to patients with a history of penicillin allergy is common in clinical practice. Opting for non-beta-lactam antibiotics has its inconveniences and is often unnecessary, because most of these patients are in fact not allergic. This study aimed to determine how physicians in a large Canadian tertiary-care academic hospital without allergists on staff treat patients with a history of penicillin allergy. A retrospective study was conducted during a 1-year period among all patients hospitalized in the intensive care unit, coronary care unit, and internal medicine wards. Files of patients with a record of penicillin allergy were reviewed to assess the need for antibiotics during their hospitalization and the decision-making process underlying the choice of antibiotic. The additional costs of alternative antibiotics were calculated. The files of 1738 patients admitted over a 1-year period were hand reviewed. A history of penicillin allergy was found in 172 patients (9.9%). The allergic reaction was described in only 30% of cases and left unmentioned in 20.7%. Beta-lactam antibiotics were used on 56 occasions despite a history of penicillin allergy. The use of alternative antibiotics in place of the beta-lactam standard of care carried an additional cost of $15,672 Canadian. Alleged penicillin allergy is common among hospitalized patients and leads to substantial additional costs. Poor documentation of penicillin allergy likely reflects a lack of knowledge on this issue in the medical community, which impairs optimal treatment of these patients. Increased education on this matter is needed, and allergists on staff could be part of the solution. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Financial impact of tertiary care in an academic medical center.

    PubMed

    Huber, T S; Carlton, L M; O'Hern, D G; Hardt, N S; Keith Ozaki, C; Flynn, T C; Seeger, J M

    2000-06-01

    To analyze the financial impact of three complex vascular surgical procedures to both an academic hospital and a department of surgery and to examine the potential impact of decreased reimbursements. The cost of providing tertiary care has been implicated as one potential cause of the financial difficulties affecting academic medical centers. Patients undergoing revascularization for chronic mesenteric ischemia, elective thoracoabdominal aortic aneurysm repair, and treatment of infected aortic grafts at the University of Florida were compared with those undergoing elective infrarenal aortic reconstruction and carotid endarterectomy. Hospital costs and profit summaries were obtained from the Clinical Resource Management Office. Departmental costs and profit summary were estimated based on the procedural relative value units (RVUs), the average clinical cost per RVU ($33.12), surgeon charges, and the collection rate for the vascular surgery division (30.2%) obtained from the Faculty Group Practice. Surgeon work effort was analyzed using the procedural work RVUs and the estimated total care time. The analyses were performed for all payors and the subset of Medicare patients, and the potential impact of a 15% reduction in hospital and physician reimbursement was analyzed. Net hospital income was positive for all but one of the tertiary care procedures, but net losses were sustained by the hospital for the mesenteric ischemia and infected aortic graft groups among the Medicare patients. In contrast, the estimated reimbursement to the department of surgery for all payors was insufficient to offset the clinical cost of providing the RVUs for all procedures, and the estimated losses were greater for the Medicare patients alone. The surgeon work effort was dramatically higher for the tertiary care procedures, whereas the reimbursement per work effort was lower. A 15% reduction in reimbursement would result in an estimated net loss to the hospital for each of the tertiary

  9. Evaluating the impact of new anticoagulants in the hospital setting

    PubMed Central

    Braidy, Nady; Bui, Khai; Bajorek, Beata

    2010-01-01

    The short-comings of current anticoagulants have led to the development of newer, albeit more expensive, oral alternatives. Objective To explore the potential impact the new anticoagulants dabigatran and rivaroxaban in the local hospital setting, in terms of utilisation and subsequent costing. Method A preliminary costing analysis was performed based on a prospective 2-week clinical audit (29th June - 13th July 2009). Data regarding current anticoagulation management were extracted from the medical files of patients admitted to Ryde Hospital. To model potential costing implications of using the newer agents, the reported incidence of VTE/stroke and bleeding events were obtained from key clinical trials. Results Data were collected for 67 patients treated with either warfarin (n=46) or enoxaparin (n=21) for prophylaxis of VTE/stroke. At least two-thirds of all patients were deemed suitable candidates for the use of newer oral anticoagulants (by current therapy: warfarin: 65.2% (AF), 34.8% (VTE); enoxaparin: 100%, (VTE)). The use of dabigatran in VTE/stroke prevention was found to be more cost- effective than warfarin and enoxaparin due to significantly lower costs of therapeutic monitoring and reduced administration costs. Rivaroxaban was more cost-effective than warfarin and enoxaparin for VTE/stroke prevention when supplier-rebates (33%) were factored into costing. Conclusion This study highlights the potential cost- effectiveness of newer anticoagulants, dabigatran and rivaroxaban, compared to warfarin and enoxaparin. These agents may offer economic advantages, as well as clinical benefits, in the hospital-based management of anticoagulated patients. PMID:25132883

  10. Efficacy Beliefs and the Learning Experiences of Children with Cancer in the Hospital Setting.

    ERIC Educational Resources Information Center

    Crossland, Andrea

    2002-01-01

    A study examined how self-efficacy beliefs influenced motivation, affect, and adjustment in five students aged 9-13 with cancer, receiving educational services in a hospital setting. Education was an effective vehicle through which children with cancer could experience control and autonomy and also achieve many necessary developmental outcomes for…

  11. Does Geographic Setting Alter the Roles of Academically Supportive Factors? African American Adolescents' Friendships, Math Self-Concept, and Math Performance

    ERIC Educational Resources Information Center

    Jones, Martin H.; Irvin, Matthew J.; Kibe, Grace W.

    2012-01-01

    The study is one of few to examine how living in rural, suburban, or urban settings may alter factors supporting African Americans adolescents' math performance. The study examines the relationship of math self-concept and perceptions of friends' academic behaviors to African American students' math performance. Participants (N = 1,049) are…

  12. Experiences of Physical Therapists Working in the Acute Hospital Setting: Systematic Review.

    PubMed

    Lau, Bonnie; Skinner, Elizabeth H; Lo, Kristin; Bearman, Margaret

    2016-09-01

    Physical therapists working in acute care hospitals require unique skills to adapt to the challenging environment and short patient length of stay. Previous literature has reported burnout of clinicians and difficulty with staff retention; however, no systematic reviews have investigated qualitative literature in the area. The purpose of this study was to investigate the experiences of physical therapists working in acute hospitals. Six databases (MEDLINE, CINAHL Plus, EMBASE, AMED, PsycINFO, and Sociological Abstracts) were searched up to and including September 30, 2015, using relevant terms. Studies in English were selected if they included physical therapists working in an acute hospital setting, used qualitative methods, and contained themes or descriptive data relating to physical therapists' experiences. Data extraction included the study authors and year, settings, participant characteristics, aims, and methods. Key themes, explanatory models/theories, and implications for policy and practice were extracted, and quality assessment was conducted. Thematic analysis was used to conduct qualitative synthesis. Eight articles were included. Overall, study quality was high. Four main themes were identified describing factors that influence physical therapists' experience and clinical decision making: environmental/contextual factors, communication/relationships, the physical therapist as a person, and professional identity/role. Qualitative synthesis may be difficult to replicate. The majority of articles were from North America and Australia, limiting transferability of the findings. The identified factors, which interact to influence the experiences of acute care physical therapists, should be considered by therapists and their managers to optimize the physical therapy role in acute care. Potential strategies include promotion of interprofessional and collegial relationships, clear delineation of the physical therapy role, multidisciplinary team member education

  13. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  14. Mobile Robotic Telepresence Solutions for the Education of Hospitalized Children.

    PubMed

    Soares, Neelkamal; Kay, Jeffrey C; Craven, Geoff

    2017-01-01

    Hospitalization affects children's school attendance, resulting in poor academic and sociodevelopmental outcomes. The increasing ubiquity of mobile and tablet technology in educational and healthcare environments, and the growth of the mobile robotic telepresence (MRT) industry, offer opportunities for the use of MRT to connect hospitalized children to their school environments. This article describes an approach at one rural healthcare center in collaboration with local school districts with the aim of describing strategies and limitations of MRT use. Future research is needed on MRT implementation, from user experiences to operational strategies, and outcome metrics need to be developed to measure academic and socioemotional outcomes. By partnering with educational systems and using this technology, hospital information technology personnel can help hospitalized children engage with their school environments to maintain connections with peers and access academic instruction.

  15. Self-reflection, growth goals, and academic outcomes: A qualitative study.

    PubMed

    Travers, Cheryl J; Morisano, Dominique; Locke, Edwin A

    2015-06-01

    Goal-setting theory continues to be among the most popular and influential theories of motivation and performance, although there have been limited academic applications relative to applications in other domains, such as organizational psychology. This paper summarizes existing quantitative research and then employs a qualitative approach to exploring academic growth via an in-depth reflective growth goal-setting methodology. The study focuses on 92 UK final-year students enrolled in an elective advanced interpersonal skills and personal development module, with self-reflection and growth goal setting at its core. Qualitative data in the form of regular reflective written diary entries and qualitative questionnaires were collected from students during, on completion of, and 6 months following the personal growth goal-setting programme. About 20% of students' self-set growth goals directly related to academic growth and performance; students reported that these had a strong impact on their achievement both during and following the reflective programme. Growth goals that were indirectly related to achievement (e.g., stress management) appeared to positively impact academic growth and other outcomes (e.g., well-being). A follow-up survey revealed that growth goal setting continued to impact academic growth factors (e.g., self-efficacy, academic performance) beyond the reflective programme itself. Academic growth can result from both academically direct and indirect growth goals, and growth goal setting appears to be aided by the process of simultaneous growth reflection. The implications for promoting academic growth via this unique learning and development approach are discussed. © 2014 The British Psychological Society.

  16. Hospital Audit as a Useful Tool in the Process of Introducing Falsified Medicines Directive (FMD) into Hospital Pharmacy Settings-A Pilot Study.

    PubMed

    Religioni, Urszula; Swieczkowski, Damian; Gawrońska, Anna; Kowalczuk, Anna; Drozd, Mariola; Zerhau, Mikołaj; Smoliński, Dariusz; Radomiński, Stanisław; Cwalina, Natalia; Brindley, David; Jaguszewski, Miłosz J; Merks, Piotr

    2017-11-09

    Recently, the European Union has introduced the Falsified Medicines Directive (FMD). Additionally, in early 2016, a Delegated Act (DA) related to the FMD was published. The main objective of this study was to evaluate the usefulness of external audits in the context of implementing new regulations provided by the FMD in the secondary care environment. The external, in-person workflow audits were performed by an authentication company in three Polish hospital pharmacies. Each audit consisted of a combination of supervision (non-participant observation), secondary data analysis, and expert interviews with the use of an independently designed authorial Diagnostic Questionnaire. The questionnaire included information about hospital drug distribution procedures, data concerning drug usage, IT systems, medication order systems, the processes of medication dispensing, and the preparation and administration of hazardous drugs. Data analysis included a thorough examination of hospital documentation in regard to drug management. All data were subjected to qualitative analysis, with the aim of generating meaningful information through inductive inference. Only one dispensing location in the Polish hospitals studied has the potential to be a primary authentication area. In the audited hospitals, an Automated Drug Dispensing System and unit dose were not identified during the study. Hospital wards contained an enclosed place within the department dedicated to drug storage under the direct supervision of senior nursing staff. An electronic order system was not available. In the largest center, unused medications are re-dispensed to different hospital departments, or may be sold to various institutions. Additionally, in one hospital pharmacy, pharmacists prepared parenteral nutrition and chemotherapeutic drugs for patients admitted to the hospital. External audits might prove beneficial in the course of introducing new regulations into everyday settings. However, such action

  17. The Impact of Setting the Standards of Health Promoting Hospitals on Hospital Indicators in Iran

    PubMed Central

    Amiri, Mohammad; Khosravi, Ahmad; Riyahi, Leila

    2016-01-01

    Hospitals play a critical role in the health promotion of the society. This study aimed to determine the impact of establishing standards of health promoting hospitals on hospital indicators in Shahroud. This applied study was a quasi-experimental one which was conducted in 2013. Standards of health promoting hospitals were established as an intervention procedure in the Fatemiyeh hospital. Parameters of health promoting hospitals were compared in intervention and control hospitals before and after of intervention (6 months). The data were analyzed using chi-square and t-test. With the establishment of standards for health promotion hospitals, standard scores in intervention and control hospitals were found to be 72.26 ± 4.1 and 16.26 ± 7.5, respectively. T-test showed a significant difference between the mean scores of the hospitals under study (P = 0.001).The chi-square test also showed a significant relationship between patient satisfaction before and after the intervention so that patients’ satisfaction was higher after the intervention (P = 0.001). Commenting on the short-term or long-term positive impacts of establishing standards of health promoting hospitals on all hospital indicators is a bit difficult but preliminary results show the positive impact of the implementation of standards in case hospitals which has led to the improvement of many indicators in the hospital. PMID:27959930

  18. Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models.

    PubMed

    Eason, Christianne M; Mazerolle, Stephanie M; Goodman, Ashley

    2017-01-01

    Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models.  To investigate the perceived benefits of and barriers in the medical and academic models.  Qualitative study.  National Collegiate Athletic Association Divisions I, II, and III.  A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models.  We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility.  In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative).  The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.

  19. Contribution of case-mix classification to profiling hospital characteristics and productivity.

    PubMed

    Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Hayashida, Kenshi; Fujimori, Kenji

    2011-01-01

    Case-mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case-mix groups at 469 hospitals (1,721,274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case-mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency. Copyright © 2010 John Wiley & Sons, Ltd.

  20. Off-label use of recombinant factor VIIa in U.S. hospitals: analysis of hospital records.

    PubMed

    Logan, Aaron C; Yank, Veronica; Stafford, Randall S

    2011-04-19

    Recombinant factor VIIa (rFVIIa) is approved for treatment of bleeding in patients who have hemophilia with inhibitors but has been applied to a wide range of off-label indications. To estimate patterns of off-label rFVIIa use in U.S. hospitals. Retrospective database analysis. Data were extracted from the Premier Perspectives database (Premier, Charlotte, North Carolina), which contains discharge records from a sample of academic and nonacademic U.S. hospitals. 12 644 hospitalizations for patients who received rFVIIa during a hospital stay. Hospital diagnoses and patient dispositions from 1 January 2000 to 31 December 2008. Statistical weights for each hospital were used to provide national estimates of rFVIIa use. From 2000 to 2008, off-label use of rFVIIa in hospitals increased more than 140-fold, such that in 2008, 97% (95% CI, 96% to 98%) of 18 311 in-hospital uses were off-label. In contrast, in-hospital use for hemophilia increased less than 4-fold and accounted for 2.7% (CI, 1.9% to 3.5%) of use in 2008. Adult and pediatric cardiovascular surgery (29% [CI, 21% to 33%]), body and brain trauma (29% [CI, 19% to 38%]), and intracranial hemorrhage (11% [CI, 7.7% to 14%]) were the most common indications for rFVIIa use. Across all indications, in-hospital mortality was 27% (CI, 19% to 34%) and 43% (CI, 26% to 59%) of patients were discharged to home. Accuracy and completeness of the discharge diagnoses and patient medication records in the database sample cannot be verified. Off-label use of rFVIIa in the hospital setting far exceeds use for approved indications. These patterns raise concern about the application of rFVIIa to conditions for which strong supporting evidence is lacking.

  1. Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital

    PubMed Central

    Engels, Melanie J.

    2015-01-01

    Background: High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. Method: Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. Results: The majority of respondents identified the organization’s high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. Conclusions: This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies. PMID:26446747

  2. Electronic prescribing increases uptake of clinical pharmacologists' recommendations in the hospital setting

    PubMed Central

    Taegtmeyer, Anne B; Curkovic, Ivanka; Rufibach, Kaspar; Corti, Natascia; Battegay, Edouard; Kullak-Ublick, Gerd A

    2011-01-01

    AIMS To determine whether electronic prescribing facilitates the uptake of clinical pharmacologists' recommendations for improving drug safety in medical inpatients. METHODS Electronic case records and prescription charts (either electronic or paper) of 502 patients hospitalized on medical wards in a large Swiss teaching hospital between January 2009 and January 2010 were studied by four junior and four senior clinical pharmacologists. Drug-related problems were identified and interventions proposed. The implementation and time delays of these proposed interventions were compared between the patients for whom paper drug charts were used and the patients for whom electronic drug charts were used. RESULTS One hundred and fifty-eight drug-related problems in 109 hospital admissions were identified and 145 recommendations were made, of which 51% were implemented. Admissions with an electronic prescription chart (n = 90) were found to have 2.74 times higher odds for implementation of the change than those with a paper prescription chart (n = 53) (95% confidence interval 1.2, 6.3, P = 0.018, adjusted for any dependency introduced by patient, ward or clinical team; follow-up for two cases missing). The time delay between recommendations being made and their implementation (if any) was minimal (median 1 day) and did not differ between the two groups. CONCLUSIONS Electronic prescribing in this hospital setting was associated with increased implementation of clinical pharmacologists' recommendations for improving drug safety when compared with handwritten prescribing on paper. PMID:21627677

  3. Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care.

    PubMed

    Aeyels, Daan; Seys, Deborah; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Bruyneel, Luk; Vanhaecht, Kris

    2018-02-01

    A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.

  4. [Care practices for neonates while setting up a neonatal unit in a university hospital].

    PubMed

    Pedron, Cecília Drebes; Bonilha, Ana Lúcia de Lourenzi

    2008-12-01

    The hospitalization process of neonates makes them vulnerable to several care practices. The aim of this study was to get to know the care practices adopted by health professionals while setting up a neonatal unit at the Hospital de Clínicas of Porto Alegre, Rio Grande do Sul, Brazil. This is a qualitative study based on the New History Theory. The study collected data from October 2006 to January 2007. Fifteen health professionals responsible for the project and/or its implementation from 1972 to 1984 provided information. The thematic data analysis highlighted the concern among health professionals of making good use of technological advances, as well as unifying scientifically-based conducts. Besides, they tried to establish routines enabling neonate's parents to stay at the bedside during the whole hospitalization period. Finally, it was inferred that the main objective of these practices was to increase the survival of neonates.

  5. Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission.

    PubMed

    Davoren, Mary; Byrne, Orla; O'Connell, Paul; O'Neill, Helen; O'Reilly, Ken; Kennedy, Harry G

    2015-11-23

    Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting. This is a prospective study. All admissions to a medium secure forensic hospital setting were collated over a 54 month period (n = 279) and followed up for a total of 66 months. Each patient was rated using the DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale as part of a pre-admission assessment (n = 279) and HCR-20 within 2 weeks of admission (n = 187). Episodes of harm to self, harm to others and episodes of seclusion whilst an in-patient were collated. Date of discharge was noted for each individual. Diagnosis at the time of pre-admission assessment (adjustment disorder v other diagnosis), predicted legal status (sentenced v mental health order) and items on the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale, also rated at the time of pre-admission assessment, predicted length of stay in the forensic hospital setting. Need for seclusion following admission also predicted length of stay. These findings may form the basis for a structured professional judgment instrument, rated prior to or at time of admission, to assist in estimating length of stay for forensic patients. Such a tool would be useful to clinicians, service planners and commissioners given the high cost of secure psychiatric care.

  6. New graduate nurses' experiences of bullying and burnout in hospital settings.

    PubMed

    Laschinger, Heather K Spence; Grau, Ashley L; Finegan, Joan; Wilk, Piotr

    2010-12-01

    This paper is a report of a study conducted to test a model linking new graduate nurses' perceptions of structural empowerment to their experiences of workplace bullying and burnout in Canadian hospital work settings using Kanter's work empowerment theory. There are numerous anecdotal reports of bullying of new graduates in healthcare settings, which is linked to serious health effects and negative organizational effects. We tested the model using data from the first wave of a 2009 longitudinal study of 415 newly graduated nurses (<3 years of experience) in acute care hospitals across Ontario, Canada. Variables were measured using the Conditions of Work Effectiveness Questionnaire, Negative Acts Questionnaire-Revised and Maslach Burnout Inventory-General Survey. The final model fit statistics revealed a reasonably adequate fit (χ² = 14·9, d.f. = 37, IFI = 0·98, CFI = 0·98, RMSEA = 0·09). Structural empowerment was statistically significantly and negatively related to workplace bullying exposure (β = -0·37), which in turn, was statistically significantly related to all three components of burnout (Emotional exhaustion: β = 0·41, Cynicism: β = 0·28, EFFICACY: β = -0·17). Emotional exhaustion had a direct effect on cynicism (β = 0·51), which in turn, had a direct effect on efficacy (β = -0·34). Conclusion.  The results suggest that new graduate nurses' exposure to bullying may be less when their work environments provide access to empowering work structures, and that these conditions promote nurses' health and wellbeing. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

  7. Implementation of a Clinical Documentation Improvement Curriculum Improves Quality Metrics and Hospital Charges in an Academic Surgery Department.

    PubMed

    Reyes, Cynthia; Greenbaum, Alissa; Porto, Catherine; Russell, John C

    2017-03-01

    Accurate clinical documentation (CD) is necessary for many aspects of modern health care, including excellent communication, quality metrics reporting, and legal documentation. New requirements have mandated adoption of ICD-10-CM coding systems, adding another layer of complexity to CD. A clinical documentation improvement (CDI) and ICD-10 training program was created for health care providers in our academic surgery department. We aimed to assess the impact of our CDI curriculum by comparing quality metrics, coding, and reimbursement before and after implementation of our CDI program. A CDI/ICD-10 training curriculum was instituted in September 2014 for all members of our university surgery department. The curriculum consisted of didactic lectures, 1-on-1 provider training, case reviews, e-learning modules, and CD queries from nurse CDI staff and hospital coders. Outcomes parameters included monthly documentation completion rates, severity of illness (SOI), risk of mortality (ROM), case-mix index (CMI), all-payer refined diagnosis-related groups (APR-DRG), and Surgical Care Improvement Program (SCIP) metrics. Financial gain from responses to CDI queries was determined retrospectively. Surgery department delinquent documentation decreased by 85% after CDI implementation. Compliance with SCIP measures improved from 85% to 97%. Significant increases in surgical SOI, ROM, CMI, and APR-DRG (all p < 0.01) were found after CDI/ICD-10 training implementation. Provider responses to CDI queries resulted in an estimated $4,672,786 increase in charges. Clinical documentation improvement/ICD-10 training in an academic surgery department is an effective method to improve documentation rates, increase the hospital estimated reimbursement based on more accurate CD, and provide better compliance with surgical quality measures. Copyright © 2016 American College of Surgeons. All rights reserved.

  8. Toward late career transitioning: a proposal for academic surgeons.

    PubMed

    Richards, Robin; McLeod, Robin; Latter, David; Keshavjee, Shaf; Rotstein, Ori; Fehlings, Michael G; Ahmed, Najma; Nathens, Avery; Rutka, James

    2017-09-01

    In the absence of a defined retirement age, academic surgeons need to develop plans for transition as they approach the end of their academic surgical careers. The development of a plan for late career transition represents an opportunity for departments of surgery across Canada to initiate a constructive process in cooperation with the key stakeholders in the hospital or institution. The goal of the process is to develop an individual plan for each faculty member that is agreeable to the academic surgeon; informs the surgical leadership; and allows the late career surgeon, the hospital, the division and the department to make plans for the future. In this commentary, the literature on the science of aging is reviewed as it pertains to surgeons, and guidelines for late career transition planning are shared. It is hoped that these guidelines will be of some value to academic programs and surgeons across the country as late career transition models are developed and adopted.

  9. Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital.

    PubMed

    Hamilton, Jane E; Heads, Angela M; Meyer, Thomas D; Desai, Pratikkumar V; Okusaga, Olaoluwa O; Cho, Raymond Y

    2018-05-30

    U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication. Copyright © 2018. Published by Elsevier B.V.

  10. Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings.

    PubMed

    Ballbè, Montse; Gual, Antoni; Nieva, Gemma; Saltó, Esteve; Fernández, Esteve

    2016-01-01

    Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals -the early adopters- based on Rogers' theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals' awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Examining the accuracy of foodservice in a hospital setting.

    PubMed

    Glover, N S; Keane, T M

    1984-09-01

    Although a great deal of research has been conducted to determine the appropriate diets for the prevention and treatment of various illnesses, there is very little in the literature about research that directly assesses the accuracy of the prescribed diets served to patients in a hospital setting. The present study was designed to evaluate the accuracy of meals served to patients by identifying critical errors and more general errors on trays about to be served. The results indicated that the error rate was greater on weekends and holidays than during the week. Significantly, a correlational analysis revealed that error rate was inversely related to the total number of foodservice supervisors and more specifically to the number of food production supervisors and registered dietitians present. The implications of the results for possible interventions and training are discussed.

  12. [Glass ceiling for women in academic medicine in France].

    PubMed

    Rosso, C; Leger, A; Steichen, O

    2018-06-03

    To determine whether career development in academic medicine is more difficult for women than for men, and, if any, the nature and level of barriers to this progression. Extraction of full-time medical staff in a Parisian hospital group, through the SIGAPS platform; an online questionnaire survey of career choices and barriers experienced by full-time male and female physicians. The study population comprises 181 hospital practitioners and 141 academic physicians (49 associate professors and 92 full professors). Women represent 49% of the medical staff but 15% of full professors. This underrepresentation of women is more important among intensivists/anesthesiologists than technique-based specialists (such as radiologists, biologists…). There is no difference in scientific output, marital status and parenthood between women and men. On the other hand, there is a difference in attitudes highlighted by the EVAR risk-taking scale as well as in the burden of familial involvement and the prejudices felt by women during the academic selection process. The glass ceiling exists in one of the largest French hospital group. Career development principles promote merit, but should decrease the benefit of "masculine" attitudes in the competition for academic positions. Academic selection criteria should evolve to limit the disadvantage of women related to deeper familial involvement and less competitive strategies and risk-taking attitudes. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  13. Balancing power: A grounded theory study on partnership of academic service institutes

    PubMed Central

    HESHMATI NABAVI, FATEMEH; VANAKI, ZOHREH; MOHAMMADI, EESA; YAZDANI, SHAHRAM

    2017-01-01

    Introduction: Governments and professional organizations have called for new partnerships between health care providers and academics to improve clinical education for the benefit of both students and patients. To develop a substantive grounded theory on the process of forming academic-service partnerships in implementing clinical education, from the perspective of academic and clinical nursing staff members and managers working in Iranian settings. Methods: The participants included 15 hospital nurses, nurse managers, nurse educators, and educational managers from two central universities and clinical settings from 2009 to 2012. Data were collected through 30 in-depth, semi-structure interviews with the individual participants and then analyzed using the methodology of Strauss and Corbin's grounded theory. Results: Utilizing “balancing power” as the core variable enabled us to integrate the concepts concerning the partnership processes between clinical and educational institutes. Three distinct and significant categories emerged to explain the process of partnership: 1) divergence, 2) conflict between educational and caring functions, and 3) creation of balance between educational and caring functions. Conclusions: In implementing clinical education, partnerships have been formed within a challenging context in Iran. Conflict between clinical and educational functions was the main concern of both sides of the partnership in forming a collaborative relationship, with our findings emphasizing the importance of nursing educators' role in the establishment of partnership programs. PMID:28761886

  14. Setting Academic Priorities: A Guide to What Boards of Trustees Can Do

    ERIC Educational Resources Information Center

    Dickeson, Robert C.

    2012-01-01

    Higher education is in the midst of a deep financial crisis, and the failure of governing boards to focus on academic programs is arguably the single greatest cause of overspending. This brochure shows trustees both why and how to prioritize academic programs. All too often, attempts to reduce expenses have concentrated on the administrative side…

  15. Setting the Stage for Academic Success through Antecedent Intervention

    ERIC Educational Resources Information Center

    Kruger, Alicia M.; Strong, Whitney; Daly, Edward J., III; O'Connor, Maureen; Sommerhalder, Mackenzie S.; Holtz, Jill; Weis, Nicole; Kane, Elizabeth J.; Hoff, Natalie; Heifner, Allison

    2016-01-01

    Behavior-analytic academic intervention research has gained popularity among school psychologists because it offers a unique combination of robust principles of behavior and a degree of clarity and precision about functional relationships that is unparalleled in other learning paradigms. This article reviews the literature for a type of antecedent…

  16. Neonatal exchange transfusions in tertiary and non-tertiary hospital settings, New South Wales, 2001-2012.

    PubMed

    Chessman, Julia C; Bowen, Jennifer R; Ford, Jane B

    2017-05-01

    To describe neonatal exchange transfusions in New South Wales (NSW) before and after release in January 2007 of a NSW Health guideline regarding exchange transfusions in tertiary and non-tertiary hospitals. The study population included neonates receiving exchange transfusion in NSW hospitals, 2001-2012. Linked birth and hospital data for mothers and babies were used to describe birth characteristics and maternal and neonatal conditions. Exchange transfusions were identified in hospital data and compared for 2001-2006 and 2007-2012. Maternal and neonatal characteristics were compared with χ 2 and Wilcoxon signed-rank tests. Between 2001 and 2012, there were 286 exchange transfusions performed for 281 neonates in NSW hospitals. The number of exchange transfusions decreased from 187 in 184 neonates for 2001-2006 to 99 in 97 neonates 2007-2012 (P < 0.001). The percentage of exchange transfusions performed at tertiary hospitals increased from 85% in 2001-2006 to 91% in 2007-2012, although this was not statistically significant (P = 0.16). Most neonates requiring exchange transfusion were born in tertiary hospitals: 62% for 2001-2006 and 69% for 2007-2012. Among those born in a non-tertiary hospital, the percentage transferred or admitted to a tertiary hospital for exchange transfusion was 63% in 2001-2006 and 77% in 2007-2012. Between 2001 and 2012, there was a decrease in neonatal exchange transfusions in NSW. After the 2007 guideline there was a non-significant increase in the proportion of exchange transfusions performed at tertiary hospitals. Although rare, exchange transfusions are still expected to occur occasionally in non-tertiary hospitals, requiring continuing support for this procedure in these settings. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  17. Integrating the hospital library with patient care, teaching and research: model and Web 2.0 tools to create a social and collaborative community of clinical research in a hospital setting.

    PubMed

    Montano, Blanca San José; Garcia Carretero, Rafael; Varela Entrecanales, Manuel; Pozuelo, Paz Martin

    2010-09-01

    Research in hospital settings faces several difficulties. Information technologies and certain Web 2.0 tools may provide new models to tackle these problems, allowing for a collaborative approach and bridging the gap between clinical practice, teaching and research. We aim to gather a community of researchers involved in the development of a network of learning and investigation resources in a hospital setting. A multi-disciplinary work group analysed the needs of the research community. We studied the opportunities provided by Web 2.0 tools and finally we defined the spaces that would be developed, describing their elements, members and different access levels. WIKINVESTIGACION is a collaborative web space with the aim of integrating the management of all the hospital's teaching and research resources. It is composed of five spaces, with different access privileges. The spaces are: Research Group Space 'wiki for each individual research group', Learning Resources Centre devoted to the Library, News Space, Forum and Repositories. The Internet, and most notably the Web 2.0 movement, is introducing some overwhelming changes in our society. Research and teaching in the hospital setting will join this current and take advantage of these tools to socialise and improve knowledge management.

  18. Impact of the Syrian Crisis on the Hospitalization of Syrians in a Psychiatric Setting.

    PubMed

    Lama, Souaiby; François, Kazour; Marwan, Zoghbi; Sami, Richa

    2016-01-01

    Determine the impact of the Syrian crisis on the hospitalization of Syrians in a psychiatric setting. All Syrians admitted to a psychiatric hospital in Lebanon between the 1st of January 2009 and the 31st of December 2013 were included. Number of admissions, psychiatric disorders and demographic and clinical data relative to patients were compared between those admitted before and after the crisis. 44 patients were admitted before the crisis and 106 after it. The distribution of diagnosis varied significantly after the crisis (p = 0.056) with the majority of patients being admitted for schizophrenia (37.7 %). The prevalence of suicidal ideation was higher after the crisis (p = 0.03) but suicidal attempts, need for electroconvulsive therapy and length of hospitalization did not differ significantly between both groups. Clinicians should be aware of the possible burden of mental illness in Syrians after the beginning of the Syrian crisis.

  19. Auditing of clinical research ethics in a children's and women's academic hospital.

    PubMed

    Bortolussi, Robert; Nicholson, Diann

    2002-06-01

    Canadian and international guidelines for research ethics practices have advocated that research ethics boards (REBs) should implement mechanisms to review and monitor human research. Despite this, few Canadian REBs fulfil this expectation. The objective of this report is to summarize the results of 6 audits of clinical research ethics conducted between 1992 and 2000 in a children's and women's academic hospital in Canada in an effort to guide other academic centres planning a similar process. Research audits were conducted by members of a research audit review committee made up of REB volunteers. With use of random and selective processes, approximately 10% of research protocols were audited through interviews with research investigators and research coordinators and by sampling research records. Predetermined criteria were used to assess evidence of good record keeping, data monitoring, adherence to protocol, consents and the recording of adverse events during the research study. An estimate of time required to undertake an audit was made by recall of participants and records. Thirty-five research studies were reviewed including 16 multicentre clinical trials and 19 single-site clinical studies. Review of record keeping and research practice revealed some deficiencies: researchers failed to maintain original authorization (7%) or renewal documentation (9%); there was 1 instance of improper storage of medication; in 5% of 174 participants for whom consent was reviewed, an outdated consent form had been used, and in 4% the signature of the enrolee was not properly shown. Other deficiencies in consent documentation occurred in less than 2% of cases. Nineteen recommendations were made with respect to deficiencies and process issues. A total of 9 to 20 person-hours are required to review each protocol in a typical audit of this type. Information from research audits has been useful to develop educational programs to correct deficiencies identified through the audits

  20. Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control.

    PubMed

    English, Krista M; Langley, Joanne M; McGeer, Allison; Hupert, Nathaniel; Tellier, Raymond; Henry, Bonnie; Halperin, Scott A; Johnston, Lynn; Pourbohloul, Babak

    2018-04-17

    Nosocomial, or healthcare-associated infections (HAI), exact a high medical and financial toll on patients, healthcare workers, caretakers, and the health system. Interpersonal contact patterns play a large role in infectious disease spread, but little is known about the relationship between health care workers' (HCW) movements and contact patterns within a heath care facility and HAI. Quantitatively capturing these patterns will aid in understanding the dynamics of HAI and may lead to more targeted and effective control strategies in the hospital setting. Staff at 3 urban university-based tertiary care hospitals in Canada completed a detailed questionnaire on demographics, interpersonal contacts, in-hospital movement, and infection prevention and control practices. Staff were divided into categories of administrative/support, nurses, physicians, and "Other HCWs" - a fourth distinct category, which excludes physicians and nurses. Using quantitative network modeling tools, we constructed the resulting HCW "co-location network" to illustrate contacts among different occupations and with locations in hospital settings. Among 3048 respondents (response rate 38%) an average of 3.79, 3.69 and 3.88 floors were visited by each HCW each week in the 3 hospitals, with a standard deviation of 2.63, 1.74 and 2.08, respectively. Physicians reported the highest rate of direct patient contacts (> 20 patients/day) but the lowest rate of contacts with other HCWs; nurses had the most extended (> 20 min) periods of direct patient contact. "Other HCWs" had the most direct daily contact with all other HCWs. Physicians also reported significantly more locations visited per week than nurses, other HCW, or administrators; nurses visited the fewest. Public spaces such as the cafeteria had the most staff visits per week, but the least mean hours spent per visit. Inpatient settings had significantly more HCW interactions per week than outpatient settings. HCW contact patterns and spatial

  1. Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature.

    PubMed

    Eddy, Kylie; Jordan, Zoe; Stephenson, Matthew

    2016-04-01

    Teamwork is seen as an important element of patient care in acute hospital settings. The complexity of the journey of care for patients highlights the need for health professionals to collaborate and communicate clearly with each other. Health organizations in western countries are committed to improving patient safety through education of staff and teamwork education programs have been integral to this focus. There are no current systematic reviews of the experience of health professionals who participate in teamwork education in acute hospital settings. The objective of this systematic review was to search for the best available evidence on the experiences of health professionals who participate in teamwork education in acute hospital settings. This review considered studies reporting on experiences of registered health professionals who work in acute hospitals. This included medical, nursing and midwifery and allied health professionals. The focus of the meta-synthesis was the experiences and reflections of health professionals who were involved in teamwork education in acute hospital settings. The geographical context for this review was acute hospitals in rural or metropolitan settings in Australia and overseas countries. The review focused on the experiences of health professionals who work in acute hospitals and participated in teamwork education programs. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.In the absence of research studies, other text such as opinion papers, discussion papers and reports were considered. Studies published in English and from 1990 to 2013 were included in this review. The literature search for relevant papers occurred between 13 September and 26 October 2013. A three-step search strategy was utilized in this review. The databases searched were PubMed, CINAHL, Embase and Scopus. The

  2. Towards a building typology and terminology for Irish hospitals.

    PubMed

    Grey, T; Kennelly, S; de Freine, P; Mahon, S; Mannion, V; O'Neill, D

    2017-02-01

    The physical form of the hospital environment shapes the care setting and influences the relationship of the hospital to the community. Due to ongoing demographic change, evolving public health needs, and advancing medical practice, typical hospitals are frequently redeveloped, retrofitted, or expanded. It is argued that multi-disciplinary and multi-stakeholder approaches are required to ensure that hospital design matches these increasingly complex needs. To facilitate such a conversation across different disciplines, experts, and community stakeholders, it is helpful to establish a hospital typology and associated terminology as part of any collaborative process. Examine the literature around hospital design, and review the layout and overall form of a range of typical Irish acute public hospitals, to outline an associated building typology, and to establish the terminology associated with the planning and design of these hospitals in Ireland. Searches in 'Academic Search Complete', 'Compendex', 'Google', 'Google Scholar', 'JSTOR', 'PADDI', 'Science Direct', 'Scopus', 'Web of Science', and Trinity College Dublin Library. The search terms included: 'hospital design history'; 'hospital typology'; 'hospital design terminology'; and 'hospital design Ireland'. Typical hospitals are composed of different layouts due to development over time; however, various discrete building typologies can still be determined within many hospitals. This paper presents a typology illustrating distinct layout, circulation, and physical form characteristics, along with a hospital planning and design terminology of key terms and definitions. This typology and terminology define the main components of Irish hospital building design to create a shared understanding around design, and support stakeholder engagement, as part of any collaborative design process.

  3. Risk factors for discharge to an acute care hospital from inpatient rehabilitation among stroke patients.

    PubMed

    Roberts, Pamela S; DiVita, Margaret A; Riggs, Richard V; Niewczyk, Paulette; Bergquist, Brittany; Granger, Carl V

    2014-01-01

    To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke. Retrospective cohort study. Academic medical center. A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings. Logistic regression analysis. Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit. No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance. Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  4. Clinical microsystems, Part 3. Transformation of two hospitals using microsystem, mesosystem, and macrosystem strategies.

    PubMed

    Godfrey, Marjorie M; Melin, Craig N; Muething, Stephen E; Batalden, Paul B; Nelson, Eugene C

    2008-10-01

    Two hospitals-a large, urban academic medical center and a rural, community hospital-have each chosen a similar microsystem-based approach to improvement, customizing the engagement of the micro-, meso-, and macrosystems and the improvement targets on the basis of an understanding of the local context. CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER (CCHMC): Since 2004, strategic changes have been developed to support microsystems and their leaders through (1) ongoing improvement training for all macro-, meso-, and microsystem leaders; (2) financial support for physicians who are serving as co-leaders of clinical microsystems; (3) increased emphasis on aligning academic pursuits with improvement work at the clinical front lines; (4) microsystem leaders' continuous access to unit-level data through the organization's intranet; and (5) encouragement of unit leaders to share outcomes data with families. CDH has moved from near closure to a survival-turnaround focus, significant engagement in quality and finally, a complete reframing of a quality focus in 2004. Since then, it has deployed the clinical microsystems approach in one pilot care unit (West 2, a medical surgery unit), broadened it to two, then six more, and is now spreading it organizationwide. In "2+2 Charters," interdisciplinary teams address two strategic goals set by senior leadership and two goals set by frontline microsystem leaders and staff CCHMC and CDH have had a clear focus on developing alignment, capability, and accountability to fuse together the work at all levels of the hospital, unifying the macrosystem with the mesosystem and microsystem. Their improvement experience suggests tips and actions at all levels of the organization that could be adapted with specific context knowledge by others.

  5. Concordance of motor vehicle crash, emergency department, and inpatient hospitalization data sets in the identification of drugs in injured drivers.

    PubMed

    Bunn, T; Singleton, M; Nicholson, V; Slavova, S

    2013-01-01

    Prescription drug overdoses, abuse, and sales have increased dramatically in the United States in the last decade. The purpose of the present study was to link crash data with emergency department (ED) and inpatient hospitalization data to assess the concordance between the data sets in the identification of the presence of drugs among injured motor vehicle drivers (passenger cars, passenger trucks, light trucks, and semi-trucks) in Kentucky. Kentucky CRASH data were probabilistically linked to ED data sets for years 2008-2010 and to inpatient hospitalization data sets for years 2000-2010. Statistical analyses were performed. Of the 72,529 linked crash/ED visits, there were 473 drivers with an associated nondependent abuse of drugs diagnosis in the ED, and 930 drivers had drug involvement recorded in the CRASH data (only 163 cases overlapped with drug involvement both recorded in CRASH data and coded as nondependent abuse of drugs in the ED); 64 drivers had multiple drug types present in their system. Of the 20,860 total linked crash/inpatient hospitalization cases, there were 973 drivers diagnosed with nondependent abuse of drugs in the inpatient hospitalization record and 499 drivers had drug involvement recorded in the CRASH data (only 207 overlapped); 250 drivers were diagnosed with multiple drugs in their system. Surveillance data from multiple public health data sets is necessary to identify the presence of drugs in injured drivers involved in motor vehicle crashes. The use of a single surveillance data set alone may significantly underreport the number of drugged drivers who were injured in a motor vehicle collision.

  6. Preparing new nurse graduates for practice in multiple settings: a community-based academic-practice partnership model.

    PubMed

    West, Nikki; Berman, Audrey; Karshmer, Judith; Prion, Susan; Van, Paulina; Wallace, Jonalyn

    2014-06-01

    Responding to local and national concerns about the nursing workforce, the California Institute for Nursing and Health Care worked with private and public funders and community health care partners to establish community-based transition-to-practice programs for new RN graduates unable to secure nursing positions in the San Francisco Bay Area. The goals were to retain new RN graduates in nursing and further develop their skills and competencies to increase their employability. Leaders from academic and inpatient, ambulatory, and community-based practice settings, as well as additional community partners, collaboratively provided four 12- to 16-week pilot transition programs in 2010-2011. A total of 345 unemployed new nurse graduates enrolled. Eighty-four percent of 188 respondents to a post-program survey were employed in inpatient and community settings 3 months after completion. Participants and clinical preceptors also reported increases in confidence and competence. Copyright 2014, SLACK Incorporated.

  7. Establishing a general medical outpatient clinic for cancer survivors in a public city hospital setting.

    PubMed

    Goytia, Elliott J; Lounsbury, David W; McCabe, Mary S; Weiss, Elisa; Newcomer, Meghan; Nelson, Deena J; Brennessel, Debra; Rapkin, Bruce D; Kemeny, M Margaret

    2009-11-01

    Many cancer centers and community hospitals are developing novel models of survivorship care. However, few are specifically focused on services for socio-economically disadvantaged cancer survivors. To describe a new model of survivorship care serving culturally diverse, urban adult cancer patients and to present findings from a feasibility evaluation. Adult cancer patients treated at a public city hospital cancer center. The clinic provides comprehensive medical and psychosocial services for patients within a public hospital cancer center where they receive their oncology care. Longitudinal data collected over a 3-year period were used to describe patient demographics, patient needs, and services delivered. Since inception, 410 cancer patients have been served. Demand for services has grown steadily. Hypertension was the most frequent comorbid condition treated. Pain, depression, cardiovascular disease, hyperlipidemia, and bowel dysfunction were the most common post-treatment problems experienced by the patients. Financial counseling was an important patient resource. This new clinical service has been well-integrated into its public urban hospital setting and constitutes an innovative model of health-care delivery for socio-economically challenged, culturally diverse adult cancer survivors.

  8. Assessing the Impact of Academic Placement on Academic Achievement among 5th Graders with Disabilities: A Causal-Comparative Inquiry

    ERIC Educational Resources Information Center

    Rivera, Roana Kasandra

    2017-01-01

    Since the mid '70s, school districts have been trying to place students with disabilities in the least restricted environment. As governments strive to create a more inclusive society, an inclusive academic setting for students with disabilities has become a priority. The purpose of the study was to examine the impact of academic setting on…

  9. What is the future for General Surgery in Model 3 Hospitals?

    PubMed

    Mealy, K; Keane, F; Kelly, P; Kelliher, G

    2017-02-01

    General Surgery consultant recruitment poses considerable challenges in Model 3 Hospitals in Ireland. The aim of this paper is to examine General Surgery activity and consultant staffing in order to inform future manpower and service planning. General surgical activity in Model 3 Hospitals was examined using the validated 2014 Hospital Inpatient Enquiry (HIPE) dataset. Current consultant staffing was ascertained from hospital personnel departments and all trainees on the National Surgical Training Programme were asked to complete a questionnaire on their career intentions. Model 3 Hospitals accounted for 50% of all General Surgery discharges. In the elective setting, 51.5% of all procedures were endoscopic investigations and in the acute setting only 22% of patients underwent an operation. Most surgical procedures were of low acuity and included excision of minor lesions, appendicectomy, cholecystectomy and hernia repair. Of 76 General Surgeons who work in Model 3 Hospitals 25% were locums and 54% had not undergone formal training in Ireland. A further 22% of these surgeons will retire in the next five years. General Surgical trainees surveyed indicated an unwillingness to take up posts in Model 3 Hospitals, while 83% indicated that a post in a Model 4 Hospital is 'most desirable'. Lack of attractiveness related to issues regarding rotas, lack of ongoing skill enhancement, poor experience in the management of complex surgical conditions, limited research and academic opportunity, isolation from colleagues and poor trainee support. These data indicated that an impending General Surgery consultant manpower crisis can only be averted in Model 3 Hospitals by either major change in the emphasis of surgical training or a significant reorganisation of surgical services.

  10. Shifting Selves: Constructing and Negotiating Academic Identities

    ERIC Educational Resources Information Center

    Vandeyar, S.

    2010-01-01

    This study set out to explore how academics construct and negotiate their identities within the world of the academe. Identity construction involves different forms of community participation and identification. Utilising the research methodology of narrative inquiry, this article explores how academics came to see themselves across those…

  11. SGLT2-I in the Hospital Setting: Diabetic Ketoacidosis and Other Benefits and Concerns.

    PubMed

    Levine, Joshua A; Karam, Susan L; Aleppo, Grazia

    2017-07-01

    Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the newest class of antihyperglycemic agents. They are increasingly being prescribed in the outpatient diabetic population. In this review, we examine the risks and benefits of continuation and initiation of SGLT2 inhibitors in the inpatient setting. There are currently no published data regarding safety and efficacy of SGLT2 inhibitor use in the hospital. Outpatient data suggests that SGLT2 inhibitors have low hypoglycemic risk. They also decrease systolic blood pressure and can prevent cardiovascular death. The EMPA-REG study also showed a decrease in admissions for acute decompensated heart failure. There have been increasing cases of diabetic ketoacidosis, and specifically the euglycemic manifestation, associated with SGLT2 inhibitors use. We present two cases of inpatient SGLT2 inhibitor use, one of continuation of outpatient therapy and one of new initiation of therapy. We then discuss potential risks and methods to mitigate these as well as benefits of these medications in the inpatient setting. We cautiously suggest the use of SGLT2 inhibitors in the hospital. However, these must be used judiciously and the practitioner must be aware of euglycemic diabetic ketoacidosis and its risk factors in this population.

  12. The Center for Healthy Weight: an academic medical center response to childhood obesity

    PubMed Central

    Robinson, T N; Kemby, K M

    2012-01-01

    Childhood obesity represents a worldwide medical and public health challenge. Academic medical centers cannot avoid the effects of the obesity epidemic, and must adopt strategies for their academic, clinical and public policy responses to childhood obesity. The Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford provides an example and model of one such strategy. The design provides both breadth and depth through six cores: Research, Patient Care, Community Programs, Advocating for Public Policy Change, Training and Professional Education, and the Healthy Hospital Initiative. The Center and its cores are designed to facilitate interdisciplinary collaboration across the university, medical school, children's hospital and surrounding community. The foci of these cores are likely to be relevant to almost any academic medical center's mission and functions. PMID:25089192

  13. Adaptation and implementation of standardized order sets in a network of multi-hospital corporations in rural Ontario.

    PubMed

    Meleskie, Jessica; Eby, Don

    2009-01-01

    Standardized, preprinted or computer-generated physician orders are an attractive project for organizations that wish to improve the quality of patient care. The successful development and maintenance of order sets is a major undertaking. This article recounts the collaborative experience of the Grey Bruce Health Network in adapting and implementing an existing set of physician orders for use in its three hospital corporations. An Order Set Committee composed of primarily front-line staff was given authority over the order set development, approval and implementation processes. This arrangement bypassed the traditional approval process and facilitated the rapid implementation of a large number of order sets in a short time period.

  14. Examining the Hospital Elder Life Program in a rehabilitation setting: a pilot feasibility study.

    PubMed

    Huson, Kelsey; Stolee, Paul; Pearce, Nancy; Bradfield, Corrie; Heckman, George A

    2016-07-18

    The Hospital Elder Life Program (HELP) has been shown to effectively prevent delirium and functional decline in older patients in acute care, but has not been examined in a rehabilitation setting. This pilot study examined potential successes and implementation factors of the HELP in a post-acute rehabilitation hospital setting. A mixed methods (quantitative and qualitative) evaluation, incorporating a repeated measures design, was used. A total of 100 patients were enrolled; 58 on the pilot intervention unit and 42 on a usual care unit. Group comparisons were made using change scores (pre-post intervention) on outcome measures between pilot unit patients and usual care patients (separate analyses compared usual care patients with pilot unit patients who did or did not receive the HELP). Qualitative data were collected using focus group and individual interviews, and analyzed using emergent coding procedures. Delirium prevalence reduced from 10.9 % (n = 6) to 2.5 % (n = 1) in the intervention group, while remaining the same in the usual care group (2.5 % at both measurement points). Those who received the HELP showed greater improvement on cognitive and functional outcomes, particularly short-term memory and recall, and a shorter average length of stay than patients who did not. Participant groups discussed perceived barriers, benefits, and recommendations for further implementation of the HELP in a rehabilitation setting. This study adds to the limited research on delirium and the effectiveness of the HELP in post-acute rehabilitation settings. The HELP was found to be feasible and have potential benefits for reduced delirium and improved outcomes among rehabilitation patients.

  15. 25 CFR 36.83 - How many hours can a student be taken out of the academic setting to receive behavioral health...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false How many hours can a student be taken out of the academic setting to receive behavioral health services? 36.83 Section 36.83 Indians BUREAU OF INDIAN AFFAIRS... AND NATIONAL CRITERIA FOR DORMITORY SITUATIONS Homeliving Programs Staffing § 36.83 How many hours can...

  16. A longitudinal study of students' academic self-concept in a streamed setting: the Singapore context.

    PubMed

    Liu, W C; Wang, C K J; Parkins, E J

    2005-12-01

    Although several studies support the existence of a negative stream effect on lower-ability stream students' academic self-concept, there is not enough longitudinal research evidence to preclude the possibility that the stream effect may only be temporary. In addition, not much is known about the effect of streaming on changes in students' academic self-concept over time. The main aims of the study were to examine the effect of streaming on (a) the students' academic self-concept immediately after the streaming process, and at yearly intervals for 3 consecutive years, and (b) the changes in students' academic self-concept over a 3 year period. The sample comprised 495 Secondary 1 students (approximate age 13) from three government coeducational schools in Singapore. A longitudinal survey using a self-reported questionnaire. Results showed that the lower-ability stream students had a more negative academic self-concept than the higher-ability stream students immediately after streaming, but they had a more positive academic self-concept 3 years after being streamed. In addition, it was established that the students' academic self-concept declined from Secondary 1 to Secondary 3. Nonetheless, the decline was more pronounced for the higher-ability stream students than the lower-ability stream students. Streaming may have a short-term negative impact on lower-ability stream students' academic self-concept. However, in the long run, being in the lower-ability stream may not be detrimental to their academic self-concept.

  17. Preferences of young physicians at community hospitals regarding academic research training through graduate school: a cross-sectional research.

    PubMed

    Kurita, Noriaki; Murakami, Minoru; Shimizu, Sayaka; Kumasawa, Junji; Azuma, Teruhisa; Kataoka, Yuki; Yamamoto, Shungo; Fukuma, Shingo; Yamamoto, Yosuke; Fukuhara, Shunichi

    2016-04-21

    Desire to attend graduate school for academic research training following the mandatory two-year clinical internship is unknown among young Japanese physicians who work at community hospitals after their internship. The aim of this study is to determine opinions and factors regarding pursuing higher education through graduate school among young physicians who work at community hospitals after their two-year internship. This cross-sectional survey was conducted among young physicians working at community hospitals after their two-year internship. We examined the percentage of young physicians considering higher education through graduate school, the planned timing and field of enrollment among those wanting to enroll, and reasons for not continuing their education among those with no such plans. The association between desire to enroll in graduate school and background characteristics was examined using modified least-squares regression to estimate proportion difference. Among 127 (73.2% internal medicine specialists, median age 30 years) physicians in 33 hospitals, 71 (55.9%) stated that they wished to enroll in graduate school. The most frequently reported timing was 7-8 years after graduation from medical school. Those who stated no desire to attend graduate school cited concerns about the quality of training or not having enough knowledge to choose an appropriate laboratory or field, among other reasons. Increased number of years since graduating medical school [adjusted proportion difference (PD) -6.0%, 95% confidence interval (95% CI) -9.8 to -2.3%], being a woman with children [adjusted PD -53.4%, 95% CI -87.3 to -19.5% (vs. a man not having children)], and completing their two-year internship at both university and community hospitals [adjusted PD -40.3%, 95% CI -72.5 to -8.0% (vs. internship only at community hospitals)] were associated with a reduction in desire to enroll in graduate school. We identified a growing trend in desire among young physicians to

  18. The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

    PubMed Central

    2014-01-01

    Background Together with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT’s experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting. Methods We conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation. Results The EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis. Conclusions EMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and

  19. Mentoring Nurse Practitioners in a Hospital Setting.

    PubMed

    Pop, Rodica S

    2017-08-01

    Nursing philosophy is the foundation of nurse practitioner (NP) training. However, NP practice is based on the medical care model. Thus, the necessity of mediating between these two approaches is often problematic for new NPs who are transitioning into their new roles. Mentoring has been used successfully to facilitate role transition and role understanding for nurses, NPs, and physicians. However, mentoring has been rarely studied in NPs. The purpose of this study was to develop a theory of mentoring for new NPs in a hospital setting. Grounded theory methodology was used. The sampling approach was initially purposive and was then shifted to theoretical to ensure the collection of meaningful data. Semistructuredinterviews were recorded and transcribed into Word documents for analysis. The three-phase analysis developed by Corbin and Strauss was initiated after the second interview. Sixteen participants (eight mentors and eight mentees) were interviewed between February and June 2011. The core category that emerged from the data was "defining self," and the main categories were forming the relationship, developing the relationship, and mentoring outcomes. A well-designed formal mentoring program may greatly improve the transition of NPs into a new role. The theory generated by the data from these study participants provides clearly defined categories that may be operationally defined and utilized to develop evaluation tools for mentoring programs.

  20. The academic quilting bee.

    PubMed

    Mayer, Anita P; Files, Julia A; Ko, Marcia G; Blair, Janis E

    2009-03-01

    In medicine, the challenges faced by female faculty members who are attempting to achieve academic advancement have been well described. Various strategies have been proposed to increase academic productivity to aid the promotion of women in medicine. We propose an innovative collaboration strategy that encourages completion of an academic writing project. This strategy acknowledges the challenges inherent in achieving work-life balance and utilizes a collaborative work style with a group of peer physicians. The model is designed to encourage the completion and collation of independently prepared sections of an academic paper within a setting that emphasizes social networking and collaboration. This approach has many similarities to the construction of a quilt during a "quilting bee."

  1. Learning science in a cooperative setting: Academic achievement and affective outcomes

    NASA Astrophysics Data System (ADS)

    Lazarowitz, Reuven; Hertz-Lazarowitz, Rachel; Baird, J. Hugh

    the overall social setting in the classroom as it relates to learning (Bruner, 1986, p. 86) and the central function of social interaction as learning occurs (Vygotsky, 1978, p. 106) seemed to have been ignored. Therefore, group mastery learning (GML), a cooperative learning tech- nique, was suggested as an antithesis to IML for teaching science over short periods. The cooperative mode of instruction considers learning as a cognitive as well as a social process, where students interact with each other as well as the teacher.To bring the social dimension back to science classrooms, the researchers chose to imple- ment GML in Grades 1 I and 12. The goal of the study was to investigate the GML's impact of the method on the individual student's academic achievement, creativity, self-esteem, and number of friends and on the overall learning environment of the classrooms. The researchers were also concerned with the students' attitudes toward earth science, the course being taught at the time of the experiment. Both cognitive and affective outcomes for students who participated in the cooperative GML approach were compared with outcomes for students who studied the same topic in an IML approach.The study addressed a number of questions related to academic and nonacademic outcomes of the two methods of study. First, it sought to determine whether academic achievement of the students taught in the cooperative GML mode would be different from the achievement of students who learned in an individualized method. Second, it sought to determine whether gains or losses would be seen in nonacademic outcomes, such as classroom learning environment, social relations, and students' self-esteem experienced by the students. The results of this study may support more use of cooperative learning in high school science.

  2. Nurses' perception of ethical climate at a large academic medical center.

    PubMed

    Lemmenes, Donna; Valentine, Pamela; Gwizdalski, Patricia; Vincent, Catherine; Liao, Chuanhong

    2016-09-07

    Nurses are confronted daily with ethical issues while providing patient care. Hospital ethical climates can affect nurses' job satisfaction, organizational commitment, retention, and physician collaboration. At a metropolitan academic medical center, we examined nurses' perceptions of the ethical climate and relationships among ethical climate factors and nurse characteristics. We used a descriptive correlational design and nurses (N = 475) completed Olson's Hospital Ethical Climate Survey. Data were analyzed using STATA. Approvals by the Nursing Research Council and Institutional Review Board were obtained; participants' rights were protected. Nurses reported an ethical climate total mean score of 3.22 ± 0.65 that varied across factors; significant differences were found for ethical climate scores by nurses' age, race, and specialty area. These findings contribute to what is known about ethical climate and nurses' characteristics and provides the foundation to develop strategies to improve the ethical climate in work settings. © The Author(s) 2016.

  3. The Relationship Between Index Hospitalizations, Sepsis, and Death or Transition to Hospice Care During 30-Day Hospital Readmissions.

    PubMed

    Dietz, Brett W; Jones, Tiffanie K; Small, Dylan S; Gaieski, David F; Mikkelsen, Mark E

    2017-04-01

    Hospital readmissions are common, expensive, and increasingly used as a metric for assessing quality of care. The relationship between index hospitalizations and specific outcomes among those readmitted remains largely unknown. Identify risk factors present during the index hospitalization associated with death or transition to hospice care during 30-day readmissions and examine the contribution of infection in readmissions resulting in death. Retrospective cohort study. A total of 17,716 30-day readmissions in an academic health system. We used mixed-effects multivariable logistic regression models to identify risk factors associated with the primary outcome, in-hospital death, or transition to hospice during 30-day readmissions. Of 17,716 30-day readmissions, 1144 readmissions resulted in death or transition to hospice care (6.5%). Risk factors identified included: age, burden, and type of comorbid conditions, recent hospitalizations, nonelective index admission type, outside hospital transfer, low discharge hemoglobin, low discharge sodium, high discharge red blood cell distribution width, and disposition to a setting other than home. Sepsis (OR=1.33; 95% CI, 1.02-1.72; P=0.03) and shock (OR=1.78; 95% CI, 1.22-2.58; P=0.002) during the index admission were associated with the primary outcome, and in-hospital mortality specifically. In patients who died, infection was the primary cause for readmission in 51.6% of readmissions after sepsis and 28.6% of readmissions after a nonsepsis hospitalization (P=0.009). We identified factors, including sepsis and shock during the index hospitalization, associated with death or transition to hospice care during readmission. Infection was frequently implicated as the cause of a readmission that ended in death.

  4. Environmental survey to assess viral contamination of air and surfaces in hospital settings.

    PubMed

    Carducci, A; Verani, M; Lombardi, R; Casini, B; Privitera, G

    2011-03-01

    The presence of pathogenic viruses in healthcare settings represents a serious risk for both staff and patients. Direct viral detection in the environment poses significant technical problems and the indirect indicators currently in use suffer from serious limitations. The aim of this study was to monitor surfaces and air in hospital settings to reveal the presence of hepatitis C virus, human adenovirus, norovirus, human rotavirus and torque teno virus by nucleic acid assays, in parallel with measurements of total bacterial count and haemoglobin presence. In total, 114 surface and 62 air samples were collected. Bacterial contamination was very low (<1 cfu/cm(2)) on surfaces, whereas the 'medium' detected value in air was 282 cfu/m(3). Overall, 19 (16.7%) surface samples tested positive for viral nucleic acids: one for norovirus, one for human adenovirus and 17 (14.9%) for torque teno virus (TTV). Only this latter virus was directly detected in 10 air samples (16.1%). Haemoglobin was found on two surfaces. No relationship was found between viral, biochemical or bacterial indicators. The data obtained confirm the difficulty of assessing viral contamination using bacterial indicators. The frequent detection of TTV suggests its possible use as an indicator for general viral contamination of the environment. Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  5. A Preliminary Investigation of Academic Disidentification, Racial Identity, and Academic Achievement among African American Adolescents

    ERIC Educational Resources Information Center

    Cokley, Kevin; McClain, Shannon; Jones, Martinique; Johnson, Samoan

    2012-01-01

    The purpose of this study was to examine academic disidentification along with demographic and psychological factors related to the academic achievement of African American adolescents. Participants included 96 African American students (41 males, 55 females) in an urban high school setting located in the Southwest. Consistent with previous…

  6. Hospital workers' perceptions of waste: a qualitative study involving photo-elicitation

    PubMed Central

    Goff, Sarah L.; Kleppel, Reva; Lindenauer, Peter K.; Rothberg, Michael B.

    2015-01-01

    Objectives To elicit sources of waste as viewed by hospital workers Design Qualitative study using photo-elicitation, an ethnographic technique for prompting in-depth discussion Setting U.S. academic tertiary care hospital Participants Physicians, nurses, pharmacists, administrative support personnel, administrators and respiratory therapists Methods A purposive sample of personnel at an academic tertiary care hospital was invited to take up to 10 photos of waste. Participants discussed their selections using photos as prompts during in-depth interviews. Transcripts were analyzed in an iterative process using grounded theory; open and axial coding was performed, followed by selective and thematic coding to develop major themes and sub-themes. Results Twenty-one participants (9 women, average number of years in field=19.3) took 159 photos. Major themes included types of waste and recommendations to reduce waste. Types of waste comprised four major categories: Time, Materials, Energy and Talent. Participants emphasized time wastage (50% of photos) over other types of waste such as excess utilization (2.5%). Energy and Talent were novel categories of waste. Recommendations to reduce waste included interventions at the micro-level (e.g. individual/ward), meso-level (e.g. institution) and macro-level (e.g., payor/public policy). Conclusions The waste hospital workers identified differed from previously described waste both in the types of waste described and the emphasis placed on wasted time. The findings of this study represent a possible need for education of hospital workers about known types of waste, an opportunity to assess the impact of novel types of waste described and an opportunity to intervene to reduce the waste identified. PMID:23748192

  7. Hospitalizations of Adults with Intellectual Disability in Academic Medical Centers

    ERIC Educational Resources Information Center

    Ailey, Sarah H.; Johnson, Tricia; Fogg, Louis; Friese, Tanya R.

    2014-01-01

    Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however,…

  8. A midwifery-led in-hospital birth center within an academic medical center: successes and challenges.

    PubMed

    Perdion, Karen; Lesser, Rebecca; Hirsch, Jennifer; Barger, Mary; Kelly, Thomas F; Moore, Thomas R; Lacoursiere, D Yvette

    2013-01-01

    The University of California San Diego Community Women's Health Program (CWHP) has emerged as a successful and sustainable coexistence model of women's healthcare. The cornerstone of this midwifery practice is California's only in-hospital birth center. Located within the medical center, this unique and physically separate birth center has been the site for more than 4000 births. With 10% cesarean delivery and 98% breast-feeding rates, it is an exceptional example of low-intervention care. Integrating this previously freestanding birth center into an academic center has brought trials of mistrust and ineffectual communication. Education, consistent leadership, and development of multidisciplinary guidelines aided in overcoming these challenges. This collaborative model provides a structure in which residents learn to be respectful consultants and appreciate differences in medical practice. The CWHP and its Birth Center illustrates that through persistence and flexibility a collaborative model of maternity services can flourish and not only positively influence new families but also future generations of providers.

  9. Impoverished Students with Academic Promise in Rural Settings: 10 Lessons from Project Aspire

    ERIC Educational Resources Information Center

    Burney, Virginia H.; Cross, Tracy L.

    2006-01-01

    Project Aspire was created to identify poor rural students with academic potential and to provide them with academic and counseling support in advanced placement courses and prerequisites. This article describes Project Aspire and its foundations; the relevant lessons learned from the literature on poverty, small schools, rural schools, and gifted…

  10. An Analysis of Disability, Academic Performance, and Seeking Support in One University Setting

    ERIC Educational Resources Information Center

    Dong, Shengli; Lucas, Margaretha S.

    2016-01-01

    This study focused on the academic performance and use of disability support services (DSS) of students with different types of disabilities who attend a postsecondary education institution. Findings show different patterns of academic success over four semesters as well as different patterns of DSS usage. Students who requested support from DSS…

  11. The academic rewards of socially-oriented happiness: Interdependent happiness promotes academic engagement.

    PubMed

    Datu, Jesus Alfonso D; King, Ronnel B; Valdez, Jana Patricia M

    2017-04-01

    Interdependent happiness has been found to be positively associated with optimal psychological outcomes in collectivist cultures. However, the association between interdependent happiness and key academic outcomes has remained unexplored. The current study examined the association of interdependent happiness with key academic outcomes such as autonomous motivation, engagement, and achievement using both cross-sectional (Study 1) and longitudinal (Study 2) approaches. Study 1 revealed that interdependent happiness positively predicted academic engagement (partly) via autonomous motivation. Study 2 showed that prior interdependent happiness positively predicted subsequent academic engagement even after controlling for autoregressor effects. In addition, reciprocal associations among the key variables were found. Taken together, results of the two studies suggest that interdependent happiness plays an adaptive role in the academic context especially in a collectivist cultural setting. Theoretical and practical implications are discussed. Copyright © 2016 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  12. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital.

    PubMed

    Sardo, Pedro Miguel Garcez; Simões, Cláudia Sofia Oliveira; Alvarelhão, José Joaquim Marques; Simões, João Filipe Fernandes Lindo; Machado, Paulo Alexandre Puga; Amado, Francisco Manuel Lemos; Amaro, António José Monteiro; Melo, Elsa Maria Oliveira Pinheiro de

    2016-11-01

    To gain more insight into the magnitude of the problem of pressure ulcer incidence in general wards of a Portuguese hospital. Retrospective cohort analysis of electronic health record database from 7132 adult patients admitted to medical and surgical wards of Aveiro Hospital during 2012. The development of (at least) one pressure ulcer during the length of stay was associated with age, gender, type of admission, specialty units, first Braden Scale score, length of stay, patient discharge outcome and ICD-9 diagnosis. An incidence of 3.4% participants with pressure ulcer category I-IV in inpatient setting during 2012. During the length of stay, 320 new pressure ulcers were developed, most of them category/stage II. The sacrum/coccyx and the trochanters were the most problematic areas. The major risk factor for the development of a new pressure ulcer during the length of stay was the presence of (at least) one pressure ulcer at the first skin assessment. The length of stay itself, age and lower Braden Scale scores of our participants also played an important role in the odds of developing a pressure ulcer. Infectious diseases, traumatism and fractures and respiratory diseases were the ICD-9 diagnoses with higher frequency of participants that developed (at least) one pressure ulcer during the length of stay. It's important to standardize procedures and documentation in all care settings. The documentation of nursing interventions is vital to evaluate the impact of evidence-based nursing. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  13. Experiential Learning in Hospitality Management Education

    ERIC Educational Resources Information Center

    Brennen, Paul George

    2017-01-01

    The research study recognized that, although the knowledge obtained from academic textbooks and traditional classes are important to post-secondary hospitality management curriculum as they provide numerous insights and perspectives of different methods to manage a particular avenue within the hospitality industry; it is not the only aspect of the…

  14. Study Drugs and Academic Integrity: The Role of Beliefs about an Academic Honor Code in the Prediction of Nonmedical Prescription Drug Use for Academic Enhancement

    ERIC Educational Resources Information Center

    Reisinger, Kelsy B.; Rutledge, Patricia C.; Conklin, Sarah M.

    2016-01-01

    The role of beliefs about academic integrity in college students' decisions to use nonmedical prescription drugs (NMPDs) in academic settings was examined. In Spring 2012 the authors obtained survey data from 645 participants at a small, undergraduate, private liberal arts institution in the Northeastern United States. A broadcast e-mail message…

  15. [Philanthropic general hospitals: a new setting for psychiatric admissions].

    PubMed

    Larrobla, Cristina; Botega, Neury José

    2006-12-01

    To understand the process that led Brazilian philanthropic general hospitals to implement psychiatric units and to describe the main characteristics and therapeutic approaches of these services. Ten institutions in three Brazilian states (Minas Gerais, São Paulo e Santa Catarina) were assessed in 2002. Forty-three semi-structured interviews were carried out with health professionals who worked at the hospitals to collect data on service implementation process, therapeutic approaches and current situation. The interviews were audio-recorded and their content was analyzed. There was no mental hospital in the cities where the institutions were located. In five hospitals, psychiatric patients were admitted to general medical wards because there was no psychiatric unit. The therapeutic approach in six hospitals was based on psychopharmacological treatment. Due to lack of resources and more appropriate therapeutic planning, the admission of patients presenting psychomotor agitation increases resistance against psychiatric patients in general hospitals. Financial constraints regarding laboratory testing is still a challenge. There is no exchange between local authorities and hospital administrators of these institutions that are compelled to exceed the allowed number of admissions to meet the demand of neighboring cities. The need for mental health care to local populations combined with individual requests of local authorities and psychiatrists made possible the implementation of psychiatric units in these localities. In spite of the efforts and flexibility of health professional working in these institutions, there are some obstacles to be overcome: resistance of hospital community against psychiatric admissions, financial constraints, limited professional training in mental health and the lack of a therapeutic approach that goes beyond psychopharmacological treatment alone.

  16. Intracranial suppuration: Review of an 8-year experience at Umtata General Hospital and Nelson Mandela Academic Hospital, Eastern Cape, South Africa.

    PubMed

    Anwary, M A

    2015-09-21

    Intracranial suppuration (ICS) is a life-threatening condition caused by various disease processes and consisting of brain abscess and extradural and subdural empyema. The major causes have changed over the decades. To the author's knowledge, the incidence of ICS in South Africa (SA) has not been established. To determine the incidence of ICS, overall and according to age and gender, and to identify the source and distribution of ICS. The archive of the radiology departments at Umtata General Hospital and Nelson Mandela Academic Hospital in the Transkei region, Eastern Cape Province, SA, was searched retrospectively for computed tomography (CT) reports of patients diagnosed with ICS. Cases in which the CT images, patients' clinical information and CT reports were available for an uninterrupted period of at least 1 year were included. Five time frames were established, encompassing 8 years of data. The first time frame established an incidence of ICS of 1/100,000/year for the Transkei region. All the time frames were utilised to determine the incidence according to gender and age, and the source and distribution of ICS. The incidence of ICS was higher among males than females, and highest in the age groups 0-10 and 11-20 years. A seasonal variation in the incidence of sinusitis- and meningitis-related ICS was noted. Numbers of cases declined during the last 3 years of the study period. Sinusitis, head trauma, ear infection and meningitis were the major sources of ICS. A pulmonary source was not a major feature. In the last 4 years, trauma became the commonest source of ICS. A steady decline in ear infection- and meningitis-related ICS was noted.

  17. Comparison of the prevalence of respiratory viruses in patients with acute respiratory infections at different hospital settings in North China, 2012-2015.

    PubMed

    Yu, Jianxing; Xie, Zhengde; Zhang, Tiegang; Lu, Yanqin; Fan, Hongwei; Yang, Donghong; Bénet, Thomas; Vanhems, Philippe; Shen, Kunling; Huang, Fang; Han, Jinxiang; Li, Taisheng; Gao, Zhancheng; Ren, Lili; Wang, Jianwei

    2018-02-08

    Acute respiratory infections (ARIs) are a great public health challenge globally. The prevalence of respiratory viruses in patients with ARIs attending at different hospital settings is fully undetermined. Laboratory-based surveillance for ARIs was conducted at inpatient and outpatient settings of 11 hospitals in North China. The first 2-5 patients with ARIs were recruited in each hospital weekly from 2012 through 2015. The presence of respiratory viruses was screened by PCR assays. The prevalence of respiratory viruses was determined and compared between patients at different hospital settings. A total of 3487 hospitalized cases and 6437 outpatients/Emergency Department (ED) patients were enrolled. The most commonly detected viruses in the hospitalized cases were respiratory syncytial virus (RSV, 33.3%) in children less than two years old, adenoviruses (13.0%) in patients 15-34 years old, and influenza viruses (IFVs, 9.6%) in patients ≥65 years. IFVs were the most common virus in outpatient/ED patients across all age groups (22.7%). After controlling for the confounders caused by other viruses and covariates, adenoviruses (adjusted odds ratio [aOR]: 3.97, 99% confidence interval [99% CI]: 2.19-7.20) and RSV (aOR: 2.04, 99% CI: 1.34-3.11) were independently associated with increased hospitalization in children, as well as adenoviruses in adults (aOR: 2.14, 99% CI: 1.19-3.85). Additionally, co-infection of RSV with IFVs was associated with increased hospitalization in children (aOR: 12.20, 99% CI: 2.65-56.18). A substantial proportion of ARIs was associated with respiratory viruses in North China. RSV, adenoviruses, and co-infection of RSV and IFVs were more frequent in hospitalized children (or adenoviruses in adults), which might predict the severity of ARIs. Attending clinicians should be more vigilant of these infections.

  18. Using Self-Monitoring with Guided Goal Setting to Increase Academic Engagement for a Student with Autism in an Inclusive Classroom in China

    ERIC Educational Resources Information Center

    Xu, Sheng; Wang, Jie; Lee, Gabrielle T.; Luke, Nicole

    2017-01-01

    The purpose of this study was to investigate whether using self-monitoring with guided goal setting was effective in increasing academic engagement for a student with autism who frequently displayed disruptive behaviors in an inclusive classroom in China. A 9-year-old male student with autism participated in this study. A changing criterion…

  19. Delivery room management of extremely low birth weight infants in Italy: comparison between academic and non-academic birth centres.

    PubMed

    Mardegan, Veronica; Satariano, Irene; Doglioni, Nicoletta; Criscoli, Giulio; Cavallin, Francesco; Gizzi, Camilla; Martano, Claudio; Ciralli, Fabrizio; Torielli, Flaminia; Villani, Paolo Ernesto; Di Fabio, Sandra; Quartulli, Lorenzo; Giannini, Luigi; Trevisanuto, Daniele

    2016-01-01

    International Guidelines provide a standardised approach to newborn resuscitation in the DR and, in their most recent versions, recommendations dedicated to management of ELBWI were progressively increased. It is expected that introduction in clinical practice and dissemination of the most recent evidence should be more consistent in academic than in non-academic hospitals. The aim of the study was to compare adherence to the International Guidelines and consistency of practice in delivery room management of extremely low birth weight infants between academic and non-academic institutions. A questionnaire was sent to the directors of all Italian level III centres between April and August 2012. There was a 92% (n = 98/107) response rate. Apart from polyethylene wrapping to optimise thermal control, perinatal management approach was comparable between academic and non-academic centres. There were minor differences in management of extremely low birth weight infants between Italian academic and non-academic institutions, apart from thermal management. Although there was a good, overall adherence to the International Guidelines for Neonatal Resuscitation, temperature management was not in accordance with official recommendations and every effort has to be done to improve this aspect.

  20. Evaluating a Moving Target: Lessons Learned from Using Practical Participatory Evaluation (P-PE) in Hospital Settings

    ERIC Educational Resources Information Center

    Wharton, Tracy; Alexander, Neil

    2013-01-01

    This article describes lessons learned about implementing evaluations in hospital settings. In order to overcome the methodological dilemmas inherent in this environment, we used a practical participatory evaluation (P-PE) strategy to engage as many stakeholders as possible in the process of evaluating a clinical demonstration project.…

  1. Strategic Planning as a Tool for Achieving Alignment in Academic Health Centers

    PubMed Central

    Higginbotham, Eve J.; Church, Kathryn C.

    2012-01-01

    After the passage of the Patient Protection and Affordable Care Act in March 2010, there is an urgent need for medical schools, teaching hospitals, and practice plans to work together seamlessly across a common mission. Although there is agreement that there should be greater coordination of initiatives and resources, there is little guidance in the literature to address the method to achieve the necessary transformation. Traditional approaches to strategic planning often engage a few leaders and produce a set of immeasurable initiatives. A nontraditional approach, consisting of a Whole-Scale (Dannemiller Tyson Associates, Ann Arbor, MI) engagement, appreciative inquiry, and a balanced scorecard can, more rapidly transform an academic health center. Using this nontraditional approach to strategic planning, increased organizational awareness was achieved in a single academic health center. Strategic planning can be an effective tool to achieve alignment, enhance accountability, and a first step in meeting the demands of the new landscape of healthcare. PMID:23303997

  2. Strategic planning as a tool for achieving alignment in academic health centers.

    PubMed

    Higginbotham, Eve J; Church, Kathryn C

    2012-01-01

    After the passage of the Patient Protection and Affordable Care Act in March 2010, there is an urgent need for medical schools, teaching hospitals, and practice plans to work together seamlessly across a common mission. Although there is agreement that there should be greater coordination of initiatives and resources, there is little guidance in the literature to address the method to achieve the necessary transformation. Traditional approaches to strategic planning often engage a few leaders and produce a set of immeasurable initiatives. A nontraditional approach, consisting of a Whole-Scale (Dannemiller Tyson Associates, Ann Arbor, MI) engagement, appreciative inquiry, and a balanced scorecard can, more rapidly transform an academic health center. Using this nontraditional approach to strategic planning, increased organizational awareness was achieved in a single academic health center. Strategic planning can be an effective tool to achieve alignment, enhance accountability, and a first step in meeting the demands of the new landscape of healthcare.

  3. [Success factors in hospital management].

    PubMed

    Heberer, M

    1998-12-01

    The hospital environment of most Western countries is currently undergoing dramatic changes. Competition among hospitals is increasing, and economic issues have become decisive factors for the allocation of medical care. Hospitals therefore require management tools to respond to these changes adequately. The balanced scorecard is a method of enabling development and implementation of a business strategy that equally respects the financial requirements, the needs of the customers, process development, and organizational learning. This method was used to derive generally valid success factors for hospital management based on an analysis of an academic hospital in Switzerland. Strategic management, the focus of medical services, customer orientation, and integration of professional groups across the hospital value chain were identified as success factors for hospital management.

  4. Women and teaching in academic psychiatry.

    PubMed

    Hirshbein, Laura D; Fitzgerald, Kate; Riba, Michelle

    2004-01-01

    This article explores past, present, and future issues for women and teaching in academic psychiatry. A small study of didactic teaching responsibilities along faculty groups in one academic psychiatry department helps to illustrate challenges and opportunities for women in psychiatric teaching settings. Although women have comprised half of all medical school admissions for over a decade, tenure-track positions are still largely dominated by men. In contrast, growing numbers of women have been entering academic medicine through clinical-track positions in which patient care and teaching, rather than research, are the key factors for promotion. Thus, the authors hypothesized better representation of clinical-track women in formal, didactic teaching within the medical school setting. The authors compared the numbers of tenure and clinical-track men and women teaching lectures to medical students and residents at the University of Michigan, Department of Psychiatry. Contrary to the hypothesis, the majority of didactic teaching was done by tenure-track men. Possible explanations and remedies for the continuing under-representation of women in academic psychiatry, particularly teaching settings, are explored. Suggestions are made for future areas in which female faculty might have opportunities for participation and leadership.

  5. The relationship between healthy work environments and retention of nurses in a hospital setting.

    PubMed

    Ritter, Desiree

    2011-01-01

    The purpose of the present paper was to determine the effect a healthy work environment has on the retention of nurses in a hospital setting. There is a nursing shortage that has been ongoing and is expected to continue, resulting in challenges for the healthcare system in the United States. The significance of this issue is the impact the nursing shortage will have on healthcare organizations and patients. The present paper included an extensive review of the current literature. The literature reviewed encompassed scholarly peer-reviewed journal articles. This article focused on nurses, work environments and the impact of the work environments on retention. Important issues that emerged from this analysis were the dangers of an unhealthy environment, the impact a healthy work environment has on patient outcomes and retention, the Magnet link to healthy work environments and the manager's role in creating and sustaining a healthy work environment. The literature provided evidence of the link between healthy work environments and the retention of nurses in a hospital setting. The implications for management are to implement changes now to create a healthy work environment that will recruit and retain nurses to secure their position in the future. © 2010 The Author. Journal compilation © 2010 Blackwell Publishing Ltd.

  6. Testing the Concept of Academic Housework in a European Setting: Part of Academic Career-Making or Gendered Barrier to the Top?

    ERIC Educational Resources Information Center

    Heijstra, Thamar M.; Einarsdóttir, Þorgerður; Pétursdóttir, Gyða M.; Steinþórsdóttir, Finnborg S.

    2017-01-01

    In the labour market women's jobs have frequently been conceptually and literally tied to housework and hence thought of as unskilled and therefore undervalued. Although academic institutions have undergone changes, the fact that women still carry the main responsibility for domestic and caring tasks continues to follow them into the academic work…

  7. Academic Unit Planning and Management. Technical Report No. 75.

    ERIC Educational Resources Information Center

    Miyataki, Glenn K.; Byers, Maureen L.

    Intended to provide a systematic aid for planning and managing academic units (schools, colleges, departments, or divisions) within an institution, the Academic Unit Planning and Management (AUPM) manual consists of a multifaceted set of techniques and procedures that can be used by academic unit administrators. Data regarding academic unit…

  8. Hospitalized for fever? Understanding hospitalization for common illnesses among insured women in a low-income setting.

    PubMed

    Sinha, Tara; Desai, Sapna; Mahal, Ajay

    2014-07-01

    Health microinsurance is a financial tool that increases utilization of health care services among low-income persons. There is limited understanding of the illnesses for which insured persons are hospitalized. Analysis of health claims at VimoSEWA, an Indian microinsurance scheme, shows that a significant proportion of hospitalization among insured adult women is for common illnesses—fever, diarrhoea and malaria—that are amenable to outpatient treatment. This study aims to understand the factors that result in hospitalization for common illnesses. The article uses a mixed methods approach. Quantitative data were collected from a household survey of 816 urban low-income households in Gujarat, India. The qualitative data are based on 10 in-depth case studies of insured women hospitalized for common illnesses and interviews with five providers. Quantitative and qualitative data were supplemented with data from the insurance scheme’s administrative records. Socioeconomic characteristics and morbidity patterns among insured and uninsured women were similar with fever the most commonly reported illness. While fever was the leading cause for hospitalization among insured women, no uninsured women were hospitalized for fever. Qualitative investigation indicates that 9 of 10 hospitalized women first sought outpatient treatment. Precipitating factors for hospitalization were either the persistence or worsening of symptoms. Factors that facilitated hospitalization included having insurance and the perceptions of doctors regarding the need for hospitalization. In the absence of quality primary care, health insurance can lead to hospitalization for non-serious illnesses. Deterrents to hospitalization point away from member moral hazard; provider moral hazard cannot be ruled out. This study underscores the need for quality primary health care and its better integration with health microinsurance schemes.

  9. An incentive plan for professional fee collections at an indigent-care teaching hospital.

    PubMed

    Stewart, M G; Jones, D B; Garson, A T

    2001-11-01

    The authors describe the implementation and development of an incentive plan to improve professional fee collections at an indigent-care teaching hospital. They theorized that an incentive plan based on relative value unit (RVU) productivity would increase billings and collections of professional fees. Unique RVU targets were set for individual services based on the number of faculty full-time equivalents and average reported productivity for academic physicians by specialty. The incentive plan was based on the level of expected faculty billings, measured in RVUs, for each department. A "base + incentive" model was used, with the base budget being distributed monthly throughout the year, and the incentive held as a "withhold" to be paid at the year's end only if the billing target in RVUs was met. Additionally, a task force worked with physician billing office and the hospital to improve collections. In the first year after implementation of the system was in place, important increases were noted in total RVU productivity (30.5% over the previous year) and in collections (49.5% over the previous year). Sixteen of 23 departments exceeded their incentive targets, and it was possible to make distributions of professional fees to those departments, to be used within the hospital system to enhance clinical services. Moreover, the plan created an overall positive attitude toward billings and documentation of faculty activities. The authors believe that this kind of incentive plan will be increasingly important for academic faculty working in public hospital systems.

  10. Common myths about caring for patients with terminal illness: opportunities to improve care in the hospital setting.

    PubMed

    Cherlin, Emily; Morris, Victor; Morris, Jensa; Johnson-Hurzeler, Rosemary; Sullivan, Gail M; Bradley, Elizabeth H

    2007-11-01

    Shortcomings in the quality of care of hospitalized patients at the end of life are well documented. Although hospitalists and residents are often involved in the care of hospitalized patients with terminal illness, little is known about their knowledge and beliefs concerning terminal illness, despite the importance of such physicians to the quality of care at the end of life. In 2006 we conducted an exploratory study at a large academic medical center to examine the knowledge, attitudes, and practices of hospitalists and residents (n = 52, response rate = 85.2%) about the care of terminally ill patients. Data were collected using a 22-item survey instrument adapted from previously published instruments. Several common myths about treating terminally ill patients were identified. These myths pertained to essential aspects of end-of-life care including pain and symptom control, indications for various medications, and eligibility for hospice. Physicians reported positive attitudes about hospice care as well as the belief that many patients who would benefit from hospice do not receive hospice at all or only late in the course of their illness. Our findings identified misunderstandings that hospitalists and residents commonly have, including about facts essential to know in order to provide appropriate pain and symptom management. Future interventions to improve knowledge need to focus on specific clinical knowledge about opioid therapy, as well as information about eligibility rules for hospice. (c) 2007 Society of Hospital Medicine.

  11. When a community hospital becomes an academic health centre.

    PubMed

    Topps, Maureen; Strasser, Roger

    2010-01-01

    With the burgeoning role of distributed medical education and the increasing use of community hospitals for training purposes, challenges arise for undergraduate and postgraduate programs expanding beyond traditional tertiary care models. It is of vital importance to encourage community hospitals and clinical faculty to embrace their roles in medical education for the 21st century. With no university hospitals in northern Ontario, the Northern Ontario School of Medicine and its educational partner hospitals identified questions of concern and collaborated to implement changes. Several themes emerged that are of relevance to any medical educational program expanding beyond its present location. Critical areas for attention include the institutional culture; human, physical and financial resources; and support for educational activities. It is important to establish and maintain the groundwork necessary for the development of thriving integrated community-engaged medical education. Done in tandem with advocacy for change in funding models, this will allow movement beyond the current educational environment. The ultimate goal is successful integration of university and accreditation ideals with practical hands-on medical care and education in new environments.

  12. Severe preeclampsia and eclampsia: incidence, complications, and perinatal outcomes at a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe.

    PubMed

    Ngwenya, Solwayo

    2017-01-01

    Severe preeclampsia is a disorder of pregnancy characterized by high blood pressure and significant proteinuria after 20 weeks gestation. Severe preeclampsia and eclampsia have considerable adverse impacts on maternal, fetal, and neonatal health especially in low-resource countries. Hypertensive disorders of pregnancy are the third leading cause of maternal deaths in Sub-Saharan Africa. Significant avoidable maternal and neonatal morbidity and mortality may result. This study aimed 1) to determine the incidence of severe preeclampsia/eclampsia in a low-resource setting; 2) to determine the maternal complications of severe preeclampsia/eclampsia in a low-resource setting; 3) to determine the perinatal outcomes of severe preeclampsia/eclampsia in a low-resource setting. This was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data were obtained from the birth registers in labor ward, intensive care unit, and neonatal intensive care unit of patients who had a diagnosis of severe preeclampsia or eclampsia for the period January 1, 2016, to December 31, 2016. The case notes were retrieved and the demographic, clinical, and outcome data were gathered. There were 9,086 deliveries at the institution during the period January 1, 2016, to December 31, 2016. There were 121 cases of severe preeclampsia/eclampsia. The incidence of severe preeclampsia/eclampsia was 1.3% at Mpilo Central Hospital. The most common major complication was HELLP syndrome (9.1%). Maternal mortality was 1.7%. There were 127 babies born with six sets of twins, 49.6% of the babies were lost through stillbirths and early neonatal deaths. The incidence of severe preeclampsia/eclampsia at Mpilo Central Hospital was 1.3%. The most common maternal complication was hemolysis elevated liver enzymes low platelet syndrome. Maternal mortality was 1.7% due to acute renal failure. Nearly

  13. Strategies to Reduce Hospitalizations of Children With Medical Complexity Through Complex Care: Expert Perspectives.

    PubMed

    Coller, Ryan J; Nelson, Bergen B; Klitzner, Thomas S; Saenz, Adrianna A; Shekelle, Paul G; Lerner, Carlos F; Chung, Paul J

    Interventions to reduce disproportionate hospital use among children with medical complexity (CMC) are needed. We conducted a rigorous, structured process to develop intervention strategies aiming to reduce hospitalizations within a complex care program population. A complex care medical home program used 1) semistructured interviews of caregivers of CMC experiencing acute, unscheduled hospitalizations and 2) literature review on preventing hospitalizations among CMC to develop key drivers for lowering hospital utilization and link them with intervention strategies. Using an adapted version of the RAND/UCLA Appropriateness Method, an expert panel rated each model for effectiveness at impacting each key driver and ultimately reducing hospitalizations. The complex care program applied these findings to select a final set of feasible intervention strategies for implementation. Intervention strategies focused on expanding access to familiar providers, enhancing general or technical caregiver knowledge and skill, creating specific and proactive crisis or contingency plans, and improving transitions between hospital and home. Activities aimed to facilitate family-centered, flexible implementation and consideration of all of the child's environments, including school and while traveling. Tailored activities and special attention to the highest utilizing subset of CMC were also critical for these interventions. A set of intervention strategies to reduce hospitalizations among CMC, informed by key drivers, can be created through a structured, reproducible process. Both this process and the results may be relevant to clinical programs and researchers aiming to reduce hospital utilization through the medical home for CMC. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  14. Reimbursement in hospital-based vascular surgery: Physician and practice perspective.

    PubMed

    Perri, Jennifer L; Zwolak, Robert M; Goodney, Philip P; Rutherford, Gretchen A; Powell, Richard J

    2017-07-01

    The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care. Adjustments were made for work performed, case complexity, and inflation. To reflect the effect of these variables, net revenue was indexed to work relative value units (wRVUs), case mix index, and consumer price index, which adjusted for work, case complexity, and inflation, respectively. Differences in physician and hospital net revenue were compared over time. Physician work, measured in RVUs per year, increased by 4%; case complexity, assessed with case mix index, increased by 10% for the 6-year measurement period. Despite stability in payer mix at 64% to 69% Medicare, both physician and hospital vascular-related revenue/wRVU decreased during this period. Unadjusted professional revenue/wRVU declined by 14.1% (P = .09); when considering case complexity, physician revenue/wRVU declined by 20.6% (P = .09). Taking into account both case complexity and inflation, physician revenue declined by 27.0% (P = .04). Comparatively, hospital revenue for vascular surgery services decreased by 13.8% (P = .07) when adjusting for unit work, complexity, and inflation. At medical centers where vascular surgeons are hospital based, vascular care reimbursement decreased substantially from 2010 to 2015 when case complexity and inflation were considered. Physician reimbursement (professional fees) decreased at a significantly greater rate than hospital reimbursement for vascular care. This trend has significant implications for salaried vascular surgeons in hospital

  15. ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms.

    PubMed

    Probst, Danielle R; Gustin, Jillian L; Goodman, Lauren F; Lorenz, Amanda; Wells-Di Gregorio, Sharla M

    2016-04-01

    Family members of patients who die in an ICU are at increased risk of psychological sequelae compared to those who experience a death in hospice. This study explored differences in rates and levels of complicated grief (CG), posttraumatic stress disorder (PTSD), and depression between family members of patients who died in an ICU versus a non-ICU hospital setting. Differences in family members' most distressing experiences at the patient's end of life were also explored. The study was an observational cohort. Subjects were next of kin of 121 patients who died at a large, Midwestern academic hospital; 77 died in the ICU. Family members completed measures of CG, PTSD, depression, and end-of-life experiences. Participants were primarily Caucasian (93%, N = 111), female (81%, N = 98), spouses (60%, N = 73) of the decedent, and were an average of nine months post-bereavement. Forty percent of family members met the Inventory of Complicated Grief CG cut-off, 31% met the Impact of Events Scale-Revised PTSD cut-off, and 51% met the Center for Epidemiologic Studies Depression Scale depression cut-off. There were no significant differences in rates or levels of CG, PTSD, or depressive symptoms reported by family members between hospital settings. Several distressing experiences were ranked highly by both groups, but each setting presented unique distressing experiences for family members. Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.

  16. Building cancer nursing skills in a resource-constrained government hospital.

    PubMed

    Strother, R M; Fitch, Margaret; Kamau, Peter; Beattie, Kathy; Boudreau, Angela; Busakhalla, N; Loehrer, P J

    2012-09-01

    Cancer is a rising cause of morbidity and mortality in resource-constrained settings. Few places in the developing world have cancer care experts and infrastructure for caring for cancer patients; therefore, it is imperative to develop this infrastructure and expertise. A critical component of cancer care, rarely addressed in the published literature, is cancer nursing. This report describes an effort to develop cancer nursing subspecialty knowledge and skills in support of a growing resource-constrained comprehensive cancer care program in Western Kenya. This report highlights the context of cancer care delivery in a resource-constrained setting, and describes one targeted intervention to further develop the skill set and knowledge of cancer care providers, as part of collaboration between developed world academic institutions and a medical school and governmental hospital in Western Kenya. Based on observations of current practice, practice setting, and resource limitations, a pragmatic curriculum for cancer care nursing was developed and implemented.

  17. Evaluation of a modified Karnofsky score to assess physical and psychological wellbeing of cats in a hospital setting.

    PubMed

    Taffin, Elien Rl; Paepe, Dominique; Campos, Miguel; Duchateau, Luc; Goris, Nesya; De Roover, Katrien; Daminet, Sylvie

    2016-11-01

    Objectives The Karnofsky score (KS) modified for cats, a scoring system to rate health and quality of life (QOL) in cats, is used in clinical trials, but its reliability and validity are yet to be determined. The present study aims to evaluate the scientific robustness of the KS when adapted for use in a hospital setting. Methods A list of variables to consider during the physical examination, which informs the clinician's score (CS) part of the KS, was added and clinicians were allowed to choose a score anywhere between 0 and 50. The Karnofsky QOL questionnaire was adapted for use in a hospital setting. F-tests with Bonferroni correction and Spearman rank correlation coefficients were used to evaluate reliability and validity of the KS to assess the health and wellbeing of cats in a hospital setting. The records of 54 feline immunodeficiency virus-positive cats, which were recruited for a clinical trial and hospitalised for 6 weeks, were reviewed. Four veterinarians scored the CS, and one veterinarian and a veterinary nurse assessed the QOL score. Results Mean absolute difference between observers was significantly larger for the CS than for the QOL score ( P <0.001) and two veterinarians scored significantly higher than the remaining two veterinarians ( P <0.001). Inter-observer correlation ranged from 0.45-0.75 for the CS. For the QOL score, the absolute difference between observers was small, no significant difference was found between observers and a high degree of inter-observer correlation was noted (r = 0.91). Conclusions and relevance The results indicate low inter-observer reliability for the CS, requiring additional modifications to this part of the KS. The QOL score seems more reliable, and the questionnaire may serve as a reliable tool in the assessment of QOL in cats in a hospital setting. Consequently, further adaptation of the KS is mandatory when simultaneous assessment of both the cat's clinical health and perceived wellbeing is required.

  18. Hospitalist and Internal Medicine Leaders' Perspectives of Early Discharge Challenges at Academic Medical Centers.

    PubMed

    Patel, Hemali; Fang, Margaret C; Mourad, Michelle; Green, Adrienne; Wachter, Robert M; Murphy, Ryan D; Harrison, James D

    2018-06-01

    Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation. We received 61 responses from 115 institutions (53% response rate). Forty-seven (77%) "strongly agreed" or "agreed" that early discharge was a priority. "Discharge by noon" was the most cited goal (n = 23; 38%) followed by "no set time but overall goal for improvement" (n = 13; 21%). The majority of respondents reported early discharge as more important than obtaining translators for non-English-speaking patients and equally important as reducing 30-day readmissions and improving patient satisfaction. The most commonly reported factors delaying discharge were availability of postacute care beds (n = 48; 79%) and patient-related transport complications (n = 44; 72%). The most effective early discharge initiatives reported involved changes to the rounding process, such as preemptive identification and early preparation of discharge paperwork (n = 34; 56%) and communication with patients about anticipated discharge (n = 29; 48%). There is a strong interest in increasing early discharges in an effort to improve hospital throughput and patient flow. © 2017 Society of Hospital Medicine.

  19. Antimicrobial resistance patterns of Staphylococcus species isolated from cats presented at a veterinary academic hospital in South Africa.

    PubMed

    Qekwana, Daniel Nenene; Sebola, Dikeledi; Oguttu, James Wabwire; Odoi, Agricola

    2017-09-15

    Antimicrobial resistance is becoming increasingly important in both human and veterinary medicine. This study investigated the proportion of antimicrobial resistant samples and resistance patterns of Staphylococcus isolates from cats presented at a veterinary teaching hospital in South Africa. Records of 216 samples from cats that were submitted to the bacteriology laboratory of the University of Pretoria academic veterinary hospital between 2007 and 2012 were evaluated. Isolates were subjected to antimicrobial susceptibility testing against a panel of 15 drugs using the disc diffusion method. Chi square and Fisher's exact tests were used to assess simple associations between antimicrobial resistance and age group, sex, breed and specimen type. Additionally, associations between Staphylococcus infection and age group, breed, sex and specimen type were assessed using logistic regression. Staphylococcus spp. isolates were identified in 17.6% (38/216) of the samples submitted and 4.6% (10/216) of these were unspeciated. The majority (61.1%,11/18) of the isolates were from skin samples, followed by otitis media (34.5%, 10/29). Coagulase Positive Staphylococcus (CoPS) comprised 11.1% (24/216) of the samples of which 7.9% (17/216) were S. intermedius group and 3.2% (7/216) were S. aureus. Among the Coagulase Negative Staphylococcus (CoNS) (1.9%, 4/216), S. felis and S. simulans each constituted 0.9% (2/216). There was a significant association between Staphylococcus spp. infection and specimen type with odds of infection being higher for ear canal and skin compared to urine specimens. There were higher proportions of samples resistant to clindamycin 34.2% (13/25), ampicillin 32.4% (2/26), lincospectin 31.6% (12/26) and penicillin-G 29.0% (11/27). Sixty three percent (24/38) of Staphylococcus spp. were resistant to one antimicrobial agent and 15.8% were multidrug resistant (MDR). MDR was more common among S. aureus 28.6% (2/7) than S. intermedius group isolates 11.8% (2

  20. Higher surgical training opportunities in the general hospital setting; getting the balance right.

    PubMed

    Robertson, I; Traynor, O; Khan, W; Waldron, R; Barry, K

    2013-12-01

    The general hospital can play an important role in training of higher surgical trainees (HSTs) in Ireland and abroad. Training opportunities in such a setting have not been closely analysed to date. The aim of this study was to quantify operative exposure for HSTs over a 5-year period in a single institution. Analysis of electronic training logbooks (over a 5-year period, 2007-2012) was performed for general surgery trainees on the higher surgical training programme in Ireland. The most commonly performed adult and paediatric procedures per trainee, per year were analysed. Standard general surgery operations such as herniae (average 58, range 32-86) and cholecystectomy (average 60, range 49-72) ranked highly in each logbook. The most frequently performed emergency operations were appendicectomy (average 45, range 33-53) and laparotomy for acute abdomen (average 48, range 10-79). Paediatric surgical experience included appendicectomy, circumcision, orchidopexy and hernia/hydrocoele repair. Overall, the procedure most commonly performed in the adult setting was endoscopy, with each trainee recording an average of 116 (range 98-132) oesophagogastroduodenoscopies and 284 (range 227-354) colonoscopies. General hospitals continue to play a major role in the training of higher surgical trainees. Analysis of the electronic logbooks over a 5-year period reveals the high volume of procedures available to trainees in a non-specialist centre. Such training opportunities are invaluable in the context of changing work practices and limited resources.

  1. The Relationship between Academic Writing Experience and Academic Publishing for Graduate Physics Students

    ERIC Educational Resources Information Center

    Hess, Steven Timothy Michael

    2012-01-01

    Writing for scientific publication represents an opportunity to interact with colleagues and make a positive contribution to the academic community. However, there is a growing concern regarding the ability of graduate students' to transfer writing skill sets learned at the graduate and undergraduate levels into professional settings. The main…

  2. Women and Teaching in Academic Psychiatry

    ERIC Educational Resources Information Center

    Hirshbein, Laura D.; Fitzgerald, Kate; Riba, Michelle

    2004-01-01

    Objective: This article explores past, present, and future issues for women and teaching in academic psychiatry. A small study of didactic teaching responsibilities along faculty groups in one academic psychiatry department helps to illustrate challenges and opportunities for women in psychiatric teaching settings. Background: Although women have…

  3. Predictors of job satisfaction among academic family medicine faculty

    PubMed Central

    Krueger, Paul; White, David; Meaney, Christopher; Kwong, Jeffrey; Antao, Viola; Kim, Florence

    2017-01-01

    Abstract Objective To identify predictors of job satisfaction among academic family medicine faculty members. Design A comprehensive Web-based survey of all faculty members in an academic department of family medicine. Bivariate and multivariable analyses (logistic regression) were used to identify variables associated with job satisfaction. Setting The Department of Family and Community Medicine at the University of Toronto in Ontario and its 15 affiliated community teaching hospitals and community-based teaching practices. Participants All 1029 faculty members in the Department of Family and Community Medicine were invited to complete the survey. Main outcome measures Faculty members’ demographic and practice information; teaching, clinical, administration, and research activities; leadership roles; training needs and preferences; mentorship experiences; health status; stress levels; burnout levels; and job satisfaction. Faculty members’ perceptions about supports provided, recognition, communication, retention, workload, teamwork, respect, resource distribution, remuneration, and infrastructure support. Faculty members’ job satisfaction, which was the main outcome variable, was obtained from the question, “Overall, how satisfied are you with your job?” Results Of the 1029 faculty members, 687 (66.8%) responded to the survey. Bivariate analyses revealed 26 predictors as being statistically significantly associated with job satisfaction, including faculty members’ ratings of their local department and main practice setting, their ratings of leadership and mentorship experiences, health status variables, and demographic variables. The multivariable analyses identified the following 5 predictors of job satisfaction: the Maslach Burnout Inventory subscales of emotional exhaustion and personal accomplishment; being born in Canada; the overall quality of mentorship that was received being rated as very good or excellent; and teamwork being rated as very

  4. Biomechanical evaluation of nursing tasks in a hospital setting.

    PubMed

    Jang, R; Karwowski, W; Quesada, P M; Rodrick, D; Sherehiy, B; Cronin, S N; Layer, J K

    2007-11-01

    A field study was conducted to investigate spinal kinematics and loading in the nursing profession using objective and subjective measurements of selected nursing tasks observed in a hospital setting. Spinal loading was estimated using trunk motion dynamics measured by the lumbar motion monitor (LMM) and lower back compressive and shear forces were estimated using the three-dimensional (3D) Static Strength Prediction Program. Subjective measures included the rate of perceived physical effort and the perceived risk of low back pain. A multiple logistic regression model, reported in the literature for predicting low back injury based on defined risk groups, was tested. The study results concluded that the major risk factors for low back injury in nurses were the weight of patients handled, trunk moment, and trunk axial rotation. The activities that required long time exposure to awkward postures were perceived by nurses as a high physical effort. This study also concluded that self-reported perceived exertion could be used as a tool to identify nursing activities with a high risk of low-back injury.

  5. National Evaluation of Policies on Individual Financial Conflicts of Interest in Canadian Academic Health Science Centers

    PubMed Central

    Sekeres, Melanie; Gold, Jennifer; Ferris, Lorraine E.; Kalkar, Sunila R.; Wu, Wei; Van Laethem, Marleen; Chan, An-Wen; Moher, David; Maskalyk, M. James; Taback, Nathan; Rochon, Paula A.

    2008-01-01

    Background Conflicts of interest (COI) in research are an important emerging topic of investigation and are frequently cited as a serious threat to the integrity of human participant research. Objective To study financial conflicts of interest (FCOI) policies for individual investigators working in Canadian academic health centers. Design Survey instrument containing 61 items related to FCOI. Setting All Canadian academic health science centers (universities with faculties of medicine, faculties of medicine and teaching hospitals) were requested to provide their three primary FCOI policies. Measurements Number of all centers and teaching hospitals with policies addressing each of the 61 items related to FCOI. Main Results Only one item was addressed by all 74 centers. Thirteen items were present in fewer than 25% of centers. Fewer than one-quarter of hospitals required researchers to disclose FCOI to research participants. The role of research ethics boards (REBs) in hospitals was marginal. Limitations Asking centers to identify only three policies may not have inclusively identified all FCOI policies in use. Additionally, policies at other levels might apply. For instance, all institutions receiving federal grant money must comply with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Conclusions Canadian centers within the same level (for instance, teaching hospitals) differ significantly in the areas that their policies address and these policies differ widely in their coverage. Presently, no single policy in any Canadian center informs researchers about the broad range of individual FCOI issues. Canadian investigators need to understand the environment surrounding FCOI, be able to access and follow the relevant policies and be confident that they can avoid entering into a FCOI. PMID:18716848

  6. Delayed transfer from hospital to community settings: the older person's perspective.

    PubMed

    Swinkels, Annette; Mitchell, Theresa

    2009-02-01

    Prevention and management of delayed transfer of older people from hospital to community settings is an enduring issue in industrialised societies and is the subject of many recent policies in the United Kingdom. A deeper, evidence-based understanding of the complex organizational and interprofessional issues which contribute to delays in transfer has emerged in recent years. Despite this, and the relative success of recent policies, two recent reviews of the area highlight the lack of studies on patients' perspectives. We sought to address this deficit by using conversational interviews and a phenomenological approach to explore and interpret participants' perceptions of delayed transfer from hospital into the community. A purposive sampling strategy was employed to incorporate participants from different categories of delay identified on weekly Situation Reports. Participants aged 65 years and over (mean age 82 +/- 5.4 years) and with a mean delay of 32 days (+/- 26) were recruited from three hospitals based in two NHS Trusts in the South of England. This paper focuses on their perceptions of the effects of delayed transfer into the community, their involvement in discharge planning and future community care needs. Our findings show that participants actively or passively relinquished their involvement in the processes of discharge planning because of the perceived expertise of others and also feelings of disempowerment secondary to poor health, low mood, dependency, lack of information and the intricacies of discharge planning processes for complex community care needs. Participants expressed a longing for continuity, emphasised the importance of social contact and sometimes appeared unrealistic about their future care needs. While current policies may have helped reduce overall numbers of delayed patients in the UK, our study suggests that there is scope for improvement in the involvement of delayed patients in planning their discharge into the community.

  7. Academic Culture.

    ERIC Educational Resources Information Center

    Clark, Burton R.

    With fragmentation the dominant trend in academic settings around the world, the larger wholes of profession, enterprise, and system are less held together by integrative ideology. Strong ideological bonding is characteristic of the parts, primarily the disciplines. The larger aggregations are made whole mainly by formal superstructure, many…

  8. Why are hospital-based nursing homes so costly? Relative importance of acuity and treatment setting.

    PubMed

    Pizer, Steven D; White, Alan J; White, Chapin

    2002-05-01

    To determine the extent to which higher costs in hospital-based skilled nursing facilities (HBSNF) can be explained by observable resident characteristics and unobservable selection effects, implying a design shortcoming of the skilled nursing facility prospective payment system (SNF PPS) implemented for Medicare-covered stays by the Balanced Budget Act of 1997 (BBA 1997). Data on resident characteristics from the Minimum Data Set (MDS) are combined with staff time costs from the Centers for Medicare and Medicaid Services' (CMS, formerly HCFA) 1995 and 1997 SNF Staff Time Measurement (STM) studies and nontherapy ancillary claim costs extracted from CMS SNF claim records. An endogenous switching model was estimated to measure the effect on costs of the relatively high acuity of HBSNF residents, net of differences purely attributable to the treatment setting. It was found that virtually the entire HBSNF differential is attributable to setting effects with resident characteristics and selection effects playing a negligible role. In addition, it was found that marginal costs associated with particular services and conditions are often lower in hospital-based than in freestanding facilities. HBSNFs incur high costs regardless of the characteristics of their residents. Their high fixed costs accompany relatively low marginal costs associated with admitting high-acuity residents. Consequently, a PPS casemix system that depends on resident characteristics and excludes consideration of facility characteristics (as mandated by BBA 1997) need not unfairly penalize HBSNFs, provided a powerful casemix system is used and HBSNFs specialize in the care of high-acuity residents.

  9. Validating diagnostic information on the Minimum Data Set in Ontario Hospital-based long-term care.

    PubMed

    Wodchis, Walter P; Naglie, Gary; Teare, Gary F

    2008-08-01

    Over 20 countries currently use the Minimum Data Set Resident Assessment Instrument (MDS) in long-term care settings for care planning, policy, and research purposes. A full assessment of the quality of the diagnostic information recorded on the MDS is lacking. The primary goal of this study was to examine the quality of diagnostic coding on the MDS. Subjects for this study were admitted to Ontario Complex Continuing Care Hospitals (CCC) directly from acute hospitals between April 1, 1997 and March 31, 2005 (n = 80,664). Encrypted unique identifiers, common across acute and CCC administrative databases, were used to link administrative records for patients in the sample. After linkage, each resident had 2 sources of diagnostic information: the acute discharge abstract database and the MDS. Using the discharge abstract database as the reference standard, we calculated the sensitivity for each of 43 MDS diagnoses. Compared with primary diagnoses coded in acute care abstracts, 12 of 43 MDS diagnoses attained a sensitivity of at least 0.80, including 7 of the 10 diagnoses with the highest prevalence as an acute care primary diagnosis before CCC admission. Although the sensitivity was high for many of the most prevalent conditions, important diagnostic information is missed increasing the potential for suboptimal clinical care. Emphasis needs to be put on improving information flow across care settings during patient transitions. Researchers should exercise caution when using MDS diagnoses to identify patient populations, particularly those shown to have low sensitivity in this study.

  10. South African Academic Health--the future challenge.

    PubMed

    van Zyl, G J

    2004-02-01

    In South Africa, significant changes in Academic Health have taken place since the first democratic elections in 1994. Academic Health came from a separated academic hospital, departmental-based curriculum and research focussed on achievement, and an abundance of money, to a position of integrated service delivery with specific reference to primary health care, separation of service levels, a new integrated curriculum, research focussed according to the need and contract research, and financial constraints with limited budgets. The management of this change is a task challenging the manager in all fields of Academic Health. Leaders need to know their environment and organisation to be able to manage change. Academic Health centres are experiencing major changes as a result of the effects of managed care, reduced rate and growing expenditure on health services. In addition to restructuring of the clinical services, Academic Health centres are being challenged to sustain their academic mission and priorities in the face of resource constraints. In order to tackle these challenges, institutions need physicians in administrative positions at all levels who can provide leadership and thoughtful managerial initiatives. The future challenge for managers focuses on service delivery, research, health education and training, Academic Health management, professionalism and financial management.

  11. Supporting Veteran Transitions to the Academic Setting: VA on Campus

    ERIC Educational Resources Information Center

    O'Connor, Ashley; Herbst, Ellen; McCaslin, Shannon; Armstrong, Keith; Leach, Bridget; Jersky, Brandina

    2018-01-01

    In this case study, we assessed academic functioning, service satisfaction, and needs of student veterans at a community college who had accessed the Veterans Health Administration (VHA) Student Veteran Health Program (SVHP) (n = 36). The SVHP provides outreach and behavioral health services directly on a large community college campus to overcome…

  12. The Potential Role of Recombinant Activated Factor VIIa (rFVIIa) in Military Pre-Hospital Setting

    DTIC Science & Technology

    2004-09-01

    coagulation factors and platelets by crystalloids, colloids, or blood products The severity of dilutional coagulopathy is determined by both volume and...RTO-MP-HFM-109 3 - 1 The Potential Role of Recombinant Activated Factor VIIa (rFVIIa) in Military Pre-Hospital Setting LTC (ret.) Uri...decrease mortality from exsanguinations. Recombinant factor VIIa (rFVIIa) has been shown to overcome a variety of coagulation and platelet disorders

  13. Use of portable electronic devices in a hospital setting and their potential for bacterial colonization.

    PubMed

    Khan, Amber; Rao, Amitha; Reyes-Sacin, Carlos; Hayakawa, Kayoko; Szpunar, Susan; Riederer, Kathleen; Kaye, Keith; Fishbain, Joel T; Levine, Diane

    2015-03-01

    Portable electronic devices are increasingly being used in the hospital setting. As with other fomites, these devices represent a potential reservoir for the transmission of pathogens. We conducted a convenience sampling of devices in 2 large medical centers to identify bacterial colonization rates and potential risk factors. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Academic Success of Adolescents in Poverty

    ERIC Educational Resources Information Center

    Palomar-Lever, Joaquina; Victorio-Estrada, Amparo

    2017-01-01

    This study identified significant predictors of important academic results such as academic performance and school desertion by adolescent students living in poverty in both urban and rural settings. The results indicate the relative importance of individual, family, educational and social variables reported by the young people, and the…

  15. An innovative approach to supporting hospitalist physicians towards academic success.

    PubMed

    Howell, Eric; Kravet, Steven; Kisuule, Flora; Wright, Scott M

    2008-07-01

    Academic hospitalist physicians face significant challenges that may threaten their chances for successful and timely promotions, such as heavy clinical workloads, limited training in research, and relatively few experienced mentors in their field. The appreciable growth of hospital medicine groups in recent years, as has occurred at our institution, compounds the predicament by diluting the limited resources that are available to support these physicians. A needs assessment was followed by the development of specific objectives for the division and for individual members of the division related to academic success. The resulting 3-pronged strategy to support the academic success of our group was based on securing strong mentorship, investing requisite resources, and committing to recruit fellowship-trained new faculty. To date, the initiative has resulted in an increased number of peer-reviewed publication and grants, as well as national leadership roles for division members. Copyright 2008 Society of Hospital Medicine.

  16. Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting.

    PubMed

    Sinha Gregory, Naina; Seley, Jane Jeffrie; Gerber, Linda M; Tang, Chin; Brillon, David

    2016-12-01

    More than one-third of hospitalized patients have hyperglycemia. Despite evidence that improving glycemic control leads to better outcomes, achieving recognized targets remains a challenge. The objective of this study was to evaluate the implementation of a computerized insulin order set and titration algorithm on rates of hypoglycemia and overall inpatient glycemic control. A prospective observational study evaluating the impact of a glycemic order set and titration algorithm in an academic medical center in non-critical care medical and surgical inpatients. The initial intervention was hospital-wide implementation of a comprehensive insulin order set. The secondary intervention was initiation of an insulin titration algorithm in two pilot medicine inpatient units. Point of care testing blood glucose reports were analyzed. These reports included rates of hypoglycemia (BG < 70 mg/dL) and hyperglycemia (BG >200 mg/dL in phase 1, BG > 180 mg/dL in phase 2). In the first phase of the study, implementation of the insulin order set was associated with decreased rates of hypoglycemia (1.92% vs 1.61%; p < 0.001) and increased rates of hyperglycemia (24.02% vs 27.27%; p < 0.001) from 2010 to 2011. In the second phase, addition of a titration algorithm was associated with decreased rates of hypoglycemia (2.57% vs 1.82%; p = 0.039) and increased rates of hyperglycemia (31.76% vs 41.33%; p < 0.001) from 2012 to 2013. A comprehensive computerized insulin order set and titration algorithm significantly decreased rates of hypoglycemia. This significant reduction in hypoglycemia was associated with increased rates of hyperglycemia. Hardwiring the algorithm into the electronic medical record may foster adoption.

  17. The Profile of Academic Offenders: Features of Students Who Admit to Academic Dishonesty.

    PubMed

    Korn, Liat; Davidovitch, Nitza

    2016-08-29

    Dishonesty in academic settings is a reckless behavior that is unique to students and is associated with cheat    ing and plagiarism of academic tasks. Incidents involving dishonesty in higher education have increased considerably in the past decade, with regard to the extent of these practices, the types of dishonesty employed, and their prevalence. The current study examines the profile of "academic offenders". Which types are more prone to commit academic offenses? To what degree are they "normative" and do they represent the average student with regard to personal traits, personal perceptions, features of their academic studies, risk behaviors, and health risks. The study is based on a structured anonymous questionnaire. The sample consisted of 1,432 students, of whom 899 were female (63%) and 533 male (37%). The research findings indicate a common tendency among more than one quarter of the sample reported cheating on homework and 12.5% reported cheating on tests. Strong associations were found between academic dishonesty and various personal perceptions, the academic study experience, and involvement in other risky and deviant behaviors. Significant predictors of academic dishonesty were found, i.e., self-image, ethics, grades, time devoted to homework, and deviant and daring behaviors. The research findings might help indicate policies for optimally dealing with dishonesty, maybe even before the offense is committed, by means of cooperation between academic forces.

  18. The Profile of Academic Offenders: Features of Students Who Admit to Academic Dishonesty

    PubMed Central

    Korn, Liat; Davidovitch, Nitza

    2016-01-01

    Dishonesty in academic settings is a reckless behavior that is unique to students and is associated with cheat ing and plagiarism of academic tasks. Incidents involving dishonesty in higher education have increased considerably in the past decade, with regard to the extent of these practices, the types of dishonesty employed, and their prevalence. The current study examines the profile of “academic offenders”. Which types are more prone to commit academic offenses? To what degree are they “normative” and do they represent the average student with regard to personal traits, personal perceptions, features of their academic studies, risk behaviors, and health risks. The study is based on a structured anonymous questionnaire. The sample consisted of 1,432 students, of whom 899 were female (63%) and 533 male (37%). The research findings indicate a common tendency among more than one quarter of the sample reported cheating on homework and 12.5% reported cheating on tests. Strong associations were found between academic dishonesty and various personal perceptions, the academic study experience, and involvement in other risky and deviant behaviors. Significant predictors of academic dishonesty were found, i.e., self-image, ethics, grades, time devoted to homework, and deviant and daring behaviors. The research findings might help indicate policies for optimally dealing with dishonesty, maybe even before the offense is committed, by means of cooperation between academic forces. PMID:27569198

  19. Visiting professorship in hospital medicine: An innovative twist for a growing specialty.

    PubMed

    Cumbler, Ethan; Herzke, Carrie; Smalligan, Roger; Glasheen, Jeffrey J; O'Malley, Cheryl; Pierce, J Rush

    2016-10-01

    As an emerging and rapidly growing specialty, academic hospitalists face unique challenges in career advancement. Key mentoring needs, especially developing reputation and relationships outside of their institution are often challenging. We describe the structure of a novel Visiting Professorship in Hospital Medicine Program. It utilizes reciprocal exchanges of hospitalist faculty at the rank of late assistant to early associate professor. The program is designed explicitly to facilitate spread of innovation between institutions through a presentation by the visiting professor and exposure to an innovation at the host hospital medicine group. It provides a platform to advance the career success of both early- and midcareer hospitalist faculty through 1-on-1 coaching sessions between the visiting professor and early-career faculty at the host institution and commitment by visiting professors to engage in mentoring after the visit. Five academic hospitalist groups participated. Seven visiting professors met with 29 early-career faculty. Experience following faculty exchange visits demonstrates program effectiveness, as perceived by both early-career faculty and the visiting professors, in advancing the goals of mentorship and career advancement. One-year follow-up suggests that 62% of early-career faculty will engage in subsequent interactions with the visiting professor, and half report spread of innovation between academic hospital medicine groups. The Visiting Professorship in Hospital Medicine offers a low-cost framework to promote collaboration between academic hospital medicine groups and facilitate interinstitutional hospitalist mentoring. It is reported to be effective for the goal of professional development for midcareer hospitalists. Journal of Hospital Medicine 2016;11:714-718. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  20. Addressing the Social, Academic, and Behavioral Needs of Students with Challenging Behavior in Inclusive and Alternative Settings. Highlights from the Forum on Comprehensive Programming for a Diverse Population of Children and Youth with Challenging Behavior: Addressing Social, Academic, and Behavioral Needs within Inclusive and Alternative Settings (Las Vegas, Nevada, February 9-10, 2001).

    ERIC Educational Resources Information Center

    Bullock, Lyndal M., Ed.; Gable, Robert A., Ed.

    This document presents the texts of 11 major presentations and conference highlights from a February 2001 conference on the social, academic, and behavioral needs of students with challenging behavior in inclusive and alternative settings as required under the 1997 amendments to the Individuals with Disabilities Education Act. The presentations…

  1. Identifying Sets of Maximally Efficient Items from the Academic Competence Evaluation Scales-Teacher Form

    ERIC Educational Resources Information Center

    Anthony, Christopher James; DiPerna, James Clyde

    2017-01-01

    The Academic Competence Evaluation Scales-Teacher Form (ACES-TF; DiPerna & Elliott, 2000) was developed to measure student academic skills and enablers (interpersonal skills, engagement, motivation, and study skills). Although ACES-TF scores have demonstrated psychometric adequacy, the length of the measure may be prohibitive for certain…

  2. [Proposal of a method for collective analysis of work-related accidents in the hospital setting].

    PubMed

    Osório, Claudia; Machado, Jorge Mesquita Huet; Minayo-Gomez, Carlos

    2005-01-01

    The article presents a method for the analysis of work-related accidents in hospitals, with the double aim of analyzing accidents in light of actual work activity and enhancing the vitality of the various professions that comprise hospital work. This process involves both research and intervention, combining knowledge output with training of health professionals, fostering expanded participation by workers in managing their daily work. The method consists of stimulating workers to recreate the situation in which a given accident occurred, shifting themselves to the position of observers of their own work. In the first stage of analysis, workers are asked to show the work analyst how the accident occurred; in the second stage, the work accident victim and analyst jointly record the described series of events in a diagram; in the third, the resulting record is re-discussed and further elaborated; in the fourth, the work accident victim and analyst evaluate and implement measures aimed to prevent the accident from recurring. The article concludes by discussing the method's possibilities and limitations in the hospital setting.

  3. Academic Performance of Subsequent Schools and Impacts of Early Interventions: Evidence from a Randomized Controlled Trial in Head Start Settings

    PubMed Central

    Zhai, Fuhua; Raver, C. Cybele; Jones, Stephanie M.

    2012-01-01

    The role of subsequent school contexts in the long-term effects of early childhood interventions has received increasing attention, but has been understudied in the literature. Using data from the Chicago School Readiness Project (CSRP), a cluster-randomized controlled trial conducted in Head Start programs, we investigate whether the intervention had differential effects on academic and behavioral outcomes in kindergarten if children attended high- or low-performing schools subsequent to the preschool intervention year. To address the issue of selection bias, we adopt an innovative method, principal score matching, and control for a set of child, mother, and classroom covariates. We find that exposure to the CSRP intervention in the Head Start year had significant effects on academic and behavioral outcomes in kindergarten for children who subsequently attended high-performing schools, but no significant effects on children attending low-performing schools. Policy implications of the findings are discussed. PMID:22773872

  4. Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study

    PubMed Central

    Anderson, Timothy S; Good, Chester B

    2015-01-01

    Objective To identify the prevalence, characteristics, and compensation of members of the boards of directors of healthcare industry companies who hold academic appointments as leaders, professors, or trustees. Design Cross sectional study. Setting US healthcare companies publicly traded on the NASDAQ or New York Stock Exchange in 2013. Participants 3434 directors of pharmaceutical, biotechnology, medical equipment and supply, and healthcare provider companies. Main outcome measures Prevalence, annual compensation, and beneficial stock ownership of directors with affiliations as leaders, professors, or trustees of academic medical and research institutions. Results 446 healthcare companies met the study search criteria, of which 442 (99%) had publicly accessible disclosures on boards of directors. 180 companies (41%) had one or more academically affiliated directors. Directors were affiliated with 85 geographically diverse non-profit academic institutions, including 19 of the top 20 National Institute of Health funded medical schools and all of the 17 US News honor roll hospitals. Overall, these 279 academically affiliated directors included 73 leaders, 121 professors, and 85 trustees. Leaders included 17 chief executive officers and 11 vice presidents or executive officers of health systems and hospitals; 15 university presidents, provosts, and chancellors; and eight medical school deans or presidents. The total annual compensation to academically affiliated directors for their services to companies was $54 995 786 (£35 836 000; €49 185 900) (median individual compensation $193 000) and directors beneficially owned 59 831 477 shares of company stock (median 50 699 shares). Conclusions A substantial number and diversity of academic leaders, professors, and trustees hold directorships at US healthcare companies, with compensation often approaching or surpassing common academic clinical salaries. Dual obligations to for profit company

  5. Collaborating to improve the global competitiveness of US academic medical centers.

    PubMed

    Allen, Molly; Garman, Andrew; Johnson, Tricia; Hohmann, Samuel; Meurer, Steve

    2012-01-01

    President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University.

  6. Exploring Action Learning for Academic Development in Research Intensive Settings

    ERIC Educational Resources Information Center

    Stocks, Claire; Trevitt, Chris; Hughes, Joseph

    2018-01-01

    The potential of action learning (AL) for academic development has not received a lot of attention. Building from two case studies in which AL has been used in different ways in research-intensive universities in Australia and the UK, we suggest that the approach may be of benefit to developers in the changing landscape in which they are expected…

  7. Literacy promotion at the Montreal Children’s Hospital

    PubMed Central

    Erdos, Caroline; Ferdinand, Jae-Marie

    2017-01-01

    Abstract The foundations for language and literacy are set in utero when babies hear the tone of their mother’s voice (1). There is strong evidence of a positive relationship between early literacy experiences and language and academic outcomes (2). Unfortunately, many parents do not know about the benefits of reading to and with young children, and many children enter school without the basic skills needed to learn to read and succeed. Physicians who have contact with young families are in a distinctive position to promote reading, though despite its evidence base, it has not yet become a universal intervention. A short description of the projects at the Montreal Children’s Hospital is provided. PMID:29479189

  8. Medical students' and doctors' attitudes towards older patients and their care in hospital settings: a conceptualisation

    PubMed Central

    Samra, Rajvinder; Griffiths, Amanda; Cox, Tom; Conroy, Simon; Gordon, Adam; Gladman, John R. F.

    2015-01-01

    Background: despite assertions in reports from governmental and charitable bodies that negative staff attitudes towards older patients may contribute to inequitable healthcare provision for older patients when compared with younger patients (those aged under 65 years), the research literature does not describe these attitudes in any detail. Objective: this study explored and conceptualised attitudes towards older patients using in-depth interviews. Methods: twenty-five semi-structured interviews with medical students and hospital-based doctors in a UK acute teaching hospital were conducted. Participants were asked about their beliefs, emotions and behavioural tendencies towards older patients, in line with the psychological literature on the definition of attitudes (affective, cognitive and behavioural information). Data were analysed thematically. Results: attitudes towards older patients and their care could be conceptualised under the headings: (i) beliefs about older patients; (ii) older patients' unique needs and the skills required to care for them and (iii) emotions and satisfaction with caring for older patients. Conclusions: our findings outlined common beliefs and stereotypes specific to older patients, as opposed to older people in general. Older patients had unique needs concerning their healthcare. Participants typically described negative emotions about caring for older patients, but the sources of dissatisfaction largely related to the organisational setting and system in which the care is delivered to these patients. This study marks one of the first in-depth attempts to explore attitudes towards older patients in UK hospital settings. PMID:26185282

  9. A holistic approach to supporting staff in a pediatric hospital setting.

    PubMed

    Schwerman, Nichole; Stellmacher, Judy

    2012-09-01

    Health care professionals experience significant stress in the workplace. Building opportunities for health care professionals to manage stress is essential. Children's Hospital of Wisconsin designed a holistic set of programs called the R&R Series to support the emotional, cognitive, and spiritual health of staff and assist staff in using self-care strategies to build resiliency. Six hundred seventy program evaluations were collected during a 1-year pilot series. Program participants were from a wide variety of departments throughout the health care system. Staff reported feeling more supported, being better able to manage work and life stress, and practicing the self-care techniques they learned. Programs such as the R&R Series are one way to promote the overall health and resiliency of health care professionals. Copyright 2012, SLACK Incorporated.

  10. Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda

    PubMed Central

    Shoveller, Jean; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F.; Lynd, Larry D.

    2017-01-01

    Background Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)–a locally adapted pediatric advanced life support management program–in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children. Methods A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children. Results Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated. Conclusions Our assessment provides evidence to inform new strategies

  11. Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda.

    PubMed

    Hategeka, Celestin; Shoveller, Jean; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F; Lynd, Larry D

    2017-01-01

    Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)-a locally adapted pediatric advanced life support management program-in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children. A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children. Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated. Our assessment provides evidence to inform new strategies to enhance the capacity of Rwandan district

  12. Social Media Use in Academics: Undergraduate Perceptions and Practices

    ERIC Educational Resources Information Center

    Ciampa, Mark; Thrasher, Evelyn H.; Revels, Mark A.

    2016-01-01

    The aim of this research was to elicit student perceptions and practices regarding the use of social media in the academic setting. More specifically, the objectives of this study were to (1) assess student perceptions of technology use in an academic setting and to rank their preferences; (2) determine which resources and communication options…

  13. Gender Differences in Academic Productivity and Academic Career Choice Among Urology Residents

    PubMed Central

    Yang, Glen; Villalta, Jacqueline D.; Weiss, Dana A.; Carroll, Peter R.; Breyer, Benjamin N.

    2012-01-01

    Purpose Gender disparities have long existed in medicine but they have not been well examined in urology. We analyzed a large cohort of graduating urology residents to investigate gender disparities in academic productivity, as measured by peer reviewed publications and academic career choice. Materials and Methods We assembled a list of urology residents who graduated from 2002 through 2008 who were affiliated with the top 50 urology hospitals, as ranked by 2009 U.S. News & World Report. PubMed® was queried to determine the publication output of each resident during the last 3 years of residency. We used an Internet search to determine the fellowship training, career choice and academic rank of each subject. Gender effects on each factor were evaluated. Results A total of 459 male (84.5%) and 84 female (15.5%) residents were included in analysis. During residency women produced fewer total publications (average 3.0 vs 4.8, p = 0.01) and fewer as first author (average 1.8 vs 2.5, p = 0.03) than men. A higher proportion of women than men underwent fellowship training (54.8% vs 48.5%, p =0.29) and ultimately chose an academic career (40.5% vs 33.3%, p = 0.20), although these differences were not statistically significant. Of residents who chose an academic career a higher proportion of men than women (24.7% vs 2.9%, p = 0.01) obtained associate vs assistant professor rank. Conclusions Women produced fewer peer reviewed publications than men during residency but they were equally likely to undergo fellowship training and choose an academic career. During the study period a higher proportion of men achieved associate professor rank. PMID:22902027

  14. The academic prince.

    PubMed

    McGregor, Maurice

    2002-12-01

    The author presents advice to deans and chairs of academia by imagining what Machiavelli might recommend were he to write a modern version of The Prince for academics. "Machiavelli" cautions that since modern academic "princes" have little power (except, perhaps, over teaching and laboratory space), the success of their rule depends upon respect. Regarding the choice of an academic prince, find someone who can be a good role model, set standards, and reward academic excellence, and who will, above all, be respected. Avoid choosing a prince who is a nice, nonthreatening candidate with "good human relations" and "good executive skills." Choose candidates who are already successful and fulfilled and who will see the new post not as a promotion or a balm for their insecurity, but as an intrusion into their academic lives. Fill empty positions as quickly as possible-better a weak prince than no prince at all. Seek short terms for princes, both because respected academics will want to return to their normal lives as soon as possible, and because with short mandates, greater chances can be taken with young, unproved, but promising candidates. At the same time, the appointment of aging administrators who have lost their academic skills is to be avoided. Above all, respect the throne-i.e., the position of chair or dean-even if the person holding the position may not deserve the respect, since when the prince retires with honor, the position becomes more attractive to future good candidates.

  15. Cross-sectional study on factors hampering implementation of measles pre- and postexposure measures in Dutch hospitals during the 2013-2014 measles outbreak.

    PubMed

    Fievez, L C R; Wong, A; Ruijs, W L M; Meerstadt-Rombach, F S; Timen, A

    2017-07-01

    This study examined adherence to national recommendations on measles pre- and postexposure measures, including immunization of health care workers (HCWs) in Dutch hospitals, during a national outbreak of measles in The Netherlands. This study also investigated which hospital characteristics and organizational issues hamper implementation. This was a cross-sectional survey among all general and academic hospitals in The Netherlands. An online structured questionnaire (48 questions) was administered. Analysis was performed using descriptive statistics and logistic regression. Of 88 hospitals, 70 (79.5%) were included. Of 68 hospitals, 48 (70.6%) assessed susceptibility to measles in HCWs. Of 70 hospitals, 61 (87.1%) offered vaccination to susceptible HCWs. Of 63 hospitals, 42 (66.7%) had postexposure policies consistent with national recommendations. Of 62 hospitals, 30 (48.4%) implemented all these measures, which is the minimum set of measures considered necessary to adequately prevent measles in HCWs. Logistic regression suggests that hospitals with several locations, hospitals with more employees, and hospitals where infectious disease experts designed infection prevention policies while occupational health experts implemented the policy less often implemented this minimum set of measures (P < .001, P < .01, and P < .001, respectively). During a national measles outbreak, most hospitals took measures to prevent measles in HCWs, but less than half implemented the minimum set of measures required. Implementation strategies in hospitals need to be improved, especially in large-sized hospitals and hospitals with several locations, and with respect to the assignment of responsibilities for infection prevention policies. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Academic Goals, Student Homework Engagement, and Academic Achievement in Elementary School.

    PubMed

    Valle, Antonio; Regueiro, Bibiana; Núñez, José C; Rodríguez, Susana; Piñeiro, Isabel; Rosário, Pedro

    2016-01-01

    There seems to be a general consensus in the literature that doing homework is beneficial for students. Thus, the current challenge is to examine the process of doing homework to find which variables may help students to complete the homework assigned. To address this goal, a path analysis model was fit. The model hypothesized that the way students engage in homework is explained by the type of academic goals set, and it explains the amount of time spend on homework, the homework time management, and the amount of homework done. Lastly, the amount of homework done is positively related to academic achievement. The model was fit using a sample of 535 Spanish students from the last three courses of elementary school (aged 9 to 13). Findings show that: (a) academic achievement was positively associated with the amount of homework completed, (b) the amount of homework completed was related to the homework time management, (c) homework time management was associated with the approach to homework, (d) and the approach to homework, like the rest of the variables of the model (except for the time spent on homework), was related to the student's academic motivation (i.e., academic goals).

  17. Academic Goals, Student Homework Engagement, and Academic Achievement in Elementary School

    PubMed Central

    Valle, Antonio; Regueiro, Bibiana; Núñez, José C.; Rodríguez, Susana; Piñeiro, Isabel; Rosário, Pedro

    2016-01-01

    There seems to be a general consensus in the literature that doing homework is beneficial for students. Thus, the current challenge is to examine the process of doing homework to find which variables may help students to complete the homework assigned. To address this goal, a path analysis model was fit. The model hypothesized that the way students engage in homework is explained by the type of academic goals set, and it explains the amount of time spend on homework, the homework time management, and the amount of homework done. Lastly, the amount of homework done is positively related to academic achievement. The model was fit using a sample of 535 Spanish students from the last three courses of elementary school (aged 9 to 13). Findings show that: (a) academic achievement was positively associated with the amount of homework completed, (b) the amount of homework completed was related to the homework time management, (c) homework time management was associated with the approach to homework, (d) and the approach to homework, like the rest of the variables of the model (except for the time spent on homework), was related to the student's academic motivation (i.e., academic goals). PMID:27065928

  18. Clothing norms as markers of status in a hospital setting: A Bourdieusian analysis.

    PubMed

    Jenkins, Tania M

    2014-09-01

    This article uses a Bourdieusian framework to understand the importance of clothing norms for symbolizing and reproducing social, as well as professional, hierarchy in hospitals. Using data from participant observation, it examines how a complex yet informal dress code has emerged at a community hospital in the Northeastern United States, in a setting where very few formal guidelines exist on how to dress. By conceptualizing professionals as holders of various types of capital (economic, cultural, and symbolic), this article expands previous research which considered clothing only as a marker of professional identity. The findings demonstrate (1) how clothing norms are used in subtle, but purposeful, ways to reflect varying degrees of cultural and economic capital and (2) how these complex norms also reflect professional boundaries in medical authority (symbolic capital), which is important during critical moments where clothing can quickly signal who can take control. The discussion borrows Bourdieu's concepts of habitus and field to explain why subordinates subscribe to these clothing norms, in the absence of a formal organizational dress code. © The Author(s) 2014.

  19. The Hathaway Scholarship and Academic Preparation: A Study of Perceptions of Academic Preparation and Academic Success

    ERIC Educational Resources Information Center

    Aagard, Tammy Lindsay

    2010-01-01

    With the implementation of the Hathaway scholarship in the state of Wyoming, questions arose regarding the effectiveness of a prescribed set of high school courses (the Success Curriculum) in preparing students for success in college. This research sought to determine the perceptions of academic preparation of students who earned the Hathaway…

  20. Hospital-Acquired Pressure Ulcers at Academic Medical Centers in the United States, 2008-2012: Tracking Changes Since the CMS Nonpayment Policy.

    PubMed

    Padula, William V; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Mishra, Manish K; Valuck, Robert J

    2015-06-01

    In 2007, the Centers for Medicare & Medicaid Services (CMS) announced its intention to no longer reimburse hospitals for costs associated with hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired conditions (HACs), which was followed by enactment of the nonpayment policy in October 2008. This study was conducted to define changes in HAPU incidence and variance since 2008. In a retrospective observational study, HAPU cases were identified at 210 University HealthSystem Consortium (UHC) academic medical centers in the United States. HAPU incidence rates were calculated as a ratio of HAPU cases to the total number of UHC inpatients between the first quarter of 2008 and the second quarter of 2012. HAPU cases were defined by multiple criteria: not present on admission (POA); coded for stage III or IV pressure ulcers; and a length of stay greater than four days. Among the UHC hospitals between 2008 and June 2012, 10,386 HAPU cases were identified among 4.08 million inpatients. The HAPU incidence rate decreased significantly from 11.8 cases per 1,000 inpatients in 2008 to 0.8 cases per 1,000 in 2012 (p < .001; 95% confidence interval: 8.39-8.56). Among HAPU cases were trends of more elderly patients, greater case-mix index, and more surgical cases. The analysis of covariance model identified CMS non-payment policy as a significant covariate of changing trends in HAPU incidence rates. HAPU incidence rates decreased significantly among 210 UHC AMCs after the enactment of the CMS nonpayment policy. The hospitals appeared to be reacting efficiently to economic policy incentives by improving prevention efforts.

  1. Scheduling Anesthesia Time Reduces Case Cancellations and Improves Operating Room Workflow in a University Hospital Setting.

    PubMed

    van Veen-Berkx, Elizabeth; van Dijk, Menno V; Cornelisse, Diederich C; Kazemier, Geert; Mokken, Fleur C

    2016-08-01

    A new method of scheduling anesthesia-controlled time (ACT) was implemented on July 1, 2012 in an academic inpatient operating room (OR) department. This study examined the relationship between this new scheduling method and OR performance. The new method comprised the development of predetermined time frames per anesthetic technique based on historical data of the actual time needed for anesthesia induction and emergence. Seven "anesthesia scheduling packages" (0 to 6) were established. Several options based on the quantity of anesthesia monitoring and the complexity of the patient were differentiated in time within each package. This was a quasi-experimental time-series design. Relevant data were divided into 4 equal periods of time. These time periods were compared with ANOVA with contrast analysis: an intervention, pre-intervention, and post-intervention contrast were tested. All emergency cases were excluded. A total of 34,976 inpatient elective cases performed from January 1, 2010 to December 31, 2014 were included for statistical analyses. The intervention contrast showed a significant decrease (p < 0.001) of 4.5% in the prediction error. The total number of cancellations decreased to 19.9%. The ANOVA with contrast analyses showed no significant differences with respect to under- and over-used OR time and raw use. Unanticipated results derived from this study, allowing for a smoother workflow: eg anesthesia nurses know exactly which medical equipment and devices need to be assembled and tested beforehand, based on the scheduled anesthesia package. Scheduling the 2 major components of a procedure (anesthesia- and surgeon-controlled time) more accurately leads to fewer case cancellations, lower prediction errors, and smoother OR workflow in a university hospital setting. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  2. The application of hospitality elements in hospitals.

    PubMed

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

    In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

  3. Transurethral bladder tumor resection: intraoperative and postoperative complications in a residency setting.

    PubMed

    Nieder, Alan M; Meinbach, David S; Kim, Sandy S; Soloway, Mark S

    2005-12-01

    We established a database on the incidence of intraoperative and postoperative complications associated with transurethral bladder tumor resection (TURBT) in an academic teaching setting, and we prospectively recorded all TURBTs performed by residents and fellows in our urology department. : We prospectively evaluated all TURBTs performed between November 2003 and October 2004. All cases were performed at least in part by residents and fellows under direct attending supervision at a single academic medical center with 3 different teaching hospitals. Intraoperative complications were recorded by the resident and attending surgeon at the completion of the operative procedure. At patient discharge from the hospital the data sheet was reviewed, and length of stay, postoperative transfusions and any other complications were recorded. A total of 173 consecutive TURBTs were performed by residents and fellows at 3 different teaching hospitals. There were 10 (5.8%) complications, including 4 (2.3%) cases of hematuria that required blood transfusion and 6 (3.5%) cases of bladder perforation. Of these 6 perforations 4 were small extraperitoneal perforations requiring only prolonged catheter drainage. These perforations were caused by residents in their first or third year of urology training. Two perforations were intraperitoneal, caused by a senior resident or a fellow, 1 of which required abdominal exploration to control bleeding. TURBT is a reasonably safe procedure when performed by urologists in training under direct attending supervision. The complication rate was 5.8%, however only 1 case required surgical intervention. Contrary to expected findings, more senior residents were involved in the complications, likely secondary to their disproportionate roles in more difficult resections.

  4. Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings.

    PubMed

    Schulz, M; Damkröger, A; Heins, C; Wehlitz, L; Löhr, M; Driessen, M; Behrens, J; Wingenfeld, K

    2009-04-01

    The aim of this study was to investigate whether nurses' efforts and rewards, as well as the effort-reward imbalance (ERI) and burnout, differ between subjects working in psychiatric vs. medical hospitals and between nurses under education and examined nurses respectively. Furthermore, the relationship between ERI and burnout was evaluated. Nursing is associated with high levels of emotional strain and heavy workloads. Burnout and a negative ERI can result in high absenteeism and turnover and have been identified as reasons why nurses leave their profession. In the last decade, working conditions of the nursing profession have changed in Germany, but somatic and psychiatric hospitals developed in different ways. This development may lead to different profiles. A sample of 389 nurses (78.8% female) in four German hospitals was investigated. A total of 147 nurses worked in psychiatric hospitals and 236 nurses worked in medical (somatic) hospitals. Fifty participants were still under education. The Effort-Reward Imbalance Inventory measures effort, reward and overcommitment at job and provides an imbalance score between effort and reward. The Maslach Burnout Inventory with the subscales, emotional exhaustion, lack of accomplishment and depersonalization, was also used. Nurses working in medical hospitals reported more burnout and had higher ERI scores. Subjects under education were comparable to examined nurses in terms of burnout but had lower ERI scores. Multiple regression analyses showed all ERI scales to be significant predictors for emotional exhaustion, while age, field of work and educational status further predict effort or ERI respectively. At present, the working situation of nurses in different settings appears to be characterized by a perceived imbalance of effort and reward and is associated with a high risk of developing burnout symptoms.

  5. Target-Setting, Early-Career Academic Identities and the Measurement Culture of UK Higher Education

    ERIC Educational Resources Information Center

    Smith, Jan

    2017-01-01

    Early-career academics are subject to a barrage of formal measurements when they secure a first academic post in a UK university. To support this process, guidance is provided by universities on what is measured, though this can lack disciplinary nuance. This article analyses the perceptions of a sample of social scientists of the process of…

  6. Peace of Mind, Academic Motivation, and Academic Achievement in Filipino High School Students.

    PubMed

    Datu, Jesus Alfonso D

    2017-04-09

    Recent literature has recognized the advantageous role of low-arousal positive affect such as feelings of peacefulness and internal harmony in collectivist cultures. However, limited research has explored the benefits of low-arousal affective states in the educational setting. The current study examined the link of peace of mind (PoM) to academic motivation (i.e., amotivation, controlled motivation, and autonomous motivation) and academic achievement among 525 Filipino high school students. Findings revealed that PoM was positively associated with academic achievement β = .16, p < .05, autonomous motivation β = .48, p < .001, and controlled motivation β = .25, p < .01. As expected, PoM was negatively related to amotivation β = -.19, p < .05, and autonomous motivation was positively associated with academic achievement β = .52, p < .01. Furthermore, the results of bias-corrected bootstrap analyses at 95% confidence interval based on 5,000 bootstrapped resamples demonstrated that peace of mind had an indirect influence on academic achievement through the mediating effects of autonomous motivation. In terms of the effect sizes, the findings showed that PoM explained about 1% to 18% of the variance in academic achievement and motivation. The theoretical and practical implications of the results are elucidated.

  7. User library service expectations in health science vs. other settings: a LibQUAL+ Study.

    PubMed

    Thompson, Bruce; Kyrillidou, Martha; Cook, Colleen

    2007-12-01

    To explore how the library service expectations and perceptions of users might differ across health-related libraries as against major research libraries not operating in a medical context; to determine whether users of medical libraries demand better library service quality, because the inability of users to access needed literature promptly may lead to a patient who cannot be properly diagnosed, or a diagnosis that cannot be properly treated. We compared LibQUAL+ total and subscale scores across three groups of US, Canadian and British libraries for this purpose. Anticipated differences in expectations for health as other library settings did not emerge. The expectations and perceptions are similar across different types of health science library settings, hospital and academic, and across other general research libraries.

  8. Inter-hospital communications and transport: turning one-way funnels into two-way networks.

    PubMed

    Rokos, Ivan C; Sanddal, Nels D; Pancioli, Arthur M; Wolff, Catherine; Gaieski, David F

    2010-12-01

    The Inter-hospital Communications and Transport workgroup was charged with exploring the current status, barriers, and data necessary to optimize the initial destination and subsequent transfer of patients between and among acute care settings. The subtitle, "Turning Funnels Into Two-way Networks," is descriptive of the approach that the workgroup took by exploring how and when smaller facilities in suburban, rural, and frontier areas can contribute to the daily business of caring for emergency patients across the lower-acuity spectrum-in some instances with consultant support from academic medical centers. It also focused on the need to identify high-acuity patients and expedite triage and transfer of those patients to facilities with specialty resources. Draft research recommendations were developed through an iterative writing process and presented to a breakout session of Academic Emergency Medicine's 2010 consensus conference, "Beyond Regionalization: Integrated Networks of Emergency Care." Priority research areas were determined by informal consensus of the breakout group. A subsequent iterative writing process was undertaken to complete this article. A number of broad research questions are presented. 2010 by the Society for Academic Emergency Medicine.

  9. Medical psychology services in dutch general hospitals: state of the art developments and recommendations for the future.

    PubMed

    Soons, Paul; Denollet, Johan

    2009-06-01

    In this article an overview is presented of the emergence of medical psychology in the care of somatically ill patients. The situation in the Netherlands can be considered as prototypical. For 60 years, clinical psychologists have been working in general, teaching and academic hospitals. Nowadays, they are an integrated non-medical specialism working in the medical setting of hospitals in the Netherlands, and are a full-member of the medical board. This paper discusses several topics: the position of the general hospital in the health care system in the Netherlands, the emergence of medical psychology in Dutch hospitals, the role of the professional association of medical psychologists, and the characteristics of patients seen by clinical psychologists. Following the discussion about the situation of medical psychology in other countries, recommendations are formulated for the further development of medical psychology in the Netherlands as well as in other countries.

  10. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting.

    PubMed

    van Bokhorst-de van der Schueren, Marian A E; Guaitoli, Patrícia Realino; Jansma, Elise P; de Vet, Henrica C W

    2014-02-01

    Numerous nutrition screening tools for the hospital setting have been developed. The aim of this systematic review is to study construct or criterion validity and predictive validity of nutrition screening tools for the general hospital setting. A systematic review of English, French, German, Spanish, Portuguese and Dutch articles identified via MEDLINE, Cinahl and EMBASE (from inception to the 2nd of February 2012). Additional studies were identified by checking reference lists of identified manuscripts. Search terms included key words for malnutrition, screening or assessment instruments, and terms for hospital setting and adults. Data were extracted independently by 2 authors. Only studies expressing the (construct, criterion or predictive) validity of a tool were included. 83 studies (32 screening tools) were identified: 42 studies on construct or criterion validity versus a reference method and 51 studies on predictive validity on outcome (i.e. length of stay, mortality or complications). None of the tools performed consistently well to establish the patients' nutritional status. For the elderly, MNA performed fair to good, for the adults MUST performed fair to good. SGA, NRS-2002 and MUST performed well in predicting outcome in approximately half of the studies reviewed in adults, but not in older patients. Not one single screening or assessment tool is capable of adequate nutrition screening as well as predicting poor nutrition related outcome. Development of new tools seems redundant and will most probably not lead to new insights. New studies comparing different tools within one patient population are required. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  11. Academic Vocabulary in Agriculture Research Articles: A Corpus-Based Study

    ERIC Educational Resources Information Center

    Martinez, Iliana A.; Beck, Silvia C.; Panza, Carolina B.

    2009-01-01

    Recent critical views on the usefulness of a general academic vocabulary have heightened the relevance of developing discipline specific academic wordlists to meet the needs of non-native English writers who must read and publish articles in English. Using Coxhead's (2000) Academic Word List, we set out to identify the academic words in a corpus…

  12. Factors influencing young urologists' productivity and academic career choice.

    PubMed

    Resorlu, Berkan; Silay, Mesrur Selcuk; Onem, Kadir; Bayrak, Omer; Sonbahar, Adil Emrah; Acar, Omer; Ergun, Osman; Celik, Orcun; Tefik, Tzevat; Firdolas, Fatih; Tandogdu, Zafer

    2016-01-01

    The objective of this study is to identify the variables that affect young urologists' productivity and academic career choice. We have conducted an internet-based national survey for urologists randomly sampled from the database of Turkish Urological Association and 110 physicians completed this survey. Participants were asked to answer three-page questionnaire including 37 questions, which takes around 5 min to complete. Questionnaire was consisting of four main sections: 'demography', 'education', 'working conditions' and 'quality of life'. Increased dedicated research time, being interested in an academic career, being Fellow of the European Board of Urology (FEBU), having English proficiency, and greater numbers of manuscript publication during residency were associated with increased productivity after residency (p = 0.001, p = 0.028, p = 0.046, p<0.001 and p<0.001, respectively). The remaining variables including age at marriage, age at having a child, monthly salary, length of residency, having a mentor or role model during residency showed no significant relationship with manuscript publications. Twenty-nine physicians (26.4%) stated that they had once been interested in their residency but were no longer interested in academic urology. Reasons for this loss of academic interest included lack of effective mentor or role model (27.2%), bureaucracy (17%), financial issues (13.6%), mandatory rule to work in public hospitals (18.2%) or military hospitals (9%) and language problems (21.6%). Our data indicate that increased time spent for research, being interested in an academic career, being an FEBU, having English proficiency, and greater publication during residency were associated with increased numbers of publications and academic career choice.

  13. Gender differences in academic productivity and academic career choice among urology residents.

    PubMed

    Yang, Glen; Villalta, Jacqueline D; Weiss, Dana A; Carroll, Peter R; Breyer, Benjamin N

    2012-10-01

    Gender disparities have long existed in medicine but they have not been well examined in urology. We analyzed a large cohort of graduating urology residents to investigate gender disparities in academic productivity, as measured by peer reviewed publications and academic career choice. We assembled a list of urology residents who graduated from 2002 through 2008 who were affiliated with the top 50 urology hospitals, as ranked by 2009 U.S. News & World Report. PubMed® was queried to determine the publication output of each resident during the last 3 years of residency. We used an Internet search to determine the fellowship training, career choice and academic rank of each subject. Gender effects on each factor were evaluated. A total of 459 male (84.5%) and 84 female (15.5%) residents were included in analysis. During residency women produced fewer total publications (average 3.0 vs 4.8, p = 0.01) and fewer as first author (average 1.8 vs 2.5, p = 0.03) than men. A higher proportion of women than men underwent fellowship training (54.8% vs 48.5%, p = 0.29) and ultimately chose an academic career (40.5% vs 33.3%, p = 0.20), although these differences were not statistically significant. Of residents who chose an academic career a higher proportion of men than women (24.7% vs 2.9%, p = 0.01) obtained associate vs assistant professor rank. Women produced fewer peer reviewed publications than men during residency but they were equally likely to undergo fellowship training and choose an academic career. During the study period a higher proportion of men achieved associate professor rank. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Gender inequality in career advancement for females in Japanese academic surgery.

    PubMed

    Okoshi, Kae; Nomura, Kyoko; Fukami, Kayo; Tomizawa, Yasuko; Kobayashi, Katsutoshi; Kinoshita, Koichi; Sakai, Yoshiharu

    2014-11-01

    During the past three decades, the participation of women in medicine has increased from 10.6% (1986) to 19.7% (2012) in Japan. However, women continue to be underrepresented in the top tiers of academic medicine. We highlight gender inequality and discuss the difficulties faced by female surgeons in Japanese academic surgery. Using anonymous and aggregate employment data of medical doctors at Kyoto University Hospital from 2009 and 2013, and a commercially-published faculty roster in 2012-2013, we compared gender balance stratified by a professional and an academic rank. The numbers of total and female doctors who worked at Kyoto University Hospital were 656 and 132 (20.1%) in 2009 and 655 and 132 (20.2%) in 2013, respectively. Approximately half the men (n = 281) were in temporary track and the rest (n = 242) were in tenure track, but only one fifth of women (n = 24) were in tenure track compared to 108 women in temporary track (p < 0.0001) in 2013. There were three female associate professors in basic medicine (8.1%), two female professors in clinical non-surgical medicine (3.9%) and one female lecturer in clinical surgical medicine (2.3%) in 2012. Fewer female doctors were at senior positions and at tenure positions than male doctors at Kyoto University Hospital. There were no female associate and full professors in surgery. The status of faculty members indicates the gender differences in leadership opportunities in Japanese academic surgery.

  15. Preresidency Publication Number Does Not Predict Academic Career Placement in Neurosurgery.

    PubMed

    Daniels, Marcus; Garzon-Muvdi, Tomas; Maxwell, Russell; Tamargo, Rafael J; Huang, Judy; Witham, Tim; Bettegowda, Chetan; Chaichana, Kaisorn L

    2017-05-01

    It is unclear if preresidency and/or residency research work impacts academic neurosurgery placement post residency. The goal of this study is to evaluate the impact that preresidency and residency research publication has on attaining academic faculty positions. Alumni information was collected from 65 of the 108 (60%) neurosurgery residency websites. Graduates from these programs between 2005 and 2015 (n = 949) were analyzed to determine factors associated with an academic career. Information on publications, citations, and H-index were obtained from Web of Science. Current position was designated as academic if the physician had a teaching position at a university hospital and private if the physician was not affiliated with a university hospital. Univariate and multivariate logistic regression models were used to identify factors associated with academic faculty positions post residency. Of the 949 physicians included in the analysis, 339 (36%) were in academic positions, 518 (55%) in private practice, and 92 (10%) were still in training. More than a fifth (212, or 22%) of physicians performed a research fellowship (8.2%) or attained a Ph.D. (14.1%) during medical school. Among those who had completed training, an academic career was associated with having 2 or more publications during residency (odds ratio [OR] [95% confidence interval, CI]: 3.87 [1.59-9.45]; P < 0.003), H-index ≥ 2 during residency (OR [95% CI]: 2.32 [1.40-1.69]; P < 0.0001) and having devoted research time before residency (OR [95% CI]: 1.56 [1.10-2.22]; P < 0.012). Notably, publications before residency were not an independent indicator of academic placement. These findings may help guide residency programs to identify and/or cultivate neurosurgeons to become academic neurosurgeons. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The financial impact of a clinical academic practice partnership.

    PubMed

    Greene, Mary Ann; Turner, James

    2014-01-01

    New strategies to provide clinical experiences for nursing students have caused nursing schools and hospitals to evaluate program costs. A Microsoft Excel model, which captures costs and associated benefits, was developed and is described here. The financial analysis shows that the Clinical Academic Practice Program framework for nursing clinical education, often preferred by students, can offer financial advantages to participating hospitals and schools of nursing. The model is potentially a tool for schools of nursing to enlist hospitals and to help manage expenses of clinical education. Hospitals may also use the Hospital Nursing Unit Staffing and Expense Worksheet in planning staffing when students are assigned to units and the cost/benefit findings to enlist management support.

  17. Professionalism, responsibility, and service in academic medicine.

    PubMed

    Souba, W W

    1996-01-01

    Academic medical centers have responded to health care reform initiatives by launching a series of strategic plans designed to maintain patient flow and reduce hospital expenditures. Thought is also being given to processes by which the faculty can individually and collectively adjust to these changes and maintain morale at a time when reductions in the labor force and pay cuts are virtually certain. Physicians are concerned because managed care threatens their autonomy and jeopardizes the traditional ways in which they have carried out their multiple missions. Some doctors believe that it will become increasingly difficult to obtain genuine satisfaction from their job. The strategies that academic medical centers have begun to use to address the numerous challenges posed by a system of health care based on managed competition are reviewed. Potential mechanisms by which academic departments can continue to find fulfillment in an environment that threatens their traditional missions and values are discussed. A study of the social and historical origins of medicine in the United States reveals that the introduction of corporate medicine in the United States was destined to happen. Strategies implemented by academic medical centers in response to managed care include building an integrated delivery network, the acquisition of primary care practices, increasing cost-effectiveness, and creating physician-hospital organizations. Emphasis must be placed on integrating traditional core values (excellence, leadership, and innovation) with newer values such as patient focus, accountability, and diversity. A shift from rugged individualism to entrepreneurial teamwork is crucial. These reforms, although frightening at the onset, can serve to reaffirm our commitment to academic medicine and preserve our mission. The evolving managed care environment offers unique opportunities for academic medical centers to shape and positively impact health care delivery in the twenty

  18. Bacterial Contamination of Hospital Bed-Control Handsets in a Surgical Setting: A Potential Marker of Contamination of the Healthcare Environment

    PubMed Central

    Brady, RRW; Kalima, P; Damani, NN; Wilson, RG; Dunlop, MG

    2007-01-01

    INTRODUCTION Patients undergoing colorectal surgical resections have a high incidence of surgical site infection (SSI). Many patient-specific risk factors have been recognised in association with SSI in such patients, but environmental contamination is increasingly recognised as a contributor to hospital-acquired infection (HAI). This study set out to describe the bacterial contamination of the patient environment, using hospital bed-control handsets, as they are frequently handled by both staff and patients and represent a marker of environmental contamination. PATIENTS AND METHODS On two unannounced sampling events, 1 week apart, 140 bacteriological assessments were made of 70 hospital bed control handsets within a specialist colorectal surgical unit. RESULTS Of the handsets examined, 67 (95.7%) demonstrated at least one bacterial species (52.9% grew 1, 30% grew 2 and 12.9% grew 3 or more bacterial species). Of these, 29 (41.4%) bed-control handsets grew bacteria known to cause nosocomial infection, including 22 (31.4%) handsets which grew Enterococcus spp., 9 (12.9%) which grew MRSA, 2 (2.9%) which grew MSSA, 2 (2.9%) which grew coliforms, and 1 (1.4%) handset which grew anaerobes. At 1-week follow-up, 31 bed-control handsets showed evidence of contamination by the same bacterial species. CONCLUSIONS This study revealed high levels of bacteria known to cause HAI, contaminating hospital bed-control handsets in a surgical setting. Further study is now required to confirm whether hospital environmental contamination is causally involved in SSI. PMID:17959000

  19. Psychologists in Academic Administration: A Call to Action and Service.

    PubMed

    Schmaling, Karen B; Linton, John C

    2017-06-01

    Academic psychologists' backgrounds may prepare them for many aspects of academic administration such as: understanding and working with people; prioritizing others' needs and institutional needs; and managing projects and budgets, e.g., for research grants or training programs. Contemporary academic health centers also may provide opportunities for psychologists to serve in academic health administration. This article encourages psychologists to consider preparing for and seeking administrative and higher-level leadership roles. Six psychologists serving diverse administrative roles-from vice chairs in medical school departments to presidents of universities with academic health centers-reflected on: their paths to administration; their preparation for administrative roles; and the commonalities and differences between the work and skills sets of psychologist health service providers and the work and skill sets required for higher level administrative and leadership roles.

  20. Academic career development in geriatric fellowship training.

    PubMed

    Medina-Walpole, Annette; Fonzi, Judith; Katz, Paul R

    2007-12-01

    Career development is rarely formalized in the curricula of geriatric fellowship programs, and the training of new generations of academic leaders is challenging in the 1 year of fellowship training. To effectively prepare fellows for academic leadership, the University of Rochester's Division of Geriatrics, in collaboration with the Warner School of Graduate Education, created a yearlong course to achieve excellence in teaching and career development during the 1-year geriatric fellowship. Nine interdisciplinary geriatric medicine, dentistry, and psychiatry fellows completed the course in its initial year (2005/06). As participants, fellows gained the knowledge and experience to successfully develop and implement educational initiatives in various formats. Fellows acquired teaching and leadership skills necessary to succeed as clinician-educators in an academic setting and to communicate effectively with patients, families, and colleagues. Fellows completed a series of individual and group education projects, including academic portfolio development, curriculum vitae revision, abstract submission and poster presentation at national meetings, lay lecture series development, and geriatric grand rounds presentation. One hundred percent of fellows reported that the course positively affected their career development, with six of nine fellows choosing academic careers. The course provided opportunities to teach and assess all six of the Accreditation Council of Graduate Medical Education core competencies. This academic career development course was intended to prepare geriatric fellows as the next generation of academic leaders as clinician-teacher-scholars. It could set a new standard for academic development during fellowship training and provide a model for national dissemination in other geriatric and subspecialty fellowship programs.

  1. 1. Title Sheet Jefferson's Academical Village, Bounded by University ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. Title Sheet - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  2. Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods.

    PubMed

    Drake, Gareth; de C Williams, Amanda C

    2017-02-01

    The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  3. Hospital costs associated with laparoscopic and open inguinal herniorrhaphy.

    PubMed

    Spencer Netto, Fernando; Quereshy, Fayez; Camilotti, Bruna G; Pitzul, Kristen; Kwong, Josephine; Jackson, Timothy; Penner, Todd; Okrainec, Allan

    2014-01-01

    The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs. Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827). In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.

  4. Costs of Providing Infusion Therapy for Rheumatoid Arthritis in a Hospital-based Infusion Center Setting.

    PubMed

    Schmier, Jordana; Ogden, Kristine; Nickman, Nancy; Halpern, Michael T; Cifaldi, Mary; Ganguli, Arijit; Bao, Yanjun; Garg, Vishvas

    2017-08-01

    Many hospital-based infusion centers treat patients with rheumatoid arthritis (RA) with intravenous biologic agents, yet may have a limited understanding of the overall costs of infusion in this setting. The purposes of this study were to conduct a microcosting analysis from a hospital perspective and to develop a model using an activity-based costing approach for estimating costs associated with the provision of hospital-based infusion services (preparation, administration, and follow-up) in the United States for maintenance treatment of moderate to severe RA. A spreadsheet-based model was developed. Inputs included hourly wages, time spent providing care, supply/overhead costs, laboratory testing, infusion center size, and practice pattern information. Base-case values were derived from data from surveys, published studies, standard cost sources, and expert opinion. Costs are presented in year-2017 US dollars. The base case modeled a hospital infusion center serving patients with RA treated with abatacept, tocilizumab, infliximab, or rituximab. Estimated overall costs of infusions per patient per year were $36,663 (rituximab), $36,821 (tocilizumab), $44,973 (infliximab), and $46,532 (abatacept). Of all therapies, the biologic agents represented the greatest share of overall costs, ranging from 87% to $91% of overall costs per year. Excluding infusion drug costs, labor accounted for 53% to 57% of infusion costs. Biologic agents represented the highest single cost associated with RA infusion care; however, personnel, supplies, and overhead costs also contributed substantially to overall costs (8%-16%). This model may provide a helpful and adaptable framework for use by hospitals in informing decision making about services offered and their associated financial implications. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Establishing an Integrative Medicine Program Within an Academic Health Center: Essential Considerations.

    PubMed

    Eisenberg, David M; Kaptchuk, Ted J; Post, Diana E; Hrbek, Andrea L; O'Connor, Bonnie B; Osypiuk, Kamila; Wayne, Peter M; Buring, Julie E; Levy, Donald B

    2016-09-01

    Integrative medicine (IM) refers to the combination of conventional and "complementary" medical services (e.g., chiropractic, acupuncture, massage, mindfulness training). More than half of all medical schools in the United States and Canada have programs in IM, and more than 30 academic health centers currently deliver multidisciplinary IM care. What remains unclear, however, is the ideal delivery model (or models) whereby individuals can responsibly access IM care safely, effectively, and reproducibly in a coordinated and cost-effective way.Current models of IM across existing clinical centers vary tremendously in their organizational settings, principal clinical focus, and services provided; practitioner team composition and training; incorporation of research activities and educational programs; and administrative organization (e.g., reporting structure, use of medical records, scope of clinical practice) and financial strategies (i.e., specific business plans and models for sustainability).In this article, the authors address these important strategic issues by sharing lessons learned from the design and implementation of an IM facility within an academic teaching hospital, the Brigham and Women's Hospital at Harvard Medical School; and review alternative options based on information about IM centers across the United States.The authors conclude that there is currently no consensus as to how integrative care models should be optimally organized, implemented, replicated, assessed, and funded. The time may be right for prospective research in "best practices" across emerging models of IM care nationally in an effort to standardize, refine, and replicate them in preparation for rigorous cost-effectiveness evaluations.

  6. Student Academic Optimism: A Confirmatory Factor Analysis

    ERIC Educational Resources Information Center

    Tschannen-Moran, Megan; Bankole, Regina A.; Mitchell, Roxanne M.; Moore, Dennis M., Jr.

    2013-01-01

    Purpose: This research aims to add to the literature on Academic Optimism, a composite measure composed of teacher perceptions of trust in students, academic press, and collective efficacy by exploring a similar set of constructs from the student perceptive. The relationships between student trust in teachers, student perceptions of academic…

  7. The Volume and Mix of Inpatient Services Provided by Academic Medical Centers.

    ERIC Educational Resources Information Center

    Moy, Ernest; And Others

    1996-01-01

    A study examined trends in the volume and type of inpatient clinical diagnoses, common medical services, and specialized services in academic medical centers (AMCs)--integrated and independent, other teaching hospitals, and nonteaching hospitals. Results indicate that despite rapid change in the health care environment, little change has occurred…

  8. Variation in Risk-Standardized Mortality of Stroke among Hospitals in Japan.

    PubMed

    Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

    2015-01-01

    Despite recent advances in care, stroke remains a life-threatening disease. Little is known about current hospital mortality with stroke and how it varies by hospital in a national clinical setting in Japan. Using the Diagnosis Procedure Combination database (a national inpatient database in Japan), we identified patients aged ≥ 20 years who were admitted to the hospital with a primary diagnosis of stroke within 3 days of stroke onset from April 2012 to March 2013. We constructed a multivariable logistic regression model to predict in-hospital death for each patient with patient-level factors, including age, sex, type of stroke, Japan Coma Scale, and modified Rankin Scale. We defined risk-standardized mortality ratio as the ratio of the actual number of in-hospital deaths to the expected number of such deaths for each hospital. A hospital-level multivariable linear regression was modeled to analyze the association between risk-standardized mortality ratio and hospital-level factors. We performed a patient-level Cox regression analysis to examine the association of in-hospital death with both patient-level and hospital-level factors. Of 176,753 eligible patients from 894 hospitals, overall in-hospital mortality was 10.8%. The risk-standardized mortality ratio for stroke varied widely among the hospitals; the proportions of hospitals with risk-standardized mortality ratio categories of ≤ 0.50, 0.51-1.00, 1.01-1.50, 1.51-2.00, and >2.00 were 3.9%, 47.9%, 41.4%, 5.2%, and 1.5%, respectively. Academic status, presence of a stroke care unit, higher hospital volume and availability of endovascular therapy had a significantly lower risk-standardized mortality ratio; distance from the patient's residence to the hospital was not associated with the risk-standardized mortality ratio. Our results suggest that stroke-ready hospitals play an important role in improving stroke mortality in Japan.

  9. Hospitals, market share, and consolidation.

    PubMed

    Cutler, David M; Scott Morton, Fiona

    2013-11-13

    A large reduction in use of inpatient care combined with the incentives in the Affordable Care Act is leading to significant consolidation in the hospital industry. What was once a set of independent hospitals having arms-length relationships with physicians and clinicians who provide ambulatory care is becoming a small number of locally integrated health systems, generally built around large, prestigious academic medical centers. The typical region in the United States has 3 to 5 consolidated health systems, spanning a wide range of care settings, and a smaller fringe of health care centers outside those systems. Consolidated health systems have advantages and drawbacks. The advantages include the ability to coordinate care across different practitioners and sites of care. Offsetting this is the potential for higher prices resulting from greater market power. Market power increases because it is difficult for insurers to bargain successfully with one of only a few health systems. Antitrust authorities are examining these consolidated systems as they form, but broad conclusions are difficult to draw because typically the creation of a system will generate both benefit and harm and each set of facts will be different. Moreover, the remedies traditionally used (eg, blocking the transaction or requiring that the parties divest assets) by antitrust authorities in cases of net harm are limited. For this reason, local governments may want to introduce new policies that help ensure consumers gain protection in the event of consolidation, such as insurance products that charge consumers more for high-priced clinicians and health care centers, bundling payments to clinicians and health care organizations to eliminate the incentives of big institutions to simply provide more care, and establishing area-specific price or spending targets.

  10. 2. 1827 Landscape Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. 1827 Landscape Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  11. 14. 2013 Landscape Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. 2013 Landscape Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  12. 5. 1880 Landscape Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. 1880 Landscape Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  13. 11. 1981 Landscape Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. 1981 Landscape Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  14. 7. 1914 Landscape Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. 1914 Landscape Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  15. 9. 1947 Landscape Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    9. 1947 Landscape Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  16. 3. 1860 Landscape Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. 1860 Landscape Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  17. 8. 1914 Tree Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. 1914 Tree Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  18. 6. 1880 Tree Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. 1880 Tree Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  19. 4. 1860 Tree Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. 1860 Tree Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  20. 10. 1947 Tree Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. 1947 Tree Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  1. 12. 1981 Tree Plan Jefferson's Academical Village, Bounded by ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. 1981 Tree Plan - Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  2. [Checklist Development for Women-Doctor-Friendly Working Conditions in a Hospital Setting].

    PubMed

    Horie, Saki; Takeuchi, Masumi; Yamaoka, Kazue; Nohara, Michiko; Hasunuma, Naoko; Okinaga, Hiroko; Nomura, Kyoko

    2015-01-01

    This study aims to develop a scale of "women-doctor-friendly working conditions in a hospital setting". A task team consisting of relevant people including a medical doctor and a hospital personnel identified 36 items related to women-doctor-friendly working conditions. From December in 2012 to January in 2013, we sent a self-administered questionnaire to 807 full-time employees including faculty members and medical doctors who worked for a university-affiliated hospital. We asked them to score the extent to which they think it is necessary for women doctors to balance between work and gender role responsibilities on the basis of the Likert scale. We carried out a factor analysis and computed Cronbach's alpha to develop a scale and investigated its construct validity and reliability. Of the 807 employees, 291 returned the questionnaires (response rate, 36.1%). The item-total correlation (between an individual item score and the total score) coefficient was in the range from 0.44 to 0.68. In factor analysis, we deleted six items, and five factors were extracted on the basis of the least likelihood method with the oblique Promax rotation. The factors were termed "gender equality action in an organization", "the compliance of care leave in both sexes and parental leave in men", "balance between life events and work", "childcare support at the workplace", and "flexible employment status". The Cronbach's alpha values of all the factors and the total items were 0.82-0.89 and 0.93, respectively, suggesting that the scale we developed has high reliability. The result indicated that the scale of women-doctor-friendly working conditions consisting of five factors with 30 items is highly validated and reliable.

  3. Technology-mediated awareness: facilitating the handling of (un)wanted interruptions in a hospital setting.

    PubMed

    Klemets, Joakim; Evjemo, Tor Erik

    2014-09-01

    Nurses' work in hospital departments is highly collaborative and includes communication with a variety of actors. To further support nurses' communications, wireless phones, on which nurses receive both nurse calls and ordinary phone calls, have been introduced. However, while they ensure high availability among the mobile nurses, these phones also contribute to an increased number of interruptions. This paper aims to discover whether all interruptions caused by the wireless phones are unwanted. Further, it investigates how nurses handle these interruptions in a hospital setting in order to construct a foundation for guidelines to use in designing these types of systems. Qualitative and ethnographically inspired fieldwork, including workshops with both ordinary and student nurses from a Norwegian hospital, was undertaken. Patients from two hospital departments were interviewed. Nurses struggle to handle interruptions caused by the wireless nurse call system. Deciding whether to abort an activity or not to respond to an interruption is regarded as stressful. The decision is further complicated by the complex nature of the interruptions. At the same time, patients anticipate that nurses are able to make these judgements with limited information. Nurses' work is highly collaborative, and nurses depend on one another to carry out their work and manage interruptions. The dual nature of the interruptions is complex, and whether an interruption is wanted or unwanted depends on many factors. Nurses manage interruptions mainly by making their own activities visible and monitoring colleagues' work. Therefore, nurses' awareness of colleagues' activities is a key factor in how they handle interruptions in the form of nurse calls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Navigating the self in maternity care: how Chinese midwives work on their professional identity in hospital setting.

    PubMed

    Zhang, Jing; Haycock-Stuart, Elaine; Mander, Rosemary; Hamilton, Lorna

    2015-03-01

    to explore the strategies Chinese midwives employed to work on their professional identity in hospital setting and the consequence of such identity work. this paper draws upon findings from a Constructivist Grounded Theory study that explored the professional identity construction of 15 Chinese midwives with a mixture of midwifery experiences, practising in three different types of hospital settings in a capital city in Southeast China. The accounts from participants in the form of in-depth individual interviews were collected. Work journals voluntarily provided by three participants were also included. in everyday practice, hospital midwives in China were working on their professional identity in relation to two definitions of the midwife: the external definition ('obstetric nurse'), bound up in the idea of risk management under the medical model of their work organisations; and the internal definition ('professional midwife'), associated with the philosophy of normal birth advocacy in the professional discourse. Six strategies for identity work were identified and grouped into two principle categories: 'compromise' and 'engagement'. The adoption of each strategy involved a constant negotiation between the external and internal definitions of the midwife, being influenced by midwifery experiences, relationships with women, opportunities for professional development and the definition of the situation. A 'hybrid identity', which demonstrated the dynamic nature of midwifery professional identity, was constructed as a result. this paper explored the dynamic nature of midwifery professional identity. This exploration contributes to the body of knowledge regarding understanding the professional identity of hospital midwives in China, while also extending the current theoretical knowledge of identity work by elaborating on the various strategies individuals use to work on their professional identity in the workplace. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Medical student psychological distress and academic performance.

    PubMed

    Dendle, Claire; Baulch, Julie; Pellicano, Rebecca; Hay, Margaret; Lichtwark, Irene; Ayoub, Sally; Clarke, David M; Morand, Eric F; Kumar, Arunaz; Leech, Michelle; Horne, Kylie

    2018-01-21

    The impact of medical student psychological distress on academic performance has not been systematically examined. This study provided an opportunity to closely examine the potential impacts of workplace and study related stress factors on student's psychological distress and their academic performance during their first clinical year. This one-year prospective cohort study was performed at a tertiary hospital based medical school in Melbourne, Australia. Students completed a questionnaire at three time points during the year. The questionnaire included the validated Kessler psychological distress scale (K10) and the General Health Questionnaire-28 (GHQ-28), as well as items about sources of workplace stress. Academic outcome scores were aggregated and correlated with questionnaire results. One hundred and twenty six students participated; 126 (94.7%), 102 (76.7%), and 99 (74.4%) at time points one, two, and three, respectively. 33.1% reported psychological distress at time point one, increasing to 47.4% at time point three. There was no correlation between the K10 scores and academic performance. There was weak negative correlation between the GHQ-28 at time point three and academic performance. Keeping up to date with knowledge, need to do well and fear of negative feedback were the most common workplace stress factors. Poor correlation was noted between psychological distress and academic performance.

  6. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  7. Impacts of Campus Involvement on Hospitality Student Achievement and Satisfaction

    ERIC Educational Resources Information Center

    Yin, Dean; Lei, Simon A.

    2007-01-01

    Campus involvement affecting satisfaction and academic achievement (overall grade point average) of hospitality undergraduate students at a state university in the Midwest (University X) was investigated through a survey research. A four-part survey instrument was developed to facilitate this study. There were a number of academic, professional,…

  8. Descriptive profile of the academic integrity of Australian occupational therapy students.

    PubMed

    Brown, Ted; Isbel, Stephen; Bourke-Taylor, Helen; Gustafsson, Louise; McKinstry, Carol; Logan, Alexandra

    2018-04-10

    Academic integrity is the moral code of academia. Students who demonstrate trustworthiness in an academic setting are more likely to be dependable in a clinical setting. It is, therefore, important for occupational therapy academic and fieldwork educators to know the academic integrity profile of their students and to address any areas of academic dishonesty in curriculum design and delivery. To date, there has been no baseline description of the academic honesty profile of Australian occupational therapy students. To establish a baseline of academic integrity and academic dishonesty among occupational therapy undergraduate and graduate-entry masters students in a cohort of Australian students. Seven hundred and one students from five Australian universities completed a self-report questionnaire comprising demographic questions and six standardised scales measuring academic integrity. Overall, occupational therapy students reported high levels of academic and fieldwork integrity; however, some areas of concerns exist. Students report copying material without citations at least once during their studies (55%), obtaining test questions at least once during their studies (42.6%) or padding out a bibliography (39.5%). Occupational therapy education needs to continue to emphasise the importance of academic and fieldwork integrity. Students need to be explicitly taught what academic honesty and dishonesty is and be provided with the resources and time to complete academic work to reduce the risk of academic dishonesty. © 2018 Occupational Therapy Australia.

  9. Trends in hospital librarianship and hospital library services: 1989 to 2006.

    PubMed

    Thibodeau, Patricia L; Funk, Carla J

    2009-10-01

    The research studied the status of hospital librarians and library services to better inform the Medical Library Association's advocacy activities. The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis. The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years. Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends.

  10. [Nursing students' perception of the learning process in a hospital setting].

    PubMed

    Alves, Elcilene Andreíne Terra Durgante; Cogo, Ana Luísa Petersen

    2014-03-01

    The aim of this study was to identijf how nursing students perceive and experience the learning process during curricular practice in a hospital setting. A qualitative, retrospective, documentary study was developed in an undergraduate nursing course. Data were comprised of 162 posts made by 34 students in the online discussion forum of the Learning Management System Moodle, during the first half of 2011. The following themes emergedfrom t he thematic content analysis: "nursing students' understanding about the professional practice," and "the teaching and learning process in the perspective of nursing students." The study demonstrated that the forum was a place for reporting experiences such as the description of the physical area, performing procedures, perception of nursing care activities, conJlicts with peers, coping with death and learning evaluation. The online discussion forum needs to be used by professors as a space of interaction so as to contribute to professional training.

  11. Overview of Geriatric Distance Education for Academic Courses and Continuing Education

    ERIC Educational Resources Information Center

    Johnson, Helen Arleen

    2004-01-01

    Distance education technologies may be applied to academic settings, continuing education/continuing medical education settings or in combination to both. This article provides an overview of what we have learned about academic and continuing education/continuing medical education in geriatrics and gerontology. It includes information on the scope…

  12. Unpredictable Feelings: Academic Women under Research Audit

    ERIC Educational Resources Information Center

    Grant, Barbara M.; Elizabeth, Vivienne

    2015-01-01

    Academic research is subject to audit in many national settings. In Aotearoa/New Zealand, the government regulates the flow of publicly funded research income into tertiary institutions through the Performance-Based Research Fund (PBRF). This article enquires into the effects of the PBRF by exploring data collected from 16 academic women of…

  13. Academic Integrity in Web Based Distance Education

    ERIC Educational Resources Information Center

    Baron, Julie; Crooks, Steven M.

    2005-01-01

    This paper reviews the literature relative to academic dishonesty in WBDE settings assuming the average class size to be 30-50 students with the instructor filling the role of facilitator, concept expert, grader and mentor when necessary. It shows that some common stereotypes about academic integrity and WBDE are unsubstantiated. In addition, it…

  14. Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer.

    PubMed

    van Poelgeest, Rube; van Groningen, Julia T; Daniels, John H; Roes, Kit C; Wiggers, Theo; Wouters, Michel W; Schrijvers, Guus

    2017-05-01

    A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM SM ) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital's electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients (n = 30.358) during the study period (2012-2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959-0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals (n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,915-0,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider's efforts to achieve desired quality outcomes and efficiency in Western

  15. New roles: professional staff sharing between a hospital and an academic library.

    PubMed

    Just, Melissa L

    2003-01-01

    Childrens Hospital Los Angeles is a pediatric hospital and research institute affiliated with the Keck School of Medicine of the University of Southern California (USC). Historically, the library at Childrens Hospital was staffed by a hospital-employed librarian. In 1999, the library position was outsourced to USC's Norris Medical Library. The new position is staffed by a librarian who divides her time equally between two locations: the Childrens Hospital Library and the Norris Medical Library. This staff sharing arrangement has three primary goals: increase the collaboration between the libraries; improve access to resources and library staff expertise; and provide faster document delivery service to the Childrens Hospital library. This paper presents the details of the position, and addresses the pros and cons for both libraries and the librarian.

  16. All-Round Marketing Increases Hospital Popularity.

    PubMed

    Ziqi, Tao

    2015-06-01

    Xuzhou Center Hospital is in a competing medical market in Xuzhou city. This hospital has been dedicating to improve the medical skills and provide professional and individualized service to the patients in order to improve the patient's experience and increase the patient's satisfaction. On the other side, this hospital has provided an all-round marketing campaign to build up the social influence and public reputation through public-praise marketing, web marketing, media marketing, and scholar marketing. Besides, this hospital has been cooperating with foreign medical institutions and inviting foreign medical specialists to academic communication. With the combined effects of improving medical service and all-round marketing, the hospital's economic performance has been enhanced significantly and laid a solid foundation for its ambition to become the first-class hospital in Huaihai Economic Zone.

  17. Development of postgraduate research supervisors within a teaching hospital setting.

    PubMed

    Scott, K M; Caldwell, P H Y; Oldmeadow, W; Dale, R C; Jones, C A

    2015-08-01

    The recent trend to embed medical research at point of care has created a need for postgraduate research supervisors in hospitals who are practising clinicians and lab-based researchers. We explored the training needs of supervisors to inform the design and evaluation of a hospital-based development programme. We found that if hospital-based supervisors are to improve their practice, the programme needs to be on-site to ensure access and relevance to local issues. © 2015 Royal Australasian College of Physicians.

  18. Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study.

    PubMed

    Padula, William V

    The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. Retrospective observational cohort. We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (-1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (-1.13 cases/quarter; P = .035). Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products.

  19. Jefferson's Academical Village, Bounded by University Avenue on the north, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Jefferson's Academical Village, Bounded by University Avenue on the north, Jefferson Park Avenue on the south, Hospital Drive on the east, and McCormick Road on the west, Charlottesville, Independent City, VA

  20. Radio advertising increases hospital call center volume by 48%.

    PubMed

    2006-01-01

    Since the fall of 2005, call volume at University of Southern California University Hospital of Los Angeles' call center has increased by nearly 50%. How? The hospital embarked on a long-term radio campaign to promote its presence as a premier academic medical center and to increase patient volume.

  1. An Evidence-Based Practice Model across the Academic and Clinical Settings

    ERIC Educational Resources Information Center

    Wolter, Julie A.; Corbin-Lewis, Kim; Self, Trisha; Elsweiler, Anne

    2011-01-01

    This tutorial is designed to provide academic communication sciences and disorders (CSD) programs, at both the undergraduate and graduate levels, with a comprehensive instructional model on evidence-based practice (EBP). The model was designed to help students view EBP as an ongoing process needed in all clinical decision making. The three facets…

  2. Alcohol and tobacco use and cognitive-motivational variables in school settings: effects on academic performance in Spanish adolescents.

    PubMed

    Inglés, Cándido J; Torregrosa, María S; Rodríguez-Marín, Jesús; García del Castillo, José A; Gázquez, José J; García-Fernández, José M; Delgado, Beatriz

    2013-01-01

    The aim of the present study was to analyze: (a) the relationship between alcohol and tobacco use and academic performance, and (b) the predictive role of psycho-educational factors and alcohol and tobacco abuse on academic performance in a sample of 352 Spanish adolescents from grades 8 to 10 of Compulsory Secondary Education. The Self-Description Questionnaire-II, the Sydney Attribution Scale, and the Achievement Goal Tendencies Questionnaire were administered in order to analyze cognitive-motivational variables. Alcohol and tobacco abuse, sex, and grade retention were also measured using self-reported questions. Academic performance was measured by school records. Frequency analyses and logistic regression analyses were used. Frequency analyses revealed that students who abuse of tobacco and alcohol show a higher rate of poor academic performance. Logistic regression analyses showed that health behaviours, and educational and cognitive-motivational variables exert a different effect on academic performance depending on the academic area analyzed. These results point out that not only academic, but also health variables should be address to improve academic performance in adolescence.

  3. Does stereotype threat affect women in academic medicine?

    PubMed

    Burgess, Diana Jill; Joseph, Anne; van Ryn, Michelle; Carnes, Molly

    2012-04-01

    Multiple complex factors contribute to the slow pace of women's advancement into leadership positions in academic medicine. In this article, the authors propose that stereotype threat--under which individuals who are members of a group characterized by negative stereotypes in a particular domain perform below their actual abilities in that domain when group membership is emphasized--may play an important role in the underrepresentation of women in leadership positions in academic medicine. Research to objectively assess the impact of stereotype threat for women in academic medicine is feasible and necessary to confirm this hypothesis. Still, a number of conditions present in the academic medicine community today have been shown to trigger stereotype threat in other settings, and stereotype threat fits with existing research on gender in academic medicine. In the meantime, academic health centers should implement relatively simple measures supported by experimental evidence from other settings to reduce the risk of stereotype threat, including (1) introducing the concept of stereotype threat to the academic medicine community, (2) engaging all stakeholders, male and female, to promote identity safety by enacting and making faculty aware of policies to monitor potential instances of discrimination, and training faculty to provide performance feedback that is free of gender bias, (3) counteracting the effects of sex segregation at academic health centers by increasing exposure to successful female leaders, (4) reducing gender stereotype priming by avoiding stereotypically male criteria for promotion, grants, and awards, and (5) building leadership efficacy among female physicians and scientists.

  4. The impact of outpatient clinical teaching on students' academic performance in obstetrics and gynecology.

    PubMed

    Hassan, Bahaeldin A; Elfaki, Omer A; Khan, Muhammed A

    2017-01-01

    Clinical teaching at outpatient settings is an essential part of undergraduate medical students' training. The increasing number of students in many medical schools and short hospital stays makes inpatient teaching alone insufficient to provide students with the required clinical skills. To make up this shortfall, outpatient clinical teaching has been implemented by our Department of Obstetrics and Gynecology, King Khalid University, KSA, throughout the academic year 2015-2016. The aim of this study was to evaluate the impact of clinical teaching at outpatient settings on the academic performance of our students. In this comparative retrospective study, the effects of outpatient clinical teaching of obstetrics and gynecology on the academic performance of student was assessed through an objective structured clinical examination (OSCE). During their course on obstetrics and gynecology, 58 students had their clinical teaching both at inpatient and outpatient settings and constituted "study group". The remaining 52 students had clinical teaching only at inpatient settings and were considered "control group". Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Four stations were used for assessment: obstetric history, gynecological history, obstetric physical examination of pregnant women, and gynecological procedure station. Twenty marks were allocated for each station giving a total score of 80. The OSCE scores for study group were compared with those of the control group using Student's t -test; p < 0.05 was considered statistically significant. The total mean OSCE score was statistically significantly higher in the study group (62.36 vs. 47.94, p < 0.001). The study group participants showed significantly higher scores in the gynecological procedure station (16.74 vs. 11.62, p < 0.0001) and obstetric examination station (16.72 vs. 10.79, p < 0

  5. Nutritional Competence and Resilience among Hemodialysis Patients in the Setting of Dialysis Initiation and Hospitalization

    PubMed Central

    Wong, Michelle M.Y.; Usvyat, Len A.; Xiao, Qingqing; Kotanko, Peter; Maddux, Franklin W.

    2015-01-01

    Background and objectives Dialysis patients have a high risk for inadequate nutrition. Their nutritional status is particularly susceptible to deterioration when faced with intercurrent events such as hospitalization. This study was conducted to improve the understanding of the temporal evolution of nutritional parameters as a foundation for rational and proactive nutritional intervention. Design, setting, participants, & measurements A retrospective cohort study was performed to investigate the temporal evolution of nutritional parameters (serum albumin, serum phosphate, serum creatinine, equilibrated normalized protein catabolic rate, and interdialytic weight gain) and a composite nutritional score derived from these parameters, in two populations: (1) incident hemodialysis (HD) patients who started HD between January 2006 and December 2011 and were followed for up to 54 months (median 16.3), and (2) prevalent patients with HD vintage ≥2.5 years who were hospitalized between January 2006 and December 2011 and followed from 6 months before to 6 months after hospitalization. Results In incident patients (n=126,964), each of the nutritional parameters improved after HD initiation, with a mean composite nutritional score at the 24th percentile at the start of HD and reaching a plateau at the 57th percentile toward the end of the second year on dialysis. Nutritional parameters increased more rapidly and reached higher values among patients who survived longer. In hospitalized patients (n=14,193), the nutritional parameters and the composite score began to decline 1–2 months before hospitalization, reached their lowest level in the month after hospitalization, and then partially recovered in the subsequent 5 months. The degree of recovery of the nutritional score was inversely related to the number of rehospitalizations. Conclusions This study increases the understanding of nutritional resilience and its determinants in HD patients. Application of the nutritional

  6. Establishing a multidisciplinary academic cosmetic center.

    PubMed

    Rao, Venkat K; Schmid, Daniel B; Hanson, Summer E; Bentz, Michael L

    2011-12-01

    The demand for cosmetic services has risen rapidly in recent years, but has slowed down with the current economic downturn. Managed care organizations and Medicare have been steadily reducing their reimbursements for physician services. The payment for reconstructive surgical procedures has been decreasing and is likely to worsen with healthcare reform, and many plastic surgery residency programs are facing fiscal challenges. An adequate volume of patients needing cosmetic services is necessary to recruit and train the best candidates to the residency programs. Self-pay patients will help ensure the fiscal viability of plastic surgery residency programs. Attracting patients to an academic healthcare center will become more difficult in a recession without the appropriate facilities, programs, and pricing strategies. Setting up a modern cosmetic services program at an academic center has some unique challenges, including funding, academic politics, and turf. The authors opened a free-standing academic multidisciplinary center at their medical school 3 years ago. The center is an off-site, 13,000-sq ft facility that includes faculty from plastic surgery, ear, nose, and throat, dermatology, and vascular surgery. In this article, the authors discuss the process of developing and executing a plan for starting an aesthetic services center in an academic setting. The financing of the center and factors in pricing services are discussed. The authors show the impact of the center on their cosmetic surgery patient volumes, resident education, and finances. They expect that their experience will be helpful to other plastic surgery programs at academic medical centers.

  7. Measurement of academic entitlement.

    PubMed

    Miller, Brian K

    2013-10-01

    Members of Generation Y, or Millennials, have been accused of being lazy, whiny, pampered, and entitled, particularly in the college classroom. Using an equity theory framework, eight items from a measure of work entitlement were adapted to measure academic entitlement in a university setting in three independent samples. In Study 1 (n = 229), confirmatory factor analyses indicated good model fit to a unidimensional structure for the data. In Study 2 (n = 200), the questionnaire predicted unique variance in university satisfaction beyond two more general measures of dispositional entitlement. In Study 3 (n = 161), the measure predicted unique variance in perceptions of grade fairness beyond that which was predicted by another measure of academic entitlement. This analysis provides evidence of discriminant, convergent, incremental, concurrent criterion-related, and construct validity for the Academic Equity Preference Questionnaire.

  8. Examining sustainability in a hospital setting: case of smoking cessation.

    PubMed

    Campbell, Sharon; Pieters, Karen; Mullen, Kerri-Anne; Reece, Robin; Reid, Robert D

    2011-09-14

    The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded. Six hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged. Sustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program. Applying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program

  9. Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Prasad, Shailendra; Klingner, Jill; Moscovice, Ira

    2012-01-01

    Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals,…

  10. Implementing total quality management in an academic surgery setting: lessons learned.

    PubMed

    Townes, C; Petit, B; Young, B

    1995-01-01

    Total Quality Management, a philosophy developed by W. Edwards Deming, has been used successfully in many countries and in many types of organizations to improve the quality of processes. The system is based upon the scientific method and provides the ability to solve long-standing, recalcitrant problems. The application of the TQM philosophy to health care, although recommended by many medical economists, is still in its infancy. At our medical center, three departments (Surgery, Anesthesiology, and Operating Room Services) joined forces to implement TQM. Critical activities early in implementation included establishing a Steering Committee, training key employees, providing systems for communicating TQM activities, and developing the leadership, facilitator, and other resources needed to support teams. Two of our first teams studied very different processes (one in the Operating Room, the other in outpatient Surgery clinics), providing many useful insights regarding keys to successful application of the TQM philosophy. We have learned strategies for increasing acceptance of and participation in TQM efforts on the part of staff members and, in particular, physicians, and for initiating the cultural change needed for TQM. Although the teams have met with resistance to behavioral changes and a lack of full support from some upper-level administrators in the Medical Center and the Hospital, most of them have been quite successful in improving the processes under study. We conclude that, with the proper leadership and facilitation, the TQM philosophy can be successfully implemented in the health care environment. Total Quality Management (TQM) as a system for improving the quality of processes has been successful in many countries throughout the world for organizations offering a wide variety of products and services. This article will describe specific TQM endeavors, both successful and unsuccessful, undertaken in an academic surgery department in the United States

  11. Academic Self-Handicapping and Achievement: A Meta-Analysis

    ERIC Educational Resources Information Center

    Schwinger, Malte; Wirthwein, Linda; Lemmer, Gunnar; Steinmayr, Ricarda

    2014-01-01

    Self-handicapping represents a frequently used strategy for regulating the threat to self-esteem elicited by the fear of failing in academic achievement settings. Several studies have documented negative associations between self-handicapping and different educational outcomes, inter alia academic achievement. However, studies on the relation…

  12. Comparison of prescribing indicators of academic versus non-academic specialist physicians in Urmia, Iran

    PubMed Central

    Sadigh-Rad, Laya; Majdi, Leila; Javaezi, Mehrnush; Delirrad, Mohammad

    2015-01-01

    Objective: As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran. Methods: In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations. Findings: Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients’ encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant. Conclusion: Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences. PMID:25984540

  13. Comparing least-squares and quantile regression approaches to analyzing median hospital charges.

    PubMed

    Olsen, Cody S; Clark, Amy E; Thomas, Andrea M; Cook, Lawrence J

    2012-07-01

    estimates even when lognormal and equal variance assumptions are violated. These methods may be particularly useful in describing and analyzing hospital charges from administrative data sets. © 2012 by the Society for Academic Emergency Medicine.

  14. Use of school gardens in academic instruction.

    PubMed

    Graham, Heather; Beall, Deborah Lane; Lussier, Mary; McLaughlin, Peggy; Zidenberg-Cherr, Sheri

    2005-01-01

    To determine the status of gardens in California schools. A self-administered Internet and mailed survey was sent to all California principals (N = 9805). 4194 California school principals. School garden practices, attitudes associated with the use of gardens in schools, and perceptions of barriers to having and using school gardens in academic instruction. Descriptive statistics and chi-square; P < .05. A 43% response rate was achieved. The most frequent reason for having a garden was for enhancement of academic instruction. Gardens were most commonly used for teaching science, environmental studies, and nutrition. Principals strongly agreed that resources such as curriculum materials linked to academic instruction and lessons on teaching nutrition in the garden would assist in the school garden being used for academic instruction. Principals deemed the garden as being not to slightly effective at enhancing the school meal program. School gardens appear to be predominantly used by most schools to enhance academic instruction. There is a need for curriculum materials and teacher training for gardening and nutrition. The link between the garden and the school meal program is an area that clearly requires attention. School lunch would be a logical setting for provision of edible produce, in addition to taste-testing of fresh produce in the garden or classroom setting.

  15. Academic-Service Partnerships in Nursing: An Integrative Review

    PubMed Central

    Beal, Judy A.

    2012-01-01

    This integrative review summarizes currently available evidence on academic-service partnerships in the profession of nursing. More than 300 articles, published primarily in refereed journals, were accessed. Articles (110) were included in this review as they presented detailed and substantive information about any aspect of a nursing academic-service partnership. The majority were anecdotal in nature. Topics clustered around the following categories: pre-requisites for successful partnerships, benefits of partnerships, types of partnerships, and workforce development with its themes of academic-practice progression and educational re-design. Many examples of partnerships between academic and service settings were thoroughly described and best practices suggested, most often, however, without formal evaluation of outcomes. Nursing leaders in both settings have a long tradition of partnering with very little replicable evidence to support their efforts. It is critical that future initiatives evaluate the effectiveness of these partnerships, not only to ensure quality of patient outcomes but also to maximize efforts at building capacity for tomorrow's workforce. PMID:22548160

  16. Safety and efficacy of misoprostol for induction of labour in a semi-urban hospital setting.

    PubMed

    Loto, O M; Fadahunsi, A A; Kolade, C O

    2004-09-01

    Most studies on the use of misoprostol for induction of labour have been carried out in well-endowed hospitals in developed countries with state-of-the-art monitoring equipment. There is need for more studies to be conducted in facilities with limited resources, if more patients are to benefit from the low cost and effectiveness of the drug. Following Ethical Committee approval, 152 women had labour induced in our maternity unit using intravaginal misoprostol. The patients were monitored clinically using the WHO model partograph with digital palpation of uterine contractions and intermittent auscultation of fetal heart with a pinard stethoscope. One hundred and thirty-five (88.8%) of the women had a vaginal delivery, while nine (5.9%) had a caesarean section for various obstetric indications. Eight cases of uterine hyperstimulation were noted but none of uterine rupture. We conclude that misoprostol can be used safely for induction of labour in less endowed hospital settings such as in developing countries, using basic clinical tools for monitoring.

  17. Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals.

    PubMed

    Tilahun, Binyam; Fritz, Fleur

    2015-08-01

    With the increasing implementation of Electronic Medical Record Systems (EMR) in developing countries, there is a growing need to identify antecedents of EMR success to measure and predict the level of adoption before costly implementation. However, less evidence is available about EMR success in the context of low-resource setting implementations. Therefore, this study aims to fill this gap by examining the constructs and relationships of the widely used DeLone and MacLean (D&M) information system success model to determine whether it can be applied to measure EMR success in those settings. A quantitative cross sectional study design using self-administered questionnaires was used to collect data from 384 health professionals working in five governmental hospitals in Ethiopia. The hospitals use a comprehensive EMR system since three years. Descriptive and structural equation modeling methods were applied to describe and validate the extent of relationship of constructs and mediating effects. The findings of the structural equation modeling shows that system quality has significant influence on EMR use (β = 0.32, P < 0.05) and user satisfaction (β = 0.53, P < 0.01); information quality has significant influence on EMR use (β = 0.44, P < 0.05) and user satisfaction (β = 0.48, P < 0.01) and service quality has strong significant influence on EMR use (β = 0.36, P < 0.05) and user satisfaction (β = 0.56, P < 0.01). User satisfaction has significant influence on EMR use (β = 0.41, P < 0.05) but the effect of EMR use on user satisfaction was not significant. Both EMR use and user satisfaction have significant influence on perceived net-benefit (β = 0.31, P < 0.01; β = 0.60, P < 0.01), respectively. Additionally, computer literacy was found to be a mediating factor in the relationship between service quality and EMR use (P < 0.05) as well as user satisfaction (P < 0.01). Among all the

  18. An Integrative Literature Review of Patient Turnover in Inpatient Hospital Settings.

    PubMed

    Park, Shin Hye; Weaver, Lindsay; Mejia-Johnson, Lydia; Vukas, Rachel; Zimmerman, Julie

    2016-05-01

    High patient turnover can result in fragmentation of nursing care. It can also increase nursing workload and thus impede the ability of nurses to provide safe and high-quality care. We reviewed 20 studies that examined patient turnover in relation to nursing workload, staffing, and patient outcomes as well as interventions in inpatient hospital settings. The studies consistently addressed the importance of accounting for patient turnover when estimating nurse staffing needs. They also showed that patient turnover varied by time, day, and unit type. Researchers found that higher patient turnover was associated with adverse events; however, further research on this topic is needed because evidence on the effect of patient turnover on patient outcomes is not yet strong and conclusive. We suggest that researchers and administrators need to pay more attention to patterns and levels of patient turnover and implement managerial strategies to reduce nursing workload and improve patient outcomes. © The Author(s) 2015.

  19. The Link between Basing Self-Worth on Academics and Student Performance Depends on Domain Identification and Academic Setting

    ERIC Educational Resources Information Center

    Lawrence, Jason S.; Charbonneau, Joseph

    2009-01-01

    Two studies showed that the link between how much students base their self-worth on academics and their math performance depends on whether their identification with math was statistically controlled and whether the task measured ability or not. Study 1 showed that, when math identification was uncontrolled and the task was ability-diagnostic,…

  20. Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement.

    PubMed

    Holbrook, Anne; Bowen, James M; Patel, Harsit; O'Brien, Chris; You, John J; Tahavori, Roshan; Doleweerd, Jeff; Berezny, Tim; Perri, Dan; Nieuwstraten, Carmine; Troyan, Sue; Patel, Ameen

    2016-12-30

    Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. A Study of Motivational Influences on Academic Achievement

    ERIC Educational Resources Information Center

    Dishon-Berkovits, Miriam

    2014-01-01

    This study examined the influence of motivation on academic achievement. The theoretical rationale for the study is grounded in bridging two influential yet isolated literatures of motivation: goal setting theory and achievement goal theory. Although it is clear that academic performance should be influenced by assigned learning goals,…

  2. The Burden of Child Maltreatment Leading to Hospitalization in a Provincial Setting in Papua New Guinea.

    PubMed

    Rero, Allanie; Aipit, Jimmy; Yarong-Kote, Tina; Watch, Villa; Bolnga, John W; Vei, Robert; Morris, Marilyn; Lufele, Elvin; Laman, Moses

    2016-08-01

    Child maltreatment is prevalent globally. In Papua New Guinea (PNG), child maltreatment remains an under-reported problem. As part of a 10 month prospective observational study conducted at Modilon Hospital in PNG, we investigated the burden of child maltreatment in the form of sexual abuse, physical abuse and neglect, leading to hospitalization in children ≤14 years. Of 1061 screened admissions, 107 (10%) fulfilled the definition of child maltreatment. The in-hospital admission prevalence of sexual abuse was 5.7% [60 of 1061; 95% confidence interval (CI): 4.4-7.3]. Neglect accounted for 3.4% (36 of 1061; 95% CI: 2.4-4.7) of admissions, while physical abuse accounted for 1.0% (11 of 1061; 95% CI: 0.6-1.9). Mortality was highest in the neglected group, with severe acute malnutrition accounting for 89% of deaths. Improved awareness, establishment of appropriate channels for addressing child maltreatment and enforcement of child protection laws in PNG and other epidemiologically similar settings are urgently needed. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Development approach to an enterprise-wide medication reconciliation tool in a free-standing pediatric hospital with commercial best-of-breed systems.

    PubMed

    Yu, Feliciano B; Leising, Scott; Turner, Scott

    2007-10-11

    Medication reconciliation is essential to providing a safer patient environment during transitions of care in the clinical setting. Current solutions include a mixed-bag of paper and electronic processes. Best-of-breed health information systems architecture poses a specific challenge to organizations that have limited software development resources. Using readily available service-oriented technology, a prototype for an integrated medication reconciliation tool is developed for use in an academic pediatric hospital with commercial systems.

  4. Does user-centred design affect the efficiency, usability and safety of CPOE order sets?

    PubMed

    Chan, Julie; Shojania, Kaveh G; Easty, Anthony C; Etchells, Edward E

    2011-05-01

    Application of user-centred design principles to Computerized provider order entry (CPOE) systems may improve task efficiency, usability or safety, but there is limited evaluative research of its impact on CPOE systems. We evaluated the task efficiency, usability, and safety of three order set formats: our hospital's planned CPOE order sets (CPOE Test), computer order sets based on user-centred design principles (User Centred Design), and existing pre-printed paper order sets (Paper). 27 staff physicians, residents and medical students. Sunnybrook Health Sciences Centre, an academic hospital in Toronto, Canada. Methods Participants completed four simulated order set tasks with three order set formats (two CPOE Test tasks, one User Centred Design, and one Paper). Order of presentation of order set formats and tasks was randomized. Users received individual training for the CPOE Test format only. Completion time (efficiency), requests for assistance (usability), and errors in the submitted orders (safety). 27 study participants completed 108 order sets. Mean task times were: User Centred Design format 273 s, Paper format 293 s (p=0.73 compared to UCD format), and CPOE Test format 637 s (p<0.0001 compared to UCD format). Users requested assistance in 31% of the CPOE Test format tasks, whereas no assistance was needed for the other formats (p<0.01). There were no significant differences in number of errors between formats. The User Centred Design format was more efficient and usable than the CPOE Test format even though training was provided for the latter. We conclude that application of user-centred design principles can enhance task efficiency and usability, increasing the likelihood of successful implementation.

  5. Trends in hospital librarianship and hospital library services: 1989 to 2006

    PubMed Central

    Thibodeau, Patricia L.; Funk, Carla J.

    2009-01-01

    Objective: The research studied the status of hospital librarians and library services to better inform the Medical Library Association's advocacy activities. Methods: The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis. Results: The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years. Conclusions: Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends. PMID:19851491

  6. Rightsizing Projects for Non-Research-Intensive Schools of Nursing via Academic-Clinical Partnerships.

    PubMed

    Kooken, Wendy Carter; Eckhardt, Ann L; McNutt-Dungan, Marianne; Woods, Jonathan

    Most academic-clinical partnerships are described as formal agreements between schools of nursing at research-intensive universities and large teaching hospitals. This article demonstrates less formal versions of academic-clinical partnerships established between a small, private liberal arts university school of nursing and 2 regional clinical agencies. In both exemplars, students, faculty, and staff contributed to evidence-based practice projects. Schools of nursing in non-research-intensive environments can develop right-size academic-clinical partnerships that are beneficial for all parties involved.

  7. Does Stereotype Threat Affect Women in Academic Medicine?

    PubMed Central

    Burgess, Diana Jill; Joseph, Anne; van Ryn, Michelle; Carnes, Molly

    2012-01-01

    Multiple complex factors contribute to the slow pace of women’s advancement into leadership positions in academic medicine. In this article, the authors propose that stereotype threat--under which individuals who are members of a group characterized by negative stereotypes in a particular domain perform below their actual abilities in that domain when group membership is emphasized--may play an important role in the underrepresentation of women in leadership positions in academic medicine. Research to objectively assess the impact of stereotype threat for women in academic medicine is feasible and necessary to confirm this hypothesis. Still, a number of conditions present in the academic medicine community today have been shown to trigger stereotype threat in other settings, and stereotype threat fits with existing research on gender in academic medicine. In the meantime, academic health centers should implement relatively simple measures supported by experimental evidence from other settings to reduce the risk of stereotype threat, including: (1) introducing the concept of stereotype threat to the academic medicine community; (2) engaging all stakeholders, male and female, to promote identity safety by enacting and making faculty aware of policies to monitor potential instances of discrimination, and training faculty to provide performance feedback that is free of gender bias; (3) counteracting the effects of sex segregation at academic health centers by increasing exposure to successful female leaders; (4) reducing gender stereotype priming by avoiding stereotypically male criteria for promotion, grants, and awards; and (5) building leadership efficacy among female physicians and scientists. PMID:22361794

  8. Examining sustainability in a hospital setting: Case of smoking cessation

    PubMed Central

    2011-01-01

    Background The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded. Methods Six hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged. Results Sustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program. Conclusions Applying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight

  9. Mapping nurses' activities in surgical hospital wards: A time study.

    PubMed

    van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W

    2018-01-01

    Balancing the number of nursing staff in relation to the number of patients is important for hospitals to remain efficient and optimizing the use of resources. One way to do this is to work with a workload management method. Many workload management methods use a time study to determine how nurses spend their time and to relate this to patient characteristics in order to predict nurse workload. In our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards. The research took place in an academic hospital in the Netherlands. Six surgical wards were included, capacity 15 to 30 beds. We have used a work sampling methodology where trained observers registered activities of nurses and patient details every ten minutes during the day shift for a time period of three weeks. The work sampling showed that nurses spend between 40.1% and 55.8% of their time on direct patient care. In addition to this, nurses spend between 11.0% and 14.1% on collective patient care. In total, between 52.1% and 68% of time spent on tasks is directly patient related. We found significant differences between wards for 10 of the 21 activity groups. We also found that nurses spend on average 31% with the patient (bedside), which is lower than in another study (37%). However, we noticed a difference between departments. For regular surgical departments in our study this was on average 34% and for two departments that have additional responsibilities in training and education of nursing students, this was on average 25%. We found a relatively low percentage of time spent on direct plus indirect care, and a lower percentage of time spent with the patient. We suspect that this is due to the academic setting of the study; in our hospital, there are more tasks related to education than in hospitals in other study settings. We also found differences between the wards in our study, which are mostly explained by differences

  10. Examining patterns in medication documentation of trade and generic names in an academic family practice training centre.

    PubMed

    Summers, Alexander; Ruderman, Carly; Leung, Fok-Han; Slater, Morgan

    2017-09-22

    Studies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre. A retrospective chart review of the electronic medical records of the St. Michael's Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed. Among 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%. Trade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees' clinical knowledge and decision-making.

  11. Impact of electronic health records on the patient experience in a hospital setting.

    PubMed

    Migdal, Christopher W; Namavar, Aram A; Mosley, Virgie N; Afsar-manesh, Nasim

    2014-10-01

    The impact of electronic health records (EHRs) and their effects on optimizing the patient experience has been debated nationally. Currently, there is a paucity of data in this area, and existing research offers conflicting results. Since 2006, the Assessing Residents' CI-CARE (ARC) program has evaluated the physician-patient interaction of resident physicians at University of California, Los Angeles (UCLA) Health utilizing a 20-item questionnaire administered through facilitator-patient interviews. To evaluate the impact of EHR implementation on the patient experience. Retrospective cohort study. Two academic medical campuses: Ronald Reagan UCLA Medical Center and UCLA Medical Center, Santa Monica. A total of 3417 surveys, spanning December 1, 2012 to May 30, 2013, were assessed. This included patient representation from 9 departments within UCLA Health. Surveys were analyzed to assess physician-patient communication. Statistical comparisons were made using χ analysis. All 16 questions assessing physician-patient communication received better responses in the 3 months following EHR implementation, compared to the 3 months prior to implementation. Of these, 9 questions illustrated statistically significant improvement, whereas the improvement in the remaining 7 questions was not statistically significant. These results suggest that EHRs may improve physician-patient communication. The ARC infrastructure allowed for observation of this trend; however, future research should aim to further validate and understand the etiologies of this improvement. © 2014 Society of Hospital Medicine.

  12. Omission of Dysphagia Therapies in Hospital Discharge Communications

    PubMed Central

    Kind, Amy; Anderson, Paul; Hind, Jacqueline; Robbins, JoAnne; Smith, Maureen

    2009-01-01

    Background Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. Objective To examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk sub-acute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. Design Retrospective cohort study Subjects All stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to sub-acute care in 2003-2005 from a single large academic medical center (N=187). Measurements Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included: dietary (food and liquid), postural/compensatory techniques (e.g., chin-tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Results 45% of discharge summaries omitted all SLP dysphagia recommendations. 47%(88/186) of patients with SLP dietary recommendations, 82%(93/114) with postural, 100%(16/16) with rehabilitation, 90%(69/77) with meal pacing, 95%(21/22) with medication, and 79%(96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Conclusions Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to sub-acute care. PMID:20098999

  13. Infection prevention needs assessment in Colorado hospitals: rural and urban settings.

    PubMed

    Reese, Sara M; Gilmartin, Heather; Rich, Karen L; Price, Connie S

    2014-06-01

    The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  14. Healthy cooking classes at a children’s cancer hospital and patient/survivor summer camp: initial reactions and feasibility

    PubMed Central

    Raber, Margaret; Crawford, Karla; Chandra, Joya

    2018-01-01

    Objective Childhood cancer survivors (CCS) have been shown to practice sub-optimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviors in community-based programming and academic research, however, literature on teaching cooking classes in CCS is limited. The purpose of this study is to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behavior. Design A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings. Setting One pediatric cancer hospital inpatient unit, one pediatric cancer in-hospital camp program and two off-site pediatric cancer summer camp programs. Subjects One hundred and eighty nine CCS of varying ages and thirteen parents of CCS. Results Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS. Conclusions Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS. PMID:28463101

  15. Severe Sepsis and Septic Shock Cases Meeting Guidelines Among Patients in a University Hospital Setting.

    PubMed

    Charrier, J A; Steen, C L; Borrero, E

    2017-01-01

    A diagnosis of severe sepsis or septic shock has been shown to significantly increase mortality rate independent of other factors. Research has revealed all cause hospital case fatality rates have declined yet the percentage of severe sepsis cases continues to increase and age-adjusted mortality rates from severe sepsis and septic shock has significantly increased during the same time period. Patients with severe sepsis demonstrate ongoing mortality rate increases for up to 2 years following hospitalization when compared to aged matched controls of nonseptic patients. International guidelines with mortality benefit for the management of severe sepsis and septic shock have been illustrated in the latest surviving sepsis campaign. The objective of this study was to increase the percentage of patients admitted to the hospital with a diagnosis of severe sepsis or septic shock who met guidelines based on surviving sepsis campaign. A retrospective chart review was conducted for patients admitted to UHC from January 2016 to present to identify cases with a diagnosis of severe sepsis or septic shock, and whether they met guidelines set forth by surviving sepsis campaign both before and after an intervention program which included interviews with providers failing to meet protocol, educational sessions on guidelines to meet protocol, resident led quality improvement workshops to address barriers to meeting protocol, and development of an EMR power plan to assist providers on meeting protocol. 139 cases with a diagnosis, or meeting criteria for, severe sepsis or septic shock were identified during the period of 1/1/2016-9/30/2016 with an average of 43 percent of total cases which met guidelines. Trend analysis revealed increased compliance following resident lead intervention program with 31 percent and 49 percent before and after intervention, respectively. ICU data is currently being analyzed for meeting guidelines and have not been included in current data. The most

  16. [Analysis of parents' compliance in non-hospital settings during operation of expressed breast milk bank].

    PubMed

    Yang, Xiao-Yan; Ma, Yue; Hu, Yan-Lin; Tang, Jun; Shi, Jing; Mu, De-Zhi

    2016-04-01

    To investigate the parents' compliance in non-hospital settings during the operation of expressed breast milk bank. In September 2014, a questionnaire survey was carried out to investigate the parents' willingness about feeding the inpatient neonates with maternal expressed breast milk, to evaluate the effectiveness of the breast milk feeding supporting system, and to monitor the compliance in non-hospital settings during the delivery of maternal expressed breast milk. Improvements in education were made according to the results. A second survey was done in September 2015. A total of 340 questionnaires were sent out, and 338 usable questionnaires were returned. According to the time when the questionnaires were sent out, they were divided into two groups: 2014 group (n=229) and 2015 group (n=109). The age of most mothers was 20-30 years in the 2014 group and 30-40 years in the 2015 group. Most mothers delivered at the West China Second Hospital of Sichuan University in both groups, but the 2015 group had a significantly higher proportion than the 2014 group (74.3% vs 61.6%; P<0.05). Guidance was given to mothers in the presence of insufficient breast milk production in both groups, but the 2015 group had a significantly higher proportion than the 2014 group (91.7% vs 79.9%; P<0.05). Both groups had good family compliance in the collection, storage, and transport of breast milk. There were no significant differences in their compliance with washing hands, sterilizing instruments, and using a clean special refrigerator between the two groups. The expressed breast milk was transported strictly according to the procedure in both groups, but the 2015 group had a significantly higher proportion than the 2014 group (100% vs 87.1%; P<0.05). Before and after improvements in the health education, most parents have good compliance in the collection, storage, and transport of breast milk.

  17. 38 CFR 18.434 - Education setting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Education setting. 18.434... Adult Education § 18.434 Education setting. (a) Academic setting. A recipient shall educate, or shall provide for the education of, each qualified handicapped person in its jurisdiction with persons who are...

  18. 38 CFR 18.434 - Education setting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Education setting. 18.434... Adult Education § 18.434 Education setting. (a) Academic setting. A recipient shall educate, or shall provide for the education of, each qualified handicapped person in its jurisdiction with persons who are...

  19. 38 CFR 18.434 - Education setting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Education setting. 18.434... Adult Education § 18.434 Education setting. (a) Academic setting. A recipient shall educate, or shall provide for the education of, each qualified handicapped person in its jurisdiction with persons who are...

  20. 38 CFR 18.434 - Education setting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Education setting. 18.434... Adult Education § 18.434 Education setting. (a) Academic setting. A recipient shall educate, or shall provide for the education of, each qualified handicapped person in its jurisdiction with persons who are...

  1. 38 CFR 18.434 - Education setting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Education setting. 18.434... Adult Education § 18.434 Education setting. (a) Academic setting. A recipient shall educate, or shall provide for the education of, each qualified handicapped person in its jurisdiction with persons who are...

  2. Art viewing directives in hospital settings effect on mood.

    PubMed

    Ho, Rainbow T H; Potash, Jordan S; Fang, Fan; Rollins, Judy

    2015-01-01

    The purpose of this study was to determine the effect viewing directives can have when encountering art in hospitals. A secondary objective of the study was to understand the responses of viewers to an art exhibit on the theme of medical student empathy toward patient pain and suffering. Displaying art in hospitals has been credited with increasing well-being of patients, visitors, and staff. Generally, hospital curators have focused on the type of art to display (natural, symbolic, and abstract). This focus has neglected the possibility that in addition to the type of art, the way that viewers engage art may also be responsible for the healing effect. Participants (n = 97) were randomly allocated into one of the viewing directives: (1) reflecting on one artwork, (2) creating a drawing or poem in response to one artwork, or (3) no direction. Prior to looking at the art and immediately after, participants were administered the Brief Mood Introspection Scale (BMIS) and offered an opportunity to participate in an interview. Pre-post results of the BMIS demonstrated that viewers who received directions achieved some therapeutic effect. Qualitative themes from the post-exhibit interviews identified that the empathy themed exhibit was well received, although there were differences among responses from patients, visitors, and staff. The results imply that hospitals may consider offering prompts to help viewers engage with art to enhance mood and exhibiting art that demonstrates empathy for patient suffering. © The Author(s) 2015.

  3. Mentorship, productivity, and promotion among academic hospitalists.

    PubMed

    Reid, Mark B; Misky, Gregory J; Harrison, Rebecca A; Sharpe, Brad; Auerbach, Andrew; Glasheen, Jeffrey J

    2012-01-01

    United States academic hospitals have rapidly adopted the hospitalist model of care. Academic hospitalists have taken on much of the clinical and teaching responsibilities at many institutions, yet little is known about their academic productivity and promotion. We sought to discover the attitudes and attributes of academic hospitalists regarding mentorship, productivity, and promotion. We performed a web-based email survey of academic hospitalists consisting of 61 questions. Four hundred and twenty academic hospitalists. Demographic details, scholarly production, presence of mentorship and attitudes towards mentor, academic rank Two hundred and sixty-six (63%) of hospitalists responded. The majority were under 41 (80%) and had been working as hospitalists for <5 years (62%). Only 42% of academic hospitalists had a mentor. Forty-four percent of hospitalists had not presented a poster or abstract at national meeting; 51% had not been first author on a peer-reviewed publication. Factors positively associated with publication of a peer-reviewed first author paper included: 1) male gender, AOR = 2.38 (95% CI 1.30, 4.33), 2) >20% "protected" time, AOR = 1.92 (95% CI 1.00, 3.69), and 3) a better-than-average understanding of the criteria for promotion, AOR = 3.66 (95% CI 1.76, 7.62). A lack of mentorship was negatively associated with producing any peer-reviewed first author publications AOR = 0.43 (95% CI 0.23, 0.81); any non-peer reviewed publications AOR = 0.45 (95% CI 0.24, 0.83), and leading a teaching session at a national meeting AOR = 0.41 (95% CI 0.19, 0.88). Most hospitalists promoted to the level of associate professor had been first author on four to six peer-reviewed publications. Most academic hospitalists had not presented a poster at a national meeting, authored an academic publication, or presented grand rounds at their institution. Many academic hospitalists lacked mentorship and this was associated with a failure to produce

  4. Development of emergency medicine as academic and distinct clinical discipline in Bosnia & Herzegovina.

    PubMed

    Salihefendic, Nizama; Zildzic, Muharem; Masic, Izet; Hadziahmetovic, Zoran; Vasic, Dusko

    2011-01-01

    Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam. Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries. Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina. There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through

  5. Development and implementation of a balanced scorecard in an academic hospitalist group.

    PubMed

    Hwa, Michael; Sharpe, Bradley A; Wachter, Robert M

    2013-03-01

    Academic hospitalist groups (AHGs) are often expected to excel in multiple domains: quality improvement, patient safety, education, research, administration, and clinical care. To be successful, AHGs must develop strategies to balance their energies, resources, and performance. The balanced scorecard (BSC) is a strategic management system that enables organizations to translate their mission and vision into specific objectives and metrics across multiple domains. To date, no hospitalist group has reported on BSC implementation. We set out to develop a BSC as part of a strategic planning initiative. Based on a needs assessment of the University of California, San Francisco, Division of Hospital Medicine, mission and vision statements were developed. We engaged representative faculty to develop strategic objectives and determine performance metrics across 4 BSC perspectives. There were 41 metrics identified, and 16 were chosen for the initial BSC. It allowed us to achieve several goals: 1) present a broad view of performance, 2) create transparency and accountability, 3) communicate goals and engage faculty, and 4) ensure we use data to guide strategic decisions. Several lessons were learned, including the need to build faculty consensus, establish metrics with reliable measureable data, and the power of the BSC to drive goals across the division. We successfully developed and implemented a BSC in an AHG as part of a strategic planning initiative. The BSC has been instrumental in allowing us to achieve balanced success in multiple domains. Academic groups should consider employing the BSC as it allows for a data-driven strategic planning and assessment process. Copyright © 2013 Society of Hospital Medicine.

  6. Reason for hospital admission: a pilot study comparing patient statements with chart reports.

    PubMed

    Berger, Zackary; Dembitzer, Anne; Beach, Mary Catherine

    2013-01-01

    Providers and patients bring different understandings of health and disease to their encounters in the hospital setting. The literature to date only infrequently addresses patient and provider concordance on the reported reason for hospitalization, that is, whether they express this reason in similar ways. An agreement or common ground between such understandings can serve as a basis for future communication regarding an illness and its treatment. We interviewed a convenience sample of patients on the medical wards of an urban academic medical center. We asked subjects to state the reason why their doctors admitted them to the hospital, and then compared their statement with the reason in the medical record. We defined concordance on reported reason for hospitalization as agreement between the patient's report and the reason abstracted from the chart. We interviewed and abstracted chart data from a total of 46 subjects. Concordance on reported reason for hospitalization was present in 24 (52%) and discordance in 17 (37%); 5 patients (11%) could not give any reason for their hospitalization. Among the 17 patients whose report was discordant with their chart, 12 (71%) reported a different organ system than was recorded in the chart. A significant proportion of medical inpatients could not state their physicians' reason for admission. In addition, patients who identify a different reason for hospitalization than the chart often give a different organ system altogether. Providers should explore patient understanding of the reason for their hospitalization to facilitate communication and shared decision making.

  7. Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting.

    PubMed

    Schoenfisch, Ashley L; Pompeii, Lisa A; Myers, Douglas J; James, Tamara; Yeung, Yeu-Li; Fricklas, Ethan; Pentico, Marissa; Lipscomb, Hester J

    2011-12-01

    Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred. Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability. Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated. Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption. Copyright © 2011 Wiley Periodicals, Inc.

  8. Exploring the effect of sound and music on health in hospital settings: A narrative review.

    PubMed

    Iyendo, Timothy Onosahwo

    2016-11-01

    positive emotion, and decreasing the levels of stressful conditions. Whilst sound holds both negative and positive aspects of the hospital ecosystem and may be stressful, it also possesses a soothing quality that induces positive feelings in patients. Conceptualizing the nature of sound in the hospital context as a soundscape, rather than merely noise can permit a subtler and socially useful understanding of the role of sound and music in the hospital setting, thereby creating a means for improving the hospital experience for patients and nurses. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Academic Primer Series: Five Key Papers Fostering Educational Scholarship in Junior Academic Faculty.

    PubMed

    Chan, Teresa M; Gottlieb, Michael; Fant, Abra L; Messman, Anne; Robinson, Daniel W; Cooney, Robert R; Papanagnou, Dimitrios; Yarris, Lalena M

    2016-09-01

    Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers which outline education scholarship in the setting of academic contributions for emerging clinician educators. The authors conducted a consensus-building process to generate a list of key papers that describe the importance and significance of academic scholarship, informed by social media sources. They then used a three-round voting methodology, akin to a Delphi study, to determine the most useful papers. A summary of the five most important papers on the topic of academic scholarship, as determined by this mixed group of junior faculty members and faculty developers, is presented in this paper. These authors subsequently wrote a summary of these five papers and discussed their relevance to both junior faculty members and faculty developers. Five papers on education scholarship, deemed essential by the authors' consensus process, are presented in this paper. These papers may help provide the foundational background to help junior faculty members gain a grasp of the academic scholarly environment. This list may also inform senior faculty and faculty developers on the needs of junior educators in the nascent stages of their careers.

  10. Academic Primer Series: Five Key Papers Fostering Educational Scholarship in Junior Academic Faculty

    PubMed Central

    Chan, Teresa M.; Gottlieb, Michael; Fant, Abra L.; Messman, Anne; Robinson, Daniel W.; Cooney, Robert R.; Papanagnou, Dimitrios; Yarris, Lalena M.

    2016-01-01

    Introduction Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers which outline education scholarship in the setting of academic contributions for emerging clinician educators. Methods The authors conducted a consensus-building process to generate a list of key papers that describe the importance and significance of academic scholarship, informed by social media sources. They then used a three-round voting methodology, akin to a Delphi study, to determine the most useful papers. Results A summary of the five most important papers on the topic of academic scholarship, as determined by this mixed group of junior faculty members and faculty developers, is presented in this paper. These authors subsequently wrote a summary of these five papers and discussed their relevance to both junior faculty members and faculty developers. Conclusion Five papers on education scholarship, deemed essential by the authors’ consensus process, are presented in this paper. These papers may help provide the foundational background to help junior faculty members gain a grasp of the academic scholarly environment. This list may also inform senior faculty and faculty developers on the needs of junior educators in the nascent stages of their careers. PMID:27625714

  11. Changing Environment and the Academic Medical Center: The Johns Hopkins Hospital.

    ERIC Educational Resources Information Center

    Heyssel, Robert M.

    1989-01-01

    Johns Hopkins Hospital expanded its health care delivery capabilities and strengthened its position in the marketplace by acquisitions of and mergers with other hospitals and a health maintenance organization. The resulting conglomerate has achieved its goals of expanding patient care, broadening the patient base, and enlarging the asset base and…

  12. Academic disintegrity among medical students: a randomised response technique study.

    PubMed

    Mortaz Hejri, Sameh; Zendehdel, Kazem; Asghari, Fariba; Fotouhi, Akbar; Rashidian, Arash

    2013-02-01

    Medical students, as tomorrow's doctors, are responsible for their patients' health; cheating may affect their academic knowledge and clinical skills. The main purpose of this study was to investigate the frequency of and attitudes towards academic disintegrity among medical students at Tehran University of Medical Sciences (TUMS). Anonymous questionnaires including questions about various types of academic disintegrity were distributed among medical students during the clerkship and internship phases of the curriculum. Randomised response technique (RRT) was used to maintain the responders' privacy. Because the study design guaranteed the confidentiality of respondents, the TUMS Institutional Review Board declared that formal ethical approval was not required. A total of 124 students were enrolled in this study, of whom 63 were in the clerkship phase and 61 were in the internship phase. Of these respondents, 29% (n = 36) were male. The most frequently reported type of academic disintegrity was found to be 'impersonating an absent student in a class' (93%) and the least frequent to be 'legitimising absences by using bribes' (5%). Only a small number of interns considered 'buying hospital shifts', 'selling hospital shifts', 'impersonating an absent student' and 'helping others to cheat in examinations' as representing academic disintegrity. Approximately one third of participants stated that the RRT increased their confidence in anonymity and 90% of students found the use of RRT not difficult. Academic integrity is widely disrespected in different ways among medical students. Effective policies and interventions are required to control these misbehaviours in future doctors in order to optimise medical practice. Almost all respondents found it not difficult to use the RRT; the technique proved to be an effective and easily applied method of eliciting truthful responses to sensitive questions and represents an alternative to conventional anonymising techniques.

  13. Applying Classification Trees to Hospital Administrative Data to Identify Patients with Lower Gastrointestinal Bleeding

    PubMed Central

    Siddique, Juned; Ruhnke, Gregory W.; Flores, Andrea; Prochaska, Micah T.; Paesch, Elizabeth; Meltzer, David O.; Whelan, Chad T.

    2015-01-01

    Background Lower gastrointestinal bleeding (LGIB) is a common cause of acute hospitalization. Currently, there is no accepted standard for identifying patients with LGIB in hospital administrative data. The objective of this study was to develop and validate a set of classification algorithms that use hospital administrative data to identify LGIB. Methods Our sample consists of patients admitted between July 1, 2001 and June 30, 2003 (derivation cohort) and July 1, 2003 and June 30, 2005 (validation cohort) to the general medicine inpatient service of the University of Chicago Hospital, a large urban academic medical center. Confirmed cases of LGIB in both cohorts were determined by reviewing the charts of those patients who had at least 1 of 36 principal or secondary International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) diagnosis codes associated with LGIB. Classification trees were used on the data of the derivation cohort to develop a set of decision rules for identifying patients with LGIB. These rules were then applied to the validation cohort to assess their performance. Results Three classification algorithms were identified and validated: a high specificity rule with 80.1% sensitivity and 95.8% specificity, a rule that balances sensitivity and specificity (87.8% sensitivity, 90.9% specificity), and a high sensitivity rule with 100% sensitivity and 91.0% specificity. Conclusion These classification algorithms can be used in future studies to evaluate resource utilization and assess outcomes associated with LGIB without the use of chart review. PMID:26406318

  14. An academic medical center's response to widespread computer failure.

    PubMed

    Genes, Nicholas; Chary, Michael; Chason, Kevin W

    2013-01-01

    As hospitals incorporate information technology (IT), their operations become increasingly vulnerable to technological breakdowns and attacks. Proper emergency management and business continuity planning require an approach to identify, mitigate, and work through IT downtime. Hospitals can prepare for these disasters by reviewing case studies. This case study details the disruption of computer operations at Mount Sinai Medical Center (MSMC), an urban academic teaching hospital. The events, and MSMC's response, are narrated and the impact on hospital operations is analyzed. MSMC's disaster management strategy prevented computer failure from compromising patient care, although walkouts and time-to-disposition in the emergency department (ED) notably increased. This incident highlights the importance of disaster preparedness and mitigation. It also demonstrates the value of using operational data to evaluate hospital responses to disasters. Quantifying normal hospital functions, just as with a patient's vital signs, may help quantitatively evaluate and improve disaster management and business continuity planning.

  15. The Construction of Academic Identity in the Changes of Finnish Higher Education

    ERIC Educational Resources Information Center

    Ylijoki, Oili-Helena; Ursin, Jani

    2013-01-01

    This article sets out to explore how academics make sense of the current transformations of higher education and what kinds of academic identities are thereby constructed. Based on a narrative analysis of 42 interviews with Finnish academics, nine narratives are discerned, each providing a different answer as to what it means to be an academic in…

  16. Academic Blogging: Academic Practice and Academic Identity

    ERIC Educational Resources Information Center

    Kirkup, Gill

    2010-01-01

    This paper describes a small-scale study which investigates the role of blogging in professional academic practice in higher education. It draws on interviews with a sample of academics (scholars, researchers and teachers) who have blogs and on the author's own reflections on blogging to investigate the function of blogging in academic practice…

  17. The Prehospital Sepsis Project: out-of-hospital physiologic predictors of sepsis outcomes.

    PubMed

    Baez, Amado Alejandro; Hanudel, Priscilla; Wilcox, Susan Renee

    2013-12-01

    Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis. This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the .05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI). Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P = .003) and OR 4.81 (CI, 1.16-21.01; P = .0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P = .39; HR >90: P = .60; RR >20 P = .11; SI >0.7 P = .35). This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.

  18. Does user-centred design affect the efficiency, usability and safety of CPOE order sets?

    PubMed Central

    Chan, Julie; Shojania, Kaveh G; Easty, Anthony C

    2011-01-01

    Background Application of user-centred design principles to Computerized provider order entry (CPOE) systems may improve task efficiency, usability or safety, but there is limited evaluative research of its impact on CPOE systems. Objective We evaluated the task efficiency, usability, and safety of three order set formats: our hospital's planned CPOE order sets (CPOE Test), computer order sets based on user-centred design principles (User Centred Design), and existing pre-printed paper order sets (Paper). Participants 27staff physicians, residents and medical students. Setting Sunnybrook Health Sciences Centre, an academic hospital in Toronto, Canada. Methods Participants completed four simulated order set tasks with three order set formats (two CPOE Test tasks, one User Centred Design, and one Paper). Order of presentation of order set formats and tasks was randomized. Users received individual training for the CPOE Test format only. Main Measures Completion time (efficiency), requests for assistance (usability), and errors in the submitted orders (safety). Results 27 study participants completed 108 order sets. Mean task times were: User Centred Design format 273 s, Paper format 293 s (p=0.73 compared to UCD format), and CPOE Test format 637 s (p<0.0001 compared to UCD format). Users requested assistance in 31% of the CPOE Test format tasks, whereas no assistance was needed for the other formats (p<0.01). There were no significant differences in number of errors between formats. Conclusions The User Centred Design format was more efficient and usable than the CPOE Test format even though training was provided for the latter. We conclude that application of user-centred design principles can enhance task efficiency and usability, increasing the likelihood of successful implementation. PMID:21486886

  19. Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature.

    PubMed

    Gallagher, James; McCarthy, Suzanne; Byrne, Stephen

    2014-12-01

    Clinical and cost-effectiveness evidence are needed to justify the existence or extension of routine clinical pharmacy services in hospital settings. Previous reviews have indicated that clinical pharmacist interventions are likely to have a positive economic impact on hospital budgets but highlighted issues relating to the quality of studies. The primary aim of this review was to feature economic evaluations of clinical pharmacy services which targeted hospital inpatients. The review focused on the current cost-effectiveness status of different services, in addition to evaluating the quality of individual studies. Results of this systematic review were compared with cost-effectiveness and quality related findings of reviews which considered earlier time frames and alternative settings. A systematic review of the literature included a review of the following databases: Academic Search Complete, Cochrane Library, EconLit, Embase Elsevier, NHS Economic Evaluation Database and PubMed. Only studies with an economic assessment of a clinical pharmacy service provided in a hospital setting were included. Data relating to the cost-effectiveness was extracted from eligible studies. Methodologies employed and overall quality of the studies was also reviewed. A grading system was applied to determine the quality of studies. Consolidated Health Economic Evaluation Reporting Standards statement was employed to determine which aspects of a high quality health economic study were employed. Twenty studies were deemed eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15 %) were deemed to be "good-quality" studies. No 'novel'clinical pharmacist intervention was identified during the course of this review. Clinical pharmacy interventions continue to provide cost savings. However, the standard of studies published has stagnated or even deteriorated in comparison with those included in previous reviews. Utilisation

  20. A Reengineered Hospital Discharge Program to Decrease Rehospitalization

    PubMed Central

    Jack, Brian W.; Chetty, Veerappa K.; Anthony, David; Greenwald, Jeffrey L.; Sanchez, Gail M.; Johnson, Anna E.; Forsythe, Shaula R.; O'Donnell, Julie K.; Paasche-Orlow, Michael K.; Manasseh, Christopher; Martin, Stephen; Culpepper, Larry

    2009-01-01

    Background: Emergency department visits and rehospitalization are common after hospital discharge. Objective: To test the effects of an intervention designed to minimize hospital utilization after discharge. Design: Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card. Setting: General medical service at an urban, academic, safety-net hospital. Patients: 749 English-speaking hospitalized adults (mean age, 49.9 years). Intervention: A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. Measurements: Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers′ follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment. Results: Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed. Limitation: This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome