Organizational cultures that support community: Does the competing values framework help us understand experiences of community at work?

Recent evidence has shown that when employees experience perceptions of community at work (i.e., a sense of community and a sense of community responsibility), psychological well-being and behavioral engagement improve (e.g., greater job engagement, organizational citizenship, and leadership). Recent evidence also shows that experiences of community, as a motivational state, are better able to predict employee outcomes compared to a series of factors that have long been studied in the general management (i.e., affective organizational commitment, organizational identity) and in the public management literature (i.e., public service motivation). However, we know less about the conditions that lead to perceptions of community experiences at work. One recent qualitative investigation exposed a series of organizational conditions that appear to stimulate perceptions of community at work including C-Suite leadership support, organizational structure and context, characteristics of connection, managerial, job, and work unit characteristics, and responsibilities of human resource management professionals. The present study extends this study by empirically investigating organizational cultural conditions that are associated with perceptions of community at work. We test the ability of the Competing Values Framework, which includes constructs of Hierarchy, Market, Adhocracy, and Clan organizational cultures, and their ability to predict perceptions of the community. Findings showed that clan culture was most associated with perceptions of community in general and that clan culture within a department plays an important role in perceiving community at work. This study helps scholars understand cultural conditions that can lead to psychological experiences of community, it begins to frame cultural factors that scholars can empirically test in future studies, and it assists executives and managers in conceiving approaches to building cultures of community at work.

Building community at work: An exploratory study in healthcare system management.

Recent scholarship has demonstrated that experiences in the community (i.e., a sense of community [SOC] and a SOC responsibility) can enhance employee psychological and behavioral outcomes. Recent evidence also shows that the experiences of the community are better able to predict employee outcomes compared to long-regarded management and public management constructs. However, very little empirical evidence exists on antecedent conditions that help build community experiences at work. To evaluate this gap, we conducted interviews with executive leaders, and focus groups with administrative leaders, across four major facilities in a large nonprofit healthcare system that is headquartered in Pennsylvania, United States. The study confirmed the propositions of the Community Experience Model, and explored organizational conditions that appear to build community experiences. The findings help frame factors that scholars can empirically test in future studies, and assist executives, human resource professionals, and managers throughout an organization, in building community at work.

A Coala-T-Cannabis Survey Study of breast cancer patients' use of cannabis before, during, and after treatment.

BACKGROUND: The goal of this study was to characterize cannabis use among patients with breast cancer, including their reasons for and timing of use, their sources of cannabis information and products, their satisfaction with the information found, their perceptions of its safety, and their dialogue about cannabis with their physicians. METHODS: United States-based members of the Breastcancer.org and Healthline.com communities with a self-reported diagnosis of breast cancer within 5 years (age ≥ 18 years) were invited to participate in an anonymous online survey. After informed consent was obtained, nonidentifiable data were collected and analyzed. RESULTS: Of all participants (n = 612), 42% (n = 257) reported using cannabis for relief of symptoms, which included pain (78%), insomnia (70%), anxiety (57%), stress (51%), and nausea/vomiting (46%). Furthermore, 49% of cannabis users believed that medical cannabis could be used to treat cancer itself. Of those taking cannabis, 79% had used it during treatment, which included systemic therapies, radiation, and surgery. At the same time, few (39%) had discussed it with any of their physicians. CONCLUSIONS: A significant percentage of survey participants (42%) used cannabis to address symptoms; approximately half of these participants believed that cannabis could treat cancer itself. Most participants used cannabis during active cancer treatment despite the potential for an adverse event during this vulnerable time. Furthermore, most participants believed that cannabis was safe and were unaware that product quality varied widely and depended on the source. This study reviews the research on medicinal cannabis in the setting of these findings to help physicians to recognize its risks and benefits for patients with cancer. LAY SUMMARY: Almost half of patients with breast cancer use cannabis, most commonly during active treatment to manage common symptoms and side effects: pain, anxiety, insomnia, and nausea. However, most patients do not discuss cannabis use with their physicians. Instead, the internet and family/friends are the most common sources of cannabis information. Furthermore, most participants believe that cannabis products are safe and are unaware that the safety of many products is untested.

Racial and socioeconomic disparities in breast cancer diagnosis and mortality in Pennsylvania.

PURPOSE: Many studies have demonstrated disparities in breast cancer (BC) incidence and mortality among Black women. We hypothesized that in Pennsylvania (PA), a large economically diverse state, BC diagnosis and mortality would be similar among races when stratified by a municipality's median income. METHODS: We collected the frequencies of BC diagnosis and mortality for years 2011-2015 from the Pennsylvania Cancer Registry and demographics from the 2010 US Census. We analyzed BC diagnoses and mortalities after stratifying by median income, municipality size, and race with univariable and multivariable logistic regression models. RESULTS: In this cohort, of 5,353,875 women there were 54,038 BC diagnoses (1.01% diagnosis rate) and 9,828 BC mortalities (0.18% mortality rate). Unadjusted diagnosis rate was highest among white women (1.06%) but Black women had a higher age-adjusted diagnosis rate (1.06%) than white women (1.02%). Race, age and income were all significantly associated with BC diagnosis, but there were no differences in BC diagnosis between white and Black women across all levels of income in the multivariable model. BC mortality was highest in Black women, a difference which persisted when adjusted for age. Black women 35 years and older had a higher mortality rate in all income quartiles. CONCLUSION: We found that in PA, age, race and income are all associated with BC diagnosis and mortality with noteworthy disparities for Black women. Continued surveillance of differences in both breast cancer diagnosis and mortality, and targeted interventions related to education, screening and treatment may help to eliminate these socioeconomic and racial disparities.

Outcomes of Abbreviated MRI (Ab-MRI) for Women of any Breast Cancer Risk and Breast Density in a Community Academic Setting.

BACKGROUND: Abbreviated magnetic resonance imaging (Ab-MRI) has been evaluated for elevated breast cancer risk or dense breasts but has not been evaluated across all risk profiles. METHODS: Patients selected underwent Ab-MRI from February 2020 to September 2021. Women were older than aged 30 years, up to date with screening mammography, and paid $299 cash. RESULTS: A total of 93 patients were identified with a mean age of 52 years; 92.5% were Caucasian, 0% black, and 97.9% were from high socioeconomic status. Mean Gail score was 14.2, and 83.3% had a lifetime risk of breast cancer <20%. Reasons for Ab-MRI: dense breasts (36.6%); family history (24.7%); palpable mass (12.9%). Providers ordering: OBGYN (49.5%); breast surgeon (39.1%); primary care (6.6%). Thirteen biopsies (14%) detected one breast cancer. 31.1% had a change in follow-up screening: 58.6% 6-month MRI, 20.7% 6-month mammogram, and 10.3% 6-month ultrasound. Negative predictive value was 100% (95% confidence interval [CI]: 95-100%, p < 0.0001). Sensitivity was 100% (95% CI: 2.5-100%, p < 0.0001), and specificity was 87% (95% CI: 78.3-93.1%, p < 0.0001) compared with 77.6% and 98.8% for mammography. Only one cancer was detected: cost of $27,807 plus cost of 13 MRI or ultrasound (US)-guided biopsies and additional follow-up imaging. Historically 20% of abnormalities detected on full MRI are malignant; however, 7.7% of ab-MRI abnormalities were malignant CONCLUSIONS: One third of women were recommended a change in follow-up, which predominantly included a 6-month MRI. Ab-MRI may introduce average risk women to unnecessary follow-up and increased biopsies with a lower cancer detection rate. Ab-MRI should be evaluated closely before implementation.

Metabolic Syndrome: does this influence breast cancer outcomes in the triple-negative population?

INTRODUCTION: Metabolic syndrome (MS) is defined by having at least 3 of 4 components: obesity, dyslipidemia, hypertension (HTN), and diabetes. Prior studies analyzed the individual components of MS for all breast cancers which are predominantly hormone positive. Our study is the first to evaluate MS in triple-negative breast cancer (TNBC). METHODS: A retrospective review of TNBC from 2007 to 2013 identified 177 patients with complete information for statistical analysis. Cox proportional hazards models were used to test the association between MS, disease-free survival (DFS), and overall survival (OS). RESULTS: 48 (27%) patients had MS. After controlling for age, race, pathologic stage, surgery type, and additional comorbidities outside of MS, MS was significantly associated with poorer DFS (adjusted HR: 2.24, p = 0.030), but not associated with OS (adjusted HR: 1.92, p = 0.103). HTN was significantly associated with poorer DFS (adjusted HR: 3.63, p = 0.006) and OS (adjusted HR: 3.45, p = 0.035) in the univariable and multivariable analyses. Diabetes was not associated with worse OS or DFS. The 5-year age-adjusted OS rates for 60-year-old patients with and without diabetes were 85.8% and 87.3%, respectively. The age-adjusted 5-year OS rate for 60-year old patients was higher in patients with a body mass index (BMI) > 30 (90.2%) versus BMIs of 25-29.9 (88.2%) or < 25 (83.5%). CONCLUSION: In the TNBC population, MS was significantly associated with poorer DFS, but not associated with OS. HTN was the only component of MS that was significantly associated with both DFS and OS. Obesity has a potential small protective benefit in the TNBC population.

Socio-Environmental Conditions Associated with Geospatial Clusters of Urothelial Carcinoma: A Multi-Institutional Analysis.

PURPOSE: The interaction between sources of industrial byproducts and environmental pollutants (IBP/EP) and the prevalence of urothelial carcinoma (UC) in surrounding communities has been infrequently explored. The purpose of this research is to identify microregional UC hotspots and associated industrial and environmental risk factors. MATERIALS AND METHODS: We retrospectively queried a multi-institutional database for UC patients diagnosed between 2008 and 2018. Addresses were geocoded and used to perform hotspot analysis on the census block level. Demographic and clinicopathological characteristics, census data and proximity to sources of IBP/EP were compared between patients who did vs did not reside in a hotspot. Associations were tested using multilevel logistic regression models using 95% confidence intervals. RESULTS: A total of 5,080 patients met inclusion criteria and 148 (2.9%) were identified as living in 1 of 3 UC hotspots. In univariate analyses, race, tobacco and alcohol use, household income, IBP/EP exposure and proximity to traffic, industrial discharge and airports were significantly associated with UC hotspots. Multivariable analysis demonstrated that polycyclic aromatic hydrocarbon exposure (OR: 48.09, p ≤0.001) and proximity to high-density traffic (OR: >999, p ≤0.001) increased the odds of living in a hotspot. Patients living in a hotspot were significantly less likely to be white (OR: 0.06, p ≤0.001) or tobacco users (OR: 0.39, p=0.031) on multivariate analysis. CONCLUSIONS: Spatially related clusters of UC may be associated with locoregional environmental exposures rather than tobacco exposure and may also be correlated with socioeconomic disparities. Geospatial analysis can help to identify at-risk populations, offering the opportunity to better focus preventive and diagnostic interventions.

COVID-19 Pandemic: Changes in Care for a Community Academic Breast Center and Patient Perception of Those Changes.

BACKGROUND: Philadelphia and its suburbs were an epicenter for the initial COVID-19 outbreak. Accordingly, alterations were made in breast cancer care at a community hospital. METHODS: The authors developed a prospective database of all the patients with invasive or in situ breast cancer between March 1 and June 15 at their breast center. Any change in a breast cancer plan due to the pandemic was documented, and the patients were grouped into two cohorts according to whether a change was made (CTX) or no change was made (NC) in their care. The patients were asked a series of questions about their care, including those in the Generalized Anxiety Disorder two-item questionnaire (GAD-2), via telephone. RESULTS: The study enrolled 73 patients: 41 NC patients (56%) and 32 CTX patients (44%). The two cohorts did not differ in terms of age, race, or stage. Changes included delay in therapy (15.1%) and use of neoadjuvant endocrine therapy (NET, 28.8%). The median time to surgery was 24 days (interequartile range [IQR], 16-45 days) for the NC patients and 82 day s (IQR, 52-98 days) for the CTX patients (p ≤ 0.001). The median duration of NET was 78 days. The GAD-2 showed anxiety positivity to be 29.6% for the CTX patients and 32.4% for the NC patients (p = 1.00). More than half (55.6%) of the CTX patients believed COVID-19 affected their treatment outlook compared with 25.7% of the NC patients (p = 0.021). CONCLUSIONS: A prospective database captured changes in breast cancer care at a community academic breast center during the initial phase of the COVID-19 pandemic. 44% of patients experienced a change in breast cancer care due to COVID-19. The same level of anxiety and depression was seen in both change in therapy (CTX) and no change (NC). 55.6% of CTX cohort believed COVID-19 affected their treatment outlook.

Repair of iatrogenic tracheal injury in acute respiratory failure with veno-venous extracorporeal membrane oxygenation.

Iatrogenic tracheal injuries are rare but potentially serious complications of endotracheal intubation that frequently require lung isolation to repair. This is not tolerated in patients with severe respiratory failure. We describe a case in a patient with acute respiratory distress syndrome, repaired using veno-venous extracorporeal membrane oxygenation.

Defining Major Depressive Disorder Cohorts Using the EHR: Multiple Phenotypes Based on ICD-9 Codes and Medication Orders.

BACKGROUND: Major Depressive Disorder (MDD) is one of the most common mental illnesses and a leading cause of disability worldwide. Electronic Health Records (EHR) allow researchers to conduct unprecedented large-scale observational studies investigating MDD, its disease development and its interaction with other health outcomes. While there exist methods to classify patients as clear cases or controls, given specific data requirements, there are presently no simple, generalizable, and validated methods to classify an entire patient population into varying groups of depression likelihood and severity. METHODS: We have tested a simple, pragmatic electronic phenotype algorithm that classifies patients into one of five mutually exclusive, ordinal groups, varying in depression phenotype. Using data from an integrated health system on 278,026 patients from a 10-year study period we have tested the convergent validity of these constructs using measures of external validation, including patterns of psychiatric prescriptions, symptom severity, indicators of suicidality, comorbidity, mortality, health care utilization, and polygenic risk scores for MDD. RESULTS: We found consistent patterns of increasing morbidity and/or adverse outcomes across the five groups, providing evidence for convergent validity. LIMITATIONS: The study population is from a single rural integrated health system which is predominantly white, possibly limiting its generalizability. CONCLUSION: Our study provides initial evidence that a simple algorithm, generalizable to most EHR data sets, provides categories with meaningful face and convergent validity that can be used for stratification of an entire patient population.

Cervical Cancer Patients' Willingness and Ability to Serve as Health Care Educators to Advocate for Human Papillomavirus Vaccine Uptake.

Human papillomavirus (HPV) causes nearly all cervical cancer. Only half of females and less than half of males receive the recommended HPV vaccine dose. This study explores whether cervical cancer patients may serve as health advocates to adolescents and their parents in encouraging the uptake of the HPV vaccine. The study targeted an opportunity sample of women seen in the gynecology oncology clinic with a diagnosis of cervical cancer. During interviews, patients were asked about the following: provider conversations regarding cervical cancer, knowledge of HPV and the vaccine, discussions with family or friends about the causes or prevention of cervical cancer, and whether they would be willing to talk with others about the HPV vaccine. Twenty-three interviews were conducted in 2016-2017. Patients ranged from 28 to 61 years of age. Four team members developed a coding list, then used these themes to code the interviews. Six themes resulted from the analysis of the transcripts: (1) Expressions of fears, questioning effectiveness of vaccine; (2) Low level of health literacy; (3) Acquiring health information from television, internet; (4) Provider conversations (with patients regarding HPV and the vaccine); (5) Patient stigma surrounding cervical cancer; (6) Patients' willingness to serve as a health care educator. While cervical cancer patients overall expressed a willingness to serve as health care educators, barriers remain. Low health literacy and a lack of understanding of the causes of cervical cancer persist. These issues will need to be addressed in order for cervical cancer patients to be effective advocates.

Burden of Multiple Chronic Conditions among Patients with Urological Cancer.

PURPOSE: We describe age, multiple chronic condition profiles and health system contact in patients with urological cancer. MATERIALS AND METHODS: Using Geisinger Health System electronic health records we identified adult primary care patients and a subset with at least 1 urology encounter between 2001 and 2015. The Agency for Health Care Research and Quality Chronic Condition Indicator and Clinical Classifications Software tools were applied to ICD-9 codes to identify chronic conditions. Multiple chronic conditions were defined as 2 or more chronic conditions. Patients with urological cancer were identified using ICD-9 codes for prostate, bladder, kidney, testis and penile cancer. Inpatient and outpatient visits in the year prior to the most recent encounter were counted to document health system contact. RESULTS: We identified 357,100 primary care and 33,079 urology patients, of whom 4,023 had urological cancer. Patients with urological cancer were older than primary care patients (71 vs 46 years) and they had more median chronic conditions (7 vs 4). Kidney and bladder cancer were the most common chronic conditions (median 8 patients each). Coronary artery disease and chronic kidney disease were common in urological cancer cases compared to mental health conditions in primary care cases. Patients with urological cancer who had multiple chronic conditions had the most health system contact, including 32% with at least 1 hospitalization and 68% with more than 5 outpatient visits during 1 year. CONCLUSIONS: Urology patients are older and more medically complex, especially those with urological cancer than primary care patients. These data may inform care redesign to reduce the treatment burden and improve care coordination in urological cancer cases.

Religiosity and behavioral health outcomes of adolescents living in disaster-vulnerable areas.

The influence of religiosity on behavioral health outcomes among adolescents living in disaster-prone areas has been understudied. This study utilized data from the National Survey on Drug Use and Health (2005-2010) to examine the relationship between religion, depression, marijuana use, and binge drinking. The sample included 12,500 adolescents residing in the Gulf Coast region of the USA. Results show that religious salience was directly related to depression, marijuana, and binge drinking. It was also indirectly related to both substance use outcomes through depression. Religious service attendance was unrelated to any of the outcomes. Implications of the findings are discussed.

What do cervical cancer patients know, how do they learn, and who do they tell? A pilot study.

BACKGROUND: This study explored what patients identified with cervical cancer know about the link between human papillomavirus (HPV) and cervical cancer and where they learned this information. Patients share a great deal of information with family, friends and colleagues and we were interested in the accuracy and sources of information they are sharing. METHODS: Patients identified through the EHR of a health system who had a history of cervical cancer were invited to participate in a brief survey of their experience. The sample represents an opportunity sample of patients who responded. RESULTS: Generally, these patients, drawn from the Geisinger Health System in central Pennsylvania, were older (mean 57.5 years), White, and about half had annual household income of $35 K. Among all respondents about 17% had not heard of HPV, 21% did not know about an HPV vaccine, and about 38% did not know about the link between HPV and cervical cancer. Most frequently patients reported obtaining their information about HPV from television advertisements. About half received information from their oncologist. Patients reported having conversations with families about their own cancer, the cause of their cancer and HPV vaccination. It is important to note that these conversations were supported by information from many sources. CONCLUSIONS: Patients may serve as a conduit for information about their condition and may be informal 'educators' in the community. It is important to make certain that these opportunities are informed by information obtained from trusted and accurate sources.

A Comparison of Emergency Room Visits and Hospital Admissions Between People with Prediabetes and Diabetes.

The purpose of this study was to characterize risk factors and groups at risk among people with diabetes and prediabetes for increased hospital utilization. Electronic health records for all people who visited the emergency department (ED) and had type II diabetes mellitus (PWD) or prediabetes (PWPD) were collected. ED use, hospital admissions, demographics, and clinical characteristics were compared between the groups. Multivariable logistic regression was used to compare the odds of ED high utilization (HU) (3+ visits per year) and hospital admissions between PWD and PWPD with interactions for socioeconomic status, race, marital status, and total comorbidities. PWD had higher mean ED visits per year compared with PWPD (1.5 vs. 1.2) and were more likely to be admitted (57.3% vs. 34.9%). PWD had higher odds of ED HU (2.1 [1.6, 2.7]) and hospital admissions (1.9 [1.6, 2.1]). Among PWD, Black, not married, and those with more than one comorbidity had the highest odds of ED HU. Among PWPD, those of low SES, Black, and divorced had the higher odds of ED HU. Hospital admissions were a risk for PWD and PWPD with increasing comorbidities. Early recognition and identification of prediabetes and clear criteria for diagnosis could reduce ED visits and hospital admissions.

African American Males Have More Distress During Cancer Treatment Than White Males.

African American (AA) males have a higher incidence and mortality rate for some cancers than other races and sexes, which could be associated with distress during treatment, medical mistrust, and health disparities. We hypothesize distress in AA males during treatment is higher than in other races and sexes. We assessed effect modification of moderate to severe (≥ 4) distress scores during cancer treatment by race and sex, age, and socioeconomic status (SES). National Comprehensive Cancer Network's distress thermometer (scale 0-10) and characteristics for 770 cancer patients were collected from a Philadelphia hospital. Variables included age, sex, race, smoking status, marital status, SES, comorbidities, mental health, period before and during COVID-19, cancer diagnosis, and stage. Descriptive statistics, chi-square tests, and t-tests were used to compare AA and White patients. Effect modification of ≥ 4 distress by race and sex, age, and SES were analyzed by logistic regression. A p value of ≤ .05 was significant, and 95% confidence intervals (CIs) were reported. On average, AA patients had a non-significant, higher distress score (4.53, SD = 3.0) than White patients (4.22, SD = 2.9) (p = .196). The adjusted odds ratio of ≥4 distress was 2.8 (95% CI [1.4, 5.7]) for AA males compared with White males. There was no significant difference between White and AA females, race and age, or race and SES. There was an effect modification of ≥4 distress by race and sex. AA males in cancer treatment had higher odds of ≥4 distress compared with White males.

Primary Palliative Care Education for Graduate Medical Trainees: Impacts and Needs.

As demand for palliative care (PC) services rise, there are insufficient numbers of PC specialists to provide PC for the US population. "Primary palliative care" refers to PC services that are administered by non-specialist PC providers. Educating trainees in graduate medical education (GME) programs is 1 strategy for expanding primary palliative care, though questions remain regarding the impact of PC education for GME trainees and where additional education is needed. This study is a multicenter, cross-sectional, web-based survey study of GME trainees assessing the needs for and impacts of primary palliative care education. The survey assessed the implementation of and participants' confidence with fundamental PC skills. The survey also asked about prior exposure to PC education and for participants' beliefs regarding areas that would be particularly helpful for future education. 170 residents and fellows from diverse training backgrounds participated in the survey out of 851 potential participants (response rate 19.98%). Exposure to PC education was associated with higher confidence and increased frequency of implementation of fundamental PC skills. Of the forms of education that were assessed, clinical/experiential education was associated most often with higher confidence and higher frequency of use of PC skills. Discussing goals of care, pain management for seriously ill patients, and communicating difficult information were those skills most frequently identified as important for additional training. This study demonstrates that by improving existing PC education or increasing access to PC education for GME trainees, it may be possible to improve primary palliative care.