Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia.

INTRODUCTION: Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant. RESULTS: Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46-18.58]; p = 0.01. CONCLUSION: The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation.

OBJECTIVE: To identify variables associated with early nasal continuous positive airway pressure (ENCPAP) failure in preterm neonates less than 30 weeks gestational age. STUDY DESIGN: Multicenter prospective study including 131 preterm newborns, over a period of 2 years. Patients and respiratory variables were assessed using univariate analysis. RESULT: Variables associated with ENCPAP failure were: the need of resuscitation with a FiO(2)>0.30; a CPAP pressure of 6.4±1.2 cm H(2)O; the need of a FiO(2) of 0.40 in the first 4 h of life; male gender maintaining the need of a FiO(2)>0.25 in the first 4 h of life; and respiratory distress syndrome with criteria for surfactant administration. CONCLUSION: The need for oxygen in resuscitation and maintained in first hours of life, male gender, a CPAP pressure over 5 cm H(2)O and surfactant need are predictors of ENCPAP failure in preterm neonates 26 to 30 weeks gestational age.

Bronchopulmonary dysplasia: clinical practices in five Portuguese neonatal intensive care units.

UNLABELLED: With the advent of surfactant, prenatal corticosteroids (PNC) and advances in technology, the survival rate of extremely low birth weight (ELBW) infants has improved dramatically. Rates of bronchopulmonary dysplasia (BPD) vary widely among neonatal intensive care units (NICUs) and many studies using multiple interventions have shown some improvement in BPD rates. Implementing potentially better practices to reduce BPD has been an effort made over the last few decades. AIM: To compare five Portuguese NICUs in terms of clinical practices in very low birth weight (VLBW) infants, in order to develop better practices to prevent BPD. PATIENTS AND METHODS: 256 preterm neonates, gestational age (GA) <30 weeks and/or birthweight (BW) <1250g admitted to five Portuguese NICUs (centers 1 to 5) between 1st January 2004 and 31st December 2006, were studied. VLBW infants with major malformations, grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. We considered a practice to be improved as clinically significant whenever a decrease greater than 10% in the prevalence of BPD adjusted for the practice, GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW. RESULTS: The overall prevalence of BPD was 12.9%. Our results revealed that PNC use should be improved in centers 4 and 5; fluid policy in center 4; oxygen therapy and sepsis prevention in centers 1 and 2. Patent ductus arteriosus (PDA) treatment should be improved in center 2. CONCLUSION: The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs, according to each NICU, must be addressed to increase the prescription of PNC, to use a lower FiO2, to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis. It is necessary to follow guidelines, recommendations or protocols to improve quality in the prevention of BPD.

Team dynamics and team empowerment in health care organizations.

BACKGROUND: Despite the growing pervasiveness of team-based job designs in health care organizations, there is a degree of uncertainty and ambiguity about the process through which teams affect outcomes. PURPOSE: This research adds to our understanding of the process by which team dynamics affects team member attitudes. It investigates the role of team empowerment as a mediator in the relationships between team context, team atmosphere, job satisfaction, and organizational commitment. METHODOLOGY: Multiple regression analysis is used to test for the mediating effect of team empowerment in the relationships that team context and team atmosphere have with job satisfaction and organizational commitment. FINDINGS: Team empowerment mediates the relationships of team context and team atmosphere with job satisfaction and organizational commitment. PRACTICE IMPLICATIONS: Although adopting team-based job designs is an important first step, attention must also be paid to the context and atmosphere of such teams. Better outcomes will be achieved when team members perceive a supportive team atmosphere and an empowering team context with clear and jointly developed goals, an appropriate mix of skills and expertise, and rewards linked to team performance.

Service collaboration and hospital cost performance: direct and moderating effects.

BACKGROUND: Growing reliance on service provision through systems and networks creates the need to better understand the nature of the relationship between service collaboration and hospital performance and the conditions that affect this relationship. OBJECTIVE: We examine 1) the effects of service provision through health systems and health networks on hospital cost performance and 2) the moderating effects of market conditions and service differentiation on the collaboration-cost relationship. RESEARCH DESIGN: We used moderated regression analysis to test the direct and moderating effects. Data on 1368 private hospitals came from the 1998 AHA Annual Survey, Medicare Cost Reports, and Solucient. MEASURES: Service collaboration was measured as the proportion of hospital services provided at the system level and at the network level. Market conditions were measured by the levels of managed care penetration and competition in the hospital's market. RESULTS: The proportion of hospital services provided at the system level had a negative relationship with hospital cost. The relationship was curvilinear for network use. Degree of managed care penetration moderated the relationship between network-based collaboration and hospital cost. CONCLUSION: The benefits of service collaboration through systems and networks, as measured by reduced cost, depend on degree of collaboration rather than mere membership. In loosely structured collaborations such as networks, costs reduce initially but increase later as the extent of collaboration increases. The effect of network-based collaboration is also tempered by managed care penetration. These effects are not seen in more tightly integrated forms such as systems.

Ethics orientation as a mediator of organizational integrity in health services organizations.

Increasing scrutiny of ethical misconduct by federal and state agencies has prompted health services organizations to adopt codes of ethics and institute legal compliance programs. However, there is little understanding of the impact of ethics programs or the manner in which program elements act to enhance organizational integrity. This study examined the effect of five ethics program elements on organizational integrity and the mediating role played by ethics orientation in this relationship. It found that program elements influence organizational integrity by engendering among employees a values orientation, a compliance orientation, or both. Furthermore, program elements that induced both orientations have a larger impact on integrity. These findings have important implications for health services managers involved in designing and implementing an ethics program.

Correlates of hospital provision of prevention and health promotion services.

This study investigates the factors associated with hospital provision of prevention and health promotion services. The authors conceptualize the provision of these services as a hospital response to the community health concerns of environmental stakeholders. The response depends on hospital recognition and interpretation of institutional and resource dependence pressures and is related to interorganizational linkages, resource dependencies, and information processing structure. Data for the study came from 3,453 U.S. hospitals. The authors found that hospital provision of prevention and health promotion services is positively related to alliance and network membership, the diffusion of such services among other area hospitals, the use of community health status information, and hospital size. Also, for-profit hospitals provide fewer prevention and health promotion services than not-for-profit hospitals. These findings have policy and management implications.

A stakeholder approach to community health management.

Although community health management has become an important issue for health care organizations, there is little information on the roles that they and other community institutions ought to play in this area. This article develops a stakeholder approach to community health management, identifies the set of community health stakeholders, determines their salience to health care organizations, discusses the strategies they use to influence organizational involvement in community health management, and examines the responses of health care organizations. Implications for community institutions, health care managers, and researchers are discussed.

[Dysgenetic male pseudohermaphroditism]. / Pseudohermafroditismo masculino disgenético.

Dysgenetic male pseudohermaphroditism is the result of a defect of testis development that encompasses a large clinical heterogeneity. It is characterized by bilateral dysgenetic testis, absence of mullerian regression, ambiguous genitalia and/or stigmata of Turner's syndrome in the majority of the cases. Typically, these individuals have either a 46,XY or 45,X/46,XY karyotype. The authors present four cases of dysgenetic male psudohermaphroditism, with ages of diagnosis between 1 month and 17 years old. The first had a male phenotype with stigmata of Turner's syndrome and the others ambiguous genitalia. Two patients were 45,X/46,XY and 45X/47,XYY mosaics and the other two were 46,XY. Gonadal karyotyping showed mosaicism (45,X/46,XY) in all four cases. In the first case was programed orquidectomy; all the others assigned a male gender, with regular follow-up until the puberty.

Community orientation in hospitals: an institutional and resource dependence perspective.

OBJECTIVE: To conceptualize community orientation-defined as the generation, dissemination, and use of community health-need intelligence-as a strategic response to environmental pressures, and to test a theoretically justified model of the predictors of community orientation in hospitals. DATA SOURCES: The analysis used data for 4,578 hospitals obtained from the 1994 and 1995 American Hospital Association (AHA) Annual Survey and the 1994 Medicare Hospital Cost Report data sets. Market-level data came from the Area Resource File. STUDY DESIGN: Multiple regression analysis was used to examine the effects of hospital size, dependence on managed care, ownership, network, system and alliance memberships, and level of diffusion of community-orientation practices in the area on the degree of community orientation in hospitals. The model, based on Oliver's (1991) framework of organizational responsiveness to environmental pressures, controlled for the effects of industry concentration and lagged profitability. PRINCIPAL FINDINGS: Degree of community orientation is significantly related to hospital size; ownership; dependence on managed care; and membership in a network, system, or alliance. It is also significantly related to the diffusion of community-orientation practices among other area hospitals. CONCLUSIONS: Degree of community orientation is influenced by the nature of environmental pressures and by hospital interests. It is higher in hospitals that are large, nonprofit, or members of a network, system, or alliance; in hospitals that are more dependent on managed care; and in hospitals that operate in areas with higher diffusion of community-orientation activities.

Employee reactions to managed care.

Employee reactions to managed care get less managerial and research attention than organizational reactions to it. This article examines the manner in which health services employees react to managed care and finds that their reaction affects perceived job insecurity, organizational commitment, and job satisfaction. Organization-based self-esteem, role conflict, and supervisory support moderate these relationships. The managerial implications of these findings are discussed.

Community orientation in health services organizations: the concept and its implementation.

The management of community health needs has become a focal point in the drive to contain health care costs, enhance service quality, and improve access to care. This article presents a concept of community orientation that health services organizations can use to provide community-focused care. It also discusses the organizational antecedents and consequences of community orientation in health services organizations and develops research propositions.

Clinical decision making--what every non-clinician manager should know but was never taught.

The management of a health care system requires making decisions and establishing policies that can affect the process of patient care. Clinicians often complain that these decisions and policies are made by people without clinical training. Clinical knowledge is not a prerequisite for a career in health policy or management. Even graduates of accredited health administration programs are not required to understand the process of clinical decision making or the nature of medical practice. Much of the health services literature advocates a shared decision-making model for clinicians and managers. However, most of the literature focuses on how to involve physicians in management decision making; almost none discusses management involvement in clinical decisions. This paper briefly examines how non-clinician managers can support the clinical decision-making process and then specifies the knowledge and skills required for them to play this role.

Organizational tenure and the perceived importance of retention factors in nursing homes.

Health care organizations can avoid substantial turnover costs through retention strategies geared to the varying needs of employees. The study on which this article is based examined retention needs of registered nurses in nursing homes and found that they varied by tenure. Low tenure nurses preferred learning opportunities and advancement potential while high tenure nurses favored work flexibility. Implications for retention policy in nursing homes are discussed.

Adoption of a time-based competition paradigm into the health care industry.

Market and regulatory pressures are requiring health care organizations to find new ways to compete. This article introduces the concept of time-based competition, a strategy adopted by firms in the manufacturing sector to strengthen their competitive positions, as a new strategy for health care organizations. The Just-in-Time technique and set-up time reduction activities are used to demonstrate the adoption of this paradigm by health care organizations. A case study comparing the movement of elderly patient through the health care delivery system under traditional and time-based competition practices is used to illustrate gains from adopting the new paradigm.

Attracting RNs to nursing homes: nurses' work experience and perceived importance of organization and job attributes.

Applicant attraction theories stipulate that employment inducements be customized to meet the desires and specific characteristics of potential applicants. This study examined the relationship between nurses' level of work experience and perceived importance of organization and job attributes in attracting them to nursing home jobs. Importance ratings of recruitment factors varied significantly by nurses' level of work experience. Unique variation was attributed to education opportunities, potential for career advancement, compensation issues, benefits, and work flexibility.

Market orientation and organizational culture in hospitals.

Hospitals have been advised to respond to environmental pressures by changing from a product to a market orientation. Such changes are difficult to accomplish because of the entrenched behaviors and attitudes of hospitals employees. This article proposes organizational cultures as the avenue to a market orientation. It describes the role of hospital culture as an antecedent to market orientation. It also suggests ways to develop and maintain a market-oriented culture in hospitals.

[The imaging of malignant pancreatic tumors]. / Imagiologia dos tumores malignos do pâncreas.

Malignant neoplasias of the pancreas include various histological types with imaging characteristics and behaviour which allows them to be distinguished from one another in a good percentage of situations. However, differentiation is not always possible without resorting to anatomo-pathological techniques, differential diagnosis with benign lesions being a great challenge to imaging, with particular reference to the inflammatory masses. Adenocarcinoma makes up about 95% of pancreatic neoplasias and is one of the great causes of death by cancer in developed countries. The imaging techniques applied in the diagnosis and staging of the principal tumours of the pancreas are very diversified, including innocuous means such as ultrasound, invasive methods using angiographic techniques or the recourse to endoscopic means to endocavity assessment. The use of each of these techniques depends essentially on the type of tumor to be studied, the correct and complete knowledge of the possibilities and limitations of each one, becomes fundamental in what concerns the rational application of means in the imaging of the pancreas.