Infant Oral Candidiasis and Bottle Cleaning Methods: A Descriptive Study.

As manufacturers produce bottles with additional parts, such as an anticolic straw, cleaning time increases. Increased cleaning time potentially decreases cleaning effectiveness and, thus, increases the chance for thrush. This study explored the relationship between the number of bottle parts and cleaning methods for bottle-fed-only infants (<13 months) presenting with oral candidiasis. After obtaining demographic information on eligible infants (via parental consent) from the chart, caregivers of 60 infants verbally completed a questionnaire. The questionnaire elicited information about the preferred bottle for feeding, number of parts, washing frequency, washing method, drying method, sterilization frequency, and sterilization method. The χ2 test, and Fisher's exact test when necessary, was performed to examine the relationship between each reported cleaning method (washing, drying, and sterilization) compared with the number of bottle parts (≤3 or ≥4). The number of bottle parts showed no association with bottle cleaning methods (p > .05). Although there were no statistically significant relationships, trends did present that warrant investigation. Future studies to confirm recommended practices for cleaning methods and identify those at risk from demographic data could positively affect the health of bottle-fed infants by reducing the occurrence of thrush.

Leadership and management principles for outcomes-oriented organizations.

Outcomes and effectiveness research has provided a wealth of information about interventions that can improve patient experience and outcomes. The challenges facing healthcare leaders today highlight the need for new research on how leadership and management principles can enable healthcare providers and systems to deploy this knowledge swiftly and effectively. The Baldrige National Quality Program (BNQP) is an education and award program established by the U.S. Congress in 1987 that supports American businesses seeking to improve product and service quality, customer and workforce satisfaction, efficiency, financial results, and overall capacity to perform and respond to changing circumstances. Award recipients show a constellation of strengths that suggest that certain basic leadership and management practices are correlated with a fundamental ability to achieve desired results. This article describes characteristics of highly effective organizations based on a review of Baldrige Award recipients, focuses on the application of these characteristics to healthcare settings, illustrates their application with best practices from SSM Health Care, the first-ever healthcare recipient in 2002, and presents several priorities for outcomes and effectiveness research to inform healthcare leadership and administration.

Quality improvement and the need for IRB review.

Improving health care quality is increasingly recognized as a national priority in the United States. As a result, more and more health care organizations can be expected to undertake quality improvement (QI) initiatives. A question being raised with increasing frequency is: "Which QI activities need review by an institutional review board (IRB)?" Structured data collection and analysis is a common characteristic of most QI activities. For some QI projects, the fundamental goal is improved understanding of phenomena presumed to be generalizable to settings other than those directly studied. These activities are research. For other projects, the fundamental goal is improvement in specific processes and systems within specific organizations. These activities are not research. This article proposes that this difference in intent and the fundamental nature of the activity is crucial in deciding which QI initiatives need IRB review. The article presents test questions and markers to distinguish research from other types of QI activities. Those that are not research do not require IRB review. However, because such activities may still put patients at risk, some other review may be necessary. The article proposes five levels of risk and makes recommendations for review by an entity other than the IRB.