Organizational Factors Associated With Quality Perinatal Care.

Perinatal care has been recognized as an integral part of ensuring quality health care in hospitals, and the focus on perinatal care quality is increasing. The previous hospital literature has focused much attention on measuring and improving quality of care generally, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting. The perinatal literature is limited in addressing the association between organizational factors and perinatal quality. Using chart audit data for more than 10 000 maternity patients, we used multiple regression analysis to examine the association of organizational factors and perinatal quality of care. Findings show that ownership, setting (location), and hospital policy on infant feeding were statistically significant. Findings suggest that it is important that hospital boards and leaders develop and implement organizational policies to enhance perinatal quality of care.

Laser-heating system for high-pressure X-ray diffraction at the Extreme Conditions beamline I15 at Diamond Light Source.

In this article, the specification and application of the new double-sided YAG laser-heating system built on beamline I15 at Diamond Light Source are presented. This system, combined with diamond anvil cell and X-ray diffraction techniques, allows in situ and ex situ characterization of material properties at extremes of pressure and temperature. In order to demonstrate the reliability and stability of this experimental setup over a wide range of pressure and temperature, a case study was performed and the phase diagram of lead was investigated up to 80 GPa and 3300 K. The obtained results agree with previously published experimental and theoretical data, underlining the quality and reliability of the installed setup.

Going Beyond Compliance: A Strategic Framework for Promoting Information Security in Hospitals.

In the past decade, public and private organizations have experienced a significant and alarming rise in the number of data breaches. Across all sectors, there seems to be no safe haven for the protection of information. In the health care industry, the trend is even worse. Information security is at an unbelievable low point, and it is unlikely that government oversight can fix this issue. Health care organizations have ramped up their approaches to addressing the problem; however, these initiatives are often incremental rather than transformational. Hospitals need an overall organization-wide strategy to prevent breaches from occurring and to minimize effects if they do occur. This article provides an analysis of the literature related to health information security and offers a suggested strategy for hospital administrators to follow in order to create a more secure environment for patient health information.

Hospital Acquisitions Before Healthcare Reform.

The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.

Early Careerist Interest and Participation in Health Care Leadership Development Programs.

Health care organizations are increasingly embracing leadership development programs. These programs include a variety of specific activities, such as formally structured leadership development, as well as mentoring, personal development and coaching, 360-degree feedback, and job enlargement, in order to increase the leadership skills of managers and high-potential staff. However, there is a lack of information on how early careerists in health care management view these programs and the degree to which they participate. This article reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers. Study findings are based on a survey of 126 early careerists who are graduates of an undergraduate health services administration program. We found varying levels of interest and participation in specific leadership development activities. In addition, we found that respondents with graduate degrees and those with higher compensation were more likely to participate in selected leadership development program activities. Implications of study findings for health care organizations and early careerists in the offering of, and participation in, leadership development programs are discussed.

Laparoscopic colon resection: is it being utilized?

Since its inception, the use of laparoscopy for colon surgery has slowly increased, albeit at a slower rate than for cholecystectomy. Initial concerns about the safety and efficacy of laparoscopy have been addressed, and it is now known to have several potential short-term and long-term benefits for the patient. Early studies likely underestimated use of laparoscopy because of coding error. Currently, 40% to 50% of colectomies in the United States are performed laparoscopically, with a 10% to 20% rate of conversion to an open operation. The definitions oflaparoscopy and conversion to open remain at the discretion of the surgeons and their coders. Disparities still exist among use based on several patient, hospital, and surgeon factors. In the future, we will likely see a continuing increase in use as the new generation of surgeons enters practice, and there will be an increasing role for laparoscopy in rectal surgery. The benefit and extent of robotic surgery, natural orifice surgery, and single-incision surgery for minimally invasive colectomies are yet to be defined.

A profile of hospitals with leadership development programs.

Community hospitals face increasing organizational and environmental complexities that challenge effective leadership. Hospitals are embracing leadership development programs in efforts to ensure leadership talent. While prior literature has described the intent and availability of these programs, the characteristics and performance of hospitals having such programs and their associated market characteristics have not been fully addressed. This article identifies significant differences in organizational, operational, performance, and market factors that are associated with hospitals offering a leadership development program, compared with those hospitals lacking such a program. The authors used American Hospital Association Survey data for 2008, the Area Resource File, and Centers for Medicare & Medicaid data to identify hospitals with and without leadership development programs and analyzed the differences for a number of organizational, operational, performance, and market variables. Findings indicate that hospitals having leadership development programs were large-bed-size facilities, had not-for-profit ownership, were system affiliated, were located in metropolitan statistical areas, and were teaching affiliated facilities. These hospitals also generated higher patient discharges, had higher occupancy, and had a longer average length of stay, compared with hospitals without such programs. In addition, these hospitals had higher net patient revenue per adjusted discharge and higher total profit margins relative to the comparison group.

Market and Organizational Factors Associated with Hospital Leadership of Accountable Care Organizations.

BACKGROUND: The number of Accountable Care Organizations (ACOs) in the U.S. has been rapidly increasing during the past decade. Despite the growth of Accountable Care Organizations (ACOs), little is known about the factors that are associated with hospital leadership of ACOs that contract with public and private payers. PURPOSE: Using a resource dependency framework, this study examines the organizational characteristics and environmental factors that are associated with hospitals who are leading an ACO. METHODOLOGY: We used the data from the American Hospital Association (AHA) Annual Survey of Hospitals for 2018, the Area Health Resources Files and the Medicare Cost Reports. A multiple logistic regression was used to test associations of the independent variables with the hospital leadership of ACOs. RESULTS: We found that nearly one third of the hospitals studied were leading an ACO. System affiliated and not-for-profit hospitals were more likely to be the leaders. Hospitals that lead an ACO offer more clinical services and have better financial performance. Metropolitan core-based statistical areas and per capita income were significantly positively associated with leading an ACO. However, the proportion of population aged 65 and over and the percentage of Medicare advantage penetration were significantly negatively associated with leading an ACO. CONCLUSIONS: Hospitals vary in leading an ACO, which may provide critical resources for them by creating an infrastructure that enables accountable care, extends their services into population health and value-based care programs increasingly promoted by public and commercial payers.

Creating International Student Experiences Through Academic-INGO Partnerships.

INTRODUCTION: Short-term experiences in global health (STEGH) provide nursing students with opportunities to develop global health competencies through immersion in another culture. Skills that students obtain by participating in STEGHs can inform future practice with diverse patient populations. However, educators encounter unique challenges to the quality and sustainability of STEGHs. METHODS: This article describes an academic partnership between a baccalaureate nursing program and a community-based international nongovernmental organization (INGO), how the partnership informed development of STEGH for nursing students, the benefits of the program for students and community, and the lessons learned through the process. RESULTS: Academic-INGO partnerships provide unique benefits for creating sustainable, rigorous STEGHs that are informed and guided by the needs of the hosting community. DISCUSSION: By partnering with community-based INGOs, faculty can design STEGHs that offer robust learning opportunities that facilitate the development of global health competencies while providing thoughtful, sustainable outreach for communities.

Characteristics of pathologic complete response for locally advanced rectal cancer.

BACKGROUND: Neoadjuvant chemoradiation (NACRT) is the standard of care for locally advanced rectal cancers. The purpose of this study was to determine patient and tumor factors associated with a pathologic complete response (pCR). METHODS: The National Surgical Quality Improvement Program proctectomy-targeted database was utilized to identify all patients from 2016 to 2020 who underwent NACRT followed by proctectomy with curative intent for T3-4N0-2 rectal cancers. RESULTS: A total of 1891 patients were included, of which 253 (13.4%) demonstrated a pCR. Pretreatment N0 staging was associated with a higher rate of pCR (18.9%) when compared to N1 (6.7%) and N2 (6.7%) (p < 0.0001). Patients clinically staged at T3N0 had the highest rate of pCR (19.5%). Gender, age, race, weight, smoking status, and tumor height were not associated with pCR. CONCLUSIONS: Patients with cN0 disease were more likely to experience a pCR compared to cN1-2 patients. Tumor height relative to anal verge or patient demographics were not associated with pCR.

Studies on diketopiperazine and dipeptide analogs as opioid receptor ligands.

Using the structure of gliotoxin as a starting point, we have prepared two different chemotypes with selective affinity to the kappa opioid receptor (KOR). Using medicinal chemistry approaches and structure-activity relationship (SAR) studies, structural features required for the observed affinity were identified, and advanced molecules with favorable Multiparameter Optimization (MPO) and Ligand Lipophilicity (LLE) profiles were prepared. Using the Thermal Place Preference Test (TPPT), we have shown that compound2 blocks the antinociceptive effect of U50488, a known KOR agonist. Multiple reports suggest that modulation of KOR signaling is a promising therapeutic strategy in treating neuropathic pain (NP). As a proof-of-concept study, we tested compound 2 in a rat model of NP and recorded its ability to modulate sensory and emotional pain-related behaviors. Observed in vitro and in vivo results suggest that these ligands can be used to develop compounds with potential application as pain therapeutics.

Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers.

OBJECTIVE: This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR). METHODS: This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database-an alliance of more than 300 academic and affiliate hospitals. RESULTS: A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2%), with 5751 patients (15.8%) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5% in 2008 to 44.1% in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8%), followed by left (20.7%), right (15.6%), and sigmoid (14.3%) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5%) and in medium- to large-sized hospitals (47.0%-49.0%).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95% confidence interval (CI) = 3.6-6.4], male sex (OR = 1.2, 95% CI = 1.1-1.3), open as compared with laparoscopic approach (OR = 2.6, 95%, CI = 2.3-3.1), and greater severity of illness category (OR = 27.1, 95% CI = 23.0-31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay. CONCLUSIONS: There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.

A multinational perspective on "lifestyle" and other perceptions of contemporary medical students about general surgery.

OBJECTIVE: The aim of this multinational study was to measure and describe the perceptions of medical students toward general surgery as a career choice with a particular emphasis on "lifestyle." BACKGROUND: Past studies from individual countries have considered the perceptions of medical students toward general surgery. No multinational study to compare the perceptions of medical students from different geographic and socioeconomic regions toward general surgery, has been broadly disseminated. METHODS: A survey about student perceptions of a general surgery career was distributed to 9 medical schools in 8 countries. Two-way analysis of variance was performed on the basis of country, level of economic development [Human Development Index (HDI)], and sex. RESULTS: A total of 841 respondents were included in the study with a response rate of 60%. The overall rate of interest toward general surgery as a career choice was 24%. We noted differences in the reasons behind why medical students choose general surgery between very high HDI countries and medium/high HDI countries. In contrast, the most important reason for not choosing general surgery was found to be due to perceptions of an unpleasant lifestyle. The negative influence of "lifestyle" persisted across all countries, both sexes, and all levels of socioeconomic development. CONCLUSIONS: The negative influence of lifestyle is the most important reason why contemporary medical students from different parts of the world choose not to pursue general surgery. Strategies to counteract the perceived unfriendly nature of the lifestyle are essential to increase the interest of contemporary medical students toward general surgery.

The impact of HCA's 2006 leveraged buyout on hospital performance.

Leveraged buyout (LBO) arrangements are a reorganization strategy whereby a firm assumes a substantial amount of debt to buy back its publicly held stock to become privately held. LBOs offer a firm several advantages and have the potential to increase efficiency. In the past 20 years, several healthcare firms have engaged in LBOs, but the literature on performance changes in healthcare organizations as a result of an LBO is limited. In this article, we report on a study that examined the performance of Hospital Corporation of America (HCA) hospitals before and after the LBO that was initiated in 2006. We used data from the Medicare Hospital Cost Report Information System and analyzed data from 130 HCA hospitals and 490 comparison hospitals. Findings show that HCA hospitals reduced expenses and their number of full-time equivalents (FTEs) relative to local competitor hospitals. HCA hospitals' cash-flow-margin ratio was substantially higher when adjusted for its local competing hospitals at the beginning of the LBO as well as at end of the LBO. When compared to local hospitals, HCA hospitals had a significant decrease in their capital investment in fixed assets from 2006 to 2009. These findings underscore the effectiveness of HCA's management strategies to repay debt and increase the value of the company, and they are informative for healthcare firms and their managers who are considering LBOs.

Organizational and market factors associated with leadership development programs in hospitals: a national study.

Effective leadership in hospitals is widely recognized as the key to organizational performance. Clinical, financial, and operational performance is increasingly being linked to the leadership practices of hospital managers. Moreover, effective leadership has been described as a means to achieve competitive advantage. Recent environmental forces, including reimbursement changes and increased competition, have prompted many hospitals to focus on building leadership competencies to successfully address these challenges. Using the resource dependence theory as our conceptual framework, we present results from a national study of hospitals examining the association of organizational and market factors with the provision of leadership development program activities, including the presence of a leadership development program, a diversity plan, a program for succession planning, and career development resources. The data are taken from the American Hospital Association's (AHA) 2008 Survey of Hospitals, the Area Resource File, and the Centers for Medicare & Medicaid Services. The results of multilevel logistic regressions of each leadership development program activity on organizational and market factors indicate that hospital size, system and network affiliation, and accreditation are significantly and positively associated with all leadership development program activities. The market factors significantly associated with all leadership development activities include a positive odds ratio for metropolitan statistical area location and a negative odds ratio for the percentage of the hospital's service area population that is female and minority. For-profit hospitals are less likely to provide leadership development program activities. Additional findings are presented, and the implications for hospital management are discussed.

Hospital compliance with a state unfunded mandate: the case of California's Earthquake Safety Law.

Abstract In recent years, community hospitals have experienced heightened regulation with many unfunded mandates. The authors assessed the market, organizational, operational, and financial characteristics of general acute care hospitals in California that have a main acute care hospital building that is noncompliant with state requirements and at risk of major structural collapse from earthquakes. Using California hospital data from 2007 to 2009, and employing logistic regression analysis, the authors found that hospitals having buildings that are at the highest risk of collapse are located in larger population markets, possess smaller market share, have a higher percentage of Medicaid patients, and have less liquidity.

Celiac disease and the surgeon.

BACKGROUND: Celiac disease (CD), a disorder characterized by intestinal inflammation and villus atrophy, has protean manifestations. CD is being diagnosed more frequently but is often undiagnosed when encountered by surgeons. Our aim was to review aspects of CD that are relevant to the surgeon. METHODS: A PubMed database search was performed for articles published between January 2000 and December 2021 related to surgical issues in CD. RESULTS: CD is associated with a variety of conditions throughout the gastrointestinal tract. There is an increased risk of a variety of malignancies, including small intestinal tumors. Patients with CD are at an increased risk for operations for common problems such as appendicitis. Patients with undiagnosed CD undergoing operation may develop symptoms leading to diagnosis postoperatively. CONCLUSION: Surgeons should be aware of CD associated conditions, the risk of malignancy and confounding symptoms. Undiagnosed CD should be suspected if malabsorptive symptoms develop following operation.

The Role of Debriefing in a Community Health Study Abroad.

Study abroad experiences offer nursing students the opportunity to develop cultural competence and sensitivity while providing care within the context of a different culture. Debriefing is a strategy that engages students in conversation and active reflection to process emotions, examine personal values, and synthesize knowledge gained from active learning experiences. While debriefing can enhance learning outcomes in study abroad programs, there is currently a paucity of literature that explores its use within the context of study abroad. In this article, we describe a structured debriefing approach we use in an international community health clinical experience. We conclude with a discussion of the lessons we have learned to improve the effectiveness of our debriefing sessions and recommendations for future research.

Cholecystectomy prior to short bowel syndrome does not alter nutritional prognosis.

BACKGROUND: Previous cholecystectomy is common in patients with short bowel syndrome (SBS). An intact gallbladder is beneficial in preventing cirrhosis in SBS patients, but the nutritional consequences of cholecystectomy are largely unknown. Our aim was to evaluate the effect of pre-SBS cholecystectomy on need for chronic parenteral nutrition (PN). METHODS: We reviewed 485 adults with SBS: 267 underwent cholecystectomy prior to SBS and 218 patients had an intact gallbladder. Demographic data, intestinal anatomy, and nutritional outcome were compared. RESULTS: Pre-SBS cholecystectomy patients were more likely to have had postoperative SBS and BMI >35. Intestinal remnant length and anatomy type and performance of surgical rehabilitation procedures within the first year were similar. Overall, there was no significant difference in the need for PN > 1year between the two groups. There was also no significant difference in the need for PN > 1year in any specific subgroup of intestinal remnant length or intestinal anatomy. CONCLUSIONS: Cholecystectomy performed prior to the development of SBS does not influence the nutritional prognosis of SBS, regardless of the intestinal remnant length and anatomy type.

Interest in long-term care among health services administration students.

The aging of the population has created increased opportunities for health administrators in long-term care. This study consisted of a cross-sectional survey of 68 undergraduate health services administration students to explore factors related to interest in a career in long-term care administration. One third expressed interest working in the field. Experience in long-term care settings, quality of contact with unrelated older adults, satisfaction working with the elderly, and confidence in the ability to work in the field were positively associated with interest in long-term care administration. The findings have important implications for experiential learning in health administration programs.