Local COVID-19 Epicenter in Detroit Metropolitan Area Causing Profound and Pervasive Reorganization of Clinical, Educational, Research, and Financial Programs of a Large Academic Gastroenterology Division with a GI Fellowship and Primary Medical School Affiliation.

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.

Variabilidad de la filiación institucional y recuperación de la producción científica de un hospital / Variability of institutional affiliation and recovery of a hospital's scientific output

OBJETIVOS: analizar la variabilidad de las afiliaciones de una institución sanitaria en la base de datos Scopus y se estudió cómo influye en la recuperación de la producción científica. MÉTODOS: se realizaron búsquedas por autores y autoras, estrategia y nombre normalizado de la institución para comparar la variabilidad de los resultados. RESULTADOS: se constató una pérdida del 44,20 % de documentos en la recuperación por el campo de afiliación normalizada de la base de datos. CONCLUSIONES: tras analizar las causas, se propuso varias medidas para corregir dicha pérdida

OBJECTIVE: The variability of the affiliations of a health institution in the Scopus database is analyzed and how it influences the recovery of scientific production is studied. METHODS: Searches were conducted by authors, strategy and standardized name of the institution to compare the variability of the results. RESULTS: There is a loss of 44.20% of documents in the recovery by the standardized affiliation field of the database. CONCLUSIONS: After analysing the causes, a number of measures are proposed to correct this loss

Small is beautiful, but large is certified: A comparison between fisheries the Marine Stewardship Council (MSC) features in its promotional materials and MSC-certified fisheries.

The Marine Stewardship Council (MSC) sets a standard by which sustainable fisheries can be assessed and eco-certified. It is one of the oldest and most well-known fisheries certifications, and an estimated 15% of global fish catch is MSC-certified. While the MSC is increasingly recognized by decision-makers as an indicator for fishery success, it is also criticized for weak standards and overly-lenient third-party certifiers. This gap between the standard's reputation and its actual implementation could be a result of how the MSC markets and promotes its brand. Here we classify MSC-certified fisheries by gear type (i.e. active vs. passive) as well as by length of the vessels involved (i.e. large scale vs. small scale; with the division between the two occurring at 12 m in overall length). We compared the MSC-certified fisheries (until 31 December 2017) to 399 photographs the MSC used in promotional materials since 2009. Results show that fisheries involving small-scale vessels and passive gears were disproportionately represented in promotional materials: 64% of promotional photographs were of passive gears, although only 40% of MSC-certified fisheries and 17% of the overall catch were caught by passive gears from 2009-2017. Similarly, 49% of the photographs featured small-scale vessels, although just 20% of MSC-certified fisheries and 7% of the overall MSC-certified catch used small-scale vessels from 2009 to 2017. The MSC disproportionately features photographs of small-scale fisheries although the catch it certifies is overwhelmingly from industrial fisheries.

Relevancia de los aspectos psicológicos en el dolor crónico / No disponible

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Asociación Española de Pediatría (2009-2017). Momento de rendir cuentas / Spanish Paediatric Association (2009-2017). Time for accountability

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Calendario de vacunaciones de la Asociación Española de Pediatría (CAV-AEP): recomendaciones 2016 / Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations

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Strengthening an affiliation without a merger.

Froedtert Health and the Medical College of Wisconsin have created a shared governance structure with joint committees focused on value, IT, marketing, strategic planning, and other areas. A new funds-flow model shifts a percentage of the health system's bottom line to the medical college to support physician recruitment,joint initiatives, academic programs, and a strategic reserve. The strengthened affiliation has enhanced the ability of the organizations to engage in accountable care and population health initiatives, among other benefits.

Protecting corporate value in affiliation transactions.

Understanding the risks and rewards of affiliations is critical to determining whether the partnership will address specific challenges without compromising organizational goals. An analysis of the tension points and potential risks associated with an affiliation also should identify possible strategies for resolution. Hospitals can mitigate potential affiliation downsides through a well-run process that follows several key steps.

Combining forces to manage the continuum of care.

Many healthcare organizations are pursuing affiliation strategies to effectively manage population health. Healthcare organizations should take the following key steps in setting such a strategy: Ensuring the strategy aligns with the organization's mission Identifying potential partners. Outlining expectations for the affiliation. Assessing affiliation structure options.

Affiliation options for independents.

Many independent hospitals and medical groups are pursuing affiliations with partner organizations to meet the challenges posed by healthcare reform and value-based payments. Before embarking on such a strategy, however, these organizations should: Clearly define their objectives of pursuing an affiliation; Assess potential affiliation options; Identify a preferred strategy based on evaluation of different affiliation scenarios.

Small community hospitals programs affiliation with university programs; "lessons learned" in 28-year successful affiliation.

OBJECTIVE: Community hospitals affiliation with university hospitals in post graduate surgical education is essential for the 2 types of training programs. Many factors affect the success of the affiliation process. Additionally, various pitfalls and challenges are encountered. The goal of this work is to study the lessons learned in 28 years successful affiliation. DESIGN/SETTING: small community hospital affiliation with university program for 28 years. PARTICIPANTS: surgery residency programs in small community hospital and university hospital. RESULTS: successful affiliation for 28 years between community hospital and university program.

Physician-hospital relationships: from historical failures to successful "new kids on the block".

Trends in healthcare reveal that increasing numbers of physicians prefer to work directly with hospitals-whether through employment models, new or revived partnership structures, or other such "deals". Meanwhile, hospital executives are vigorously seeking ways to create win-win arrangements that satisfy both parties-models that will ensure medical coverage for the hospital, along with revenue gains and cost savings when possible. Add to this a competitive environment, physician shortages, and high regulatory activity and healthcare reform, and the path to clinical, operational, and financial viability in the context of a hospital/physician partnership can be a challenging one. Models such as The physician enterprise and co-management agreements are gaining popularity, each with distinct benefits. With market forces dynamically changing, along with accountable care, it is time for hospitals, health systems, and physicians to prioritize their partnering relationships, a strategy that is now key to achieving success in the future...and that's a trend that's likely to continue far into the years ahead.

Integration: from structural to functional.

Because of trends that are driving increased consolidation in the healthcare industry, community healthcare systems in the future will have fewer independent medical practices. Hospitals and physician practices can be structurally or functionally integrated, but those that are structurally integrated only, do not function as integrated health systems. For successful integration, leaders from many disciplines need to engage in a partnership and be willing to create conditions for a functional integration.

Physician acquisition: what to avoid after the deal is complete.

After a hospital acquires a physician practice, relations can become strained between the parties in any of four areas: Governance and decision making. Technology. Payment structures. Emotional factors related to the acquisition.

A propósito del aseguramiento sanitario privado / Private medical insurance

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