Analysis of Platelet Function Testing in Children Receiving Aspirin for Antiplatelet Effects.

Aspirin (ASA) remains the most common antiplatelet agent used in children. VerifyNow Aspirin Test® (VN) assesses platelet response to ASA, with therapeutic effect defined by the manufacturer as ≤ 549 aspirin reaction units (ARU). Single-center, observational, analysis of 195 children (< 18 years-old) who underwent first VN between 2015 and 2020. Primary outcome was proportion of patients with ASA biochemical resistance (> 549 ARU). Secondary outcomes included incidence of new clinical thrombotic and bleeding events during ≤ 6 months from VN in those who received ASA monotherapy (n = 113). Median age was 1.8 years. Common indications for ASA included cardiac anomalies or dysfunction (74.8%) and ischemic stroke (22.6%). Median ASA dose before VN was 4.6 mg/kg/day. Mean VN was 471 ARU. ASA biochemical resistance was detected in 14.4% (n = 28). Of 113 patients receiving ASA monotherapy, 14 (12.4%) had a thrombotic event and 2 (1.8%) had a bleeding event. Mean VN was significantly higher at initial testing in patients experiencing thrombotic event compared to those without thrombosis (516 vs 465 ARU, [95% CI: 9.8, 92.2], p = 0.02). Multivariable analysis identified initial VN ASA result ≥ 500 ARU at initial testing as the only significant independent risk factor for thrombosis (p < 0.01). VN testing identifies ASA biochemical resistance in 14.4% of children. VN ASA ≥ 500 ARU rather than ≥ 550 ARU at initial testing was independently associated with increased odds of thrombosis. Designated cut-off of 550 ARU for detecting platelet dysfunction by ASA may need reconsideration in children.

Public Health and Health Sector Crisis Leadership During Pandemics: A Review of the Medical and Business Literature.

The global scale and unpredictable nature of the current COVID-19 pandemic have put a significant burden on health care and public health leaders, for whom preparedness plans and evidence-based guidelines have proven insufficient to guide actions. This article presents a review of empirical articles on the topics of "crisis leadership" and "pandemic" across medical and business databases between 2003 (since SARS) and-December 2020 and has identified 35 articles for detailed analyses. We use the articles' evidence on leadership behaviors and skills that have been key to pandemic responses to characterize the types of leadership competencies commonly exhibited in a pandemic context. Task-oriented competencies, including preparing and planning, establishing collaborations, and conducting crisis communication, received the most attention. However, people-oriented and adaptive-oriented competencies were as fundamental in overcoming the structural, political, and cultural contexts unique to pandemics.

Building trust: The influence of mentoring behaviors on perceptions of health care managers' trustworthiness.

BACKGROUND: In health care organizations, trust is critical for effective workplace relationships that ensure patient-centered outcomes. Although research has focused on trust in the relationship between patients and clinicians, less is known about what influences workers to trust their managers. An understanding is needed of the specific behaviors that influence health care workers' evaluations of their managers' trustworthiness. Mentoring research focuses on the developmental assistance that a more experienced worker provides to a less experienced worker. Building upon seminal research on mentoring functions, we argue that health care managers can build trust by providing informational (career-related) and interpersonal (psychosocial) support. PURPOSE: The aim of the study was to investigate the influence of health care managers' informational and interpersonal mentoring behaviors on workers' perceptions of their managers' trustworthiness and the mediating role of trustworthiness on trust in the managers. METHODOLOGY/APPROACH: Surveys were completed during work hours by 315 health care workers at an acute care hospital and associated clinics in the Midwest. FINDINGS: Results showed that managers' mentoring behaviors influenced worker perceptions of their managers' trustworthiness, in terms of ability, integrity, and benevolence. Ability partially mediated the relationship between informational mentoring and trust in managers, whereas integrity and benevolence partially mediated the relationship between interpersonal mentoring and trust in managers. PRACTICE IMPLICATIONS: Health care managers can actively build trust through mentoring behaviors that inspire positive assessments of managers' ability, integrity, and benevolence.

Interpersonal mentoring and its influence on retention of valued health care workers: the moderating role of affective commitment.

BACKGROUND: Health care organizations (HCOs) invest in knowledge transfer to promote improved patient outcomes; however, these investments prove costly when health care workers with enhanced knowledge and skills leave to seek better employment opportunities. PURPOSE: The aim of this study was to examine the impact of interpersonal mentoring on affective organizational commitment and the potential moderating effect of affective commitment in the knowledge transfer-retention relationship. METHODOLOGY/APPROACH: One hundred fifty-three clinicians working at a Midwestern acute care hospital and associated clinics were surveyed at their worksite. FINDINGS: Clinicians who received more interpersonal mentoring were also more likely to have stronger affective commitment. In addition, affective commitment moderated the relationship between knowledge transfer and turnover intentions, that is, when affective commitment was low, clinicians with higher levels of knowledge transfer indicated higher turnover intentions. However, clinicians with high levels of affective commitment and knowledge transfer reported lower turnover intentions. PRACTICE IMPLICATIONS: HCOs must simultaneously invest in knowledge transfer while implementing strategies that assist in retaining knowledgeable workers. Interpersonal mentoring appears to play an important role in the retention of valued clinicians through its influence on affective commitment. HCOs must facilitate cultures that show top management support for mentoring through practices such as educational programs, flexible scheduling, and reward systems.