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Acute Effects Of Whole-Body Vibration On Lower Extremity Muscle Performance In Persons With Multiple Sclerosis, Kurt Jackson, Harold Merriman, Paul Vanderburgh, C. Brahler

C. Jayne Brahler

Background and Purpose: Whole-body vibration (WBV) is a relatively new form of exercise training that may influence muscle performance. This study investigated the acute effects of high (26 Hz) and low (2 Hz) frequency WBV on isometric muscle torque of the quadriceps and hamstrings in persons with multiple sclerosis (MS).

Participants and Method: Fifteen individuals (mean age = 54.6 years, SD = 9.6) with MS and Expanded Disability Status Scale (EDSS) scores ranging from 0-6.5 (mean = 4.2, SD = 2.3) participated in this randomized cross-over study. Following baseline measures of isometric quadricep and hamstring torque, subjects were exposed to …

Load Carriage Distance Run And Pushups Tests: No Body Mass Bias And Occupationally Relevant, Paul M. Vanderburgh, Nicholas S. Mickley, Philip A. Anloague, Kimber Lucius

Philip A. Anloague

Recent research has demonstrated body mass (M) bias in military physical fi tness tests favoring lighter, not just leaner, service members. Mathematical modeling predicts that a distance run carrying a backpack of 30 lbs would eliminate M-bias. The purpose of this study was to empirically test this prediction for the U.S. Army push-ups and 2-mile run tests. Two tests were performed for both events for each of 56 university Reserve Offi cer Training Corps male cadets: with (loaded) and without backpack (unloaded). Results indicated signifi cant M-bias in the unloaded and no M-bias in the loaded condition for both events. …

Acute Effects Of Whole-Body Vibration On Lower Extremity Muscle Performance In Persons With Multiple Sclerosis, Kurt Jackson, Harold L. Merriman, Paul M. Vanderburgh, C. Jayne Brahler

Harold L. Merriman

Background and Purpose: Whole-body vibration (WBV) is a relatively new form of exercise training that may influence muscle performance. This study investigated the acute effects of high (26 Hz) and low (2 Hz) frequency WBV on isometric muscle torque of the quadriceps and hamstrings in persons with multiple sclerosis (MS). Participants and Method: Fifteen individuals (mean age = 54.6 years, SD = 9.6) with MS and Expanded Disability Status Scale (EDSS) scores ranging from 0-6.5 (mean = 4.2, SD = 2.3) participated in this randomized cross-over study. Following baseline measures of isometric quadricep and hamstring torque, subjects were exposed to …

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How Could, Should, And Would Physicians Use Facebook With Patients, Joy Peluchette, Katherine Karl, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

After reviewing the benefits and risks of social media, we examine online discussion boards to determine the thoughts of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. Of the 290 comments analyzed, we found 42 percent were opposed to physicians using Facebook. Additionally, most (51.7 were opposed to physicians being Facebook “friends” with patients. Most opponents expressed concerns about privacy and the need to maintain professional boundaries in the physician-patient relationship. We provide suggestions for how healthcare administrators can effectively manage their social media presence and provide assistance to physicians.

Latino Access To Health Care: The Role Of Insurance, Managed Care, And Institutional Barriers, J. Emilio Carrillo, Fernando M. Trevino, Joseph R. Betancourt, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The health care system in the United States is the most expensive and yet arguably among the least cost effective in the developed world (Anderson, 1998). Despite the highest per person health care spending among the Organization for Economic Cooperation and Development (OECD) nations, the United States still ranks below many along a variety of health indicators (Woolhandler & Himmelstein, 1991). In a complicated health care system where the rules are many and economic forces drive both structure and function, the needs of vulnerable populations inevitably suffer. This chapter explores the consequences of these market forces on a vulnerable population--Latinos …

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Healthcare Information Systems: Opportunities And Challenges, Madison Ngafeeson

Madison Ngafeeson

No abstract provided.

How Does Market Making Affect Industrial Relations? Evidence From Eight German Hospitals, Ian Greer, Thorsten Schulten, Nils Böhlke

Ian Greer

The introduction of market mechanisms matters for industrial relations. In the German hospital sector, national liberalization policies have put immense pressure on local management and worker representatives and led to the growth of a low-wage sector. In case studies of eight hospitals, we find some locales where market making has led to union revitalization and mobilization, but this effect varies. Using an eight-way comparison, we infer a configuration of three aspects of the local political economy – labour markets, politics, and codetermination rules – that together provide a well fitting explanation for both variation and change.

Social Movement Unionism And Social Partnership In Germany: The Case Of Hamburg’S Hospitals, Ian Greer

Ian Greer

This paper traces the emergence of social movement unionism in Hamburg, Germany, as labor’s channels of influence have broken down and economic pressures have intensified. Trade unionists have responded to the privatization of the municipal hospitals by mobilizing members and building coalitions around issues beyond their members’ immediate interests, including democracy and public service quality. Although the loss of union influence has facilitated social movement unionism, in East Germany economic crisis has had a demobilizing effect.

When Does Marketisation Lead To Privatisation? Profit-Making In English Health Services After The 2012 Health And Social Care Act, Nick Krachler, Ian Greer

Ian Greer

Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. England’s Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6-10 months after the …

Effects Of Unionization On Graduate Student Employees: Faculty-Student Relations, Academic Freedom, And Pay, Sean Rogers, Adrienne E. Eaton, Paula B. Voos

Sean Edmund Rogers

In cases involving unionization of graduate student research and teaching assistants at private U.S. universities, the National Labor Relations Board has, at times, denied collective bargaining rights on the presumption that unionization would harm faculty-student relations and academic freedom. Using survey data collected from PhD students in five academic disciplines across eight public U.S. universities, the authors compare represented and non-represented graduate student employees in terms of faculty-student relations, academic freedom, and pay. Unionization does not have the presumed negative effect on student outcomes, and in some cases has a positive effect. Union-represented graduate student employees report higher levels of …

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Integrating Commercial Ambulatory Electronic Health Records With Hospital Systems: An Evolutionary Process., Susan A Sherer, Chad D Meyerhoefer, Michael Sheinberg Md, Donald Levick Md

Donald Levick MD, MBA, CPHIMS

OBJECTIVE: The increase in electronic health record implementation in all treatment venues has led to greater demands for integration within and across practice settings with different work cultures. We study the evolution of coordination processes when integrating ambulatory-specific electronic health records with hospital systems. MATERIALS AND METHODS: Longitudinal qualitative study using semi-structured interviews and archival documentation throughout a 5-year implementation and integration of obstetrical ambulatory and hospital records with a goal of achieving a perinatal continuum of care. RESULTS: As users implement and integrate electronic health records, there is an evolution in their focus from technology acceptance to structural adaptation …

Early Mobilization In Icu Patients, Alex Hunter, Leslie Johnson, William Willis, Alberto Coustasse

William K Willis

Introduction: Bed rest or immobilization is frequently part of treatment for patients in the intensive care unit with critical illness. The average intensive care unit length of stay was 3.3 days and for every day spent in an intensive care unit bed, the average patient spent an additional 1.5 days in a non-intensive care unit bed. Daily costs have increased more than 30% from 2000-2005 with an average daily cost of $3518. Weaning from mechanical ventilation has been correlated with increased intensive care unit and hospital length of stay. Mechanical ventilation has been correlated with the development of intensive care …

Electronic Prescribing And Its Implementation In The United States, Kate Englebert, Amber Porterfield, William Willis, Alberto Coustasse

William K Willis

Introduction: Electronic prescribing (e-prescribing) is an important part of the nation’s push to create an electronically accessible national health system. E-prescribing allows providers to send prescriptions electronically to the pharmacy and can be stand-alone systems or part of an integrated electronic health record system. Methodology: The methodology for this study was a literature review. Electronic databases accessed include EBSCOhost, PubMED, and Google Scholar. Additionally, government websites and a semi-structured interview were used. A total of 39 sources were referenced for the review. Results: The results of the literature review demonstrated that e-prescribing reduces prescribing errors, increases efficiency, and helps save …

Early Mobilization In Icu Patients, Alex Hunter, Leslie Johnson, William Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Bed rest or immobilization is frequently part of treatment for patients in the intensive care unit with critical illness. The average intensive care unit length of stay was 3.3 days and for every day spent in an intensive care unit bed, the average patient spent an additional 1.5 days in a non-intensive care unit bed. Daily costs have increased more than 30% from 2000-2005 with an average daily cost of $3518. Weaning from mechanical ventilation has been correlated with increased intensive care unit and hospital length of stay. Mechanical ventilation has been correlated with the development of intensive care …

Racial/Ethnic Differences In Exposure To Environmental Volatile Organic Compounds In The U.S. General Population: The National Health And Nutrition Examination Survey 1999–2000, Y. S. Lin, Alberto Coustasse, W. H. Ho, K. Singh, A. Arif

Alberto Coustasse, DrPH, MD, MBA, MPH

Background: Exposure to volatile organic compounds (VOCs) has been associated with many health disorders. A better understanding of unequal health risk from exposure to environmental VOCs is critical to the elimination of health disparities. Objective: The goal of this study was to investigate racial/ethnic differentials in exposure to airborne VOCs within a national sample of the U.S. population and assessed socio-demographic determinants that may contribute to these racial differences. Methods: We used data from a stratified sample of 576 participants (aged 20–59 years) who provided personal air samples for VOC measurements in the National Health and Nutrition Examination Survey (NHANES) …

Assisted Living: Trends In Cost And Staffing, Amy Kisling, David P. Paul, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Assisted living communities (ALFs), which provide a community for residents who require assistance throughout their day, is an important part of the long-term care system in the US. Trained individuals assist residents with activities known as Activities of Daily Living (ADL). The costs of ALFs are paid either out of pocket, by Medicaid or by Long-Term Care Insurance (LTCI). Medicare does not pay for ALFs. Monthly costs of ALFs have increased over the past five years on an average of 4.1%. The major reason for this cost increase is probably the increased healthcare needs of the baby boomers generation, but …

Electronic Prescribing And Its Implementation In The United States, Kate Englebert, Amber Porterfield, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: Electronic prescribing (e-prescribing) is an important part of the nation’s push to create an electronically accessible national health system. E-prescribing allows providers to send prescriptions electronically to the pharmacy and can be stand-alone systems or part of an integrated electronic health record system. Methodology: The methodology for this study was a literature review. Electronic databases accessed include EBSCOhost, PubMED, and Google Scholar. Additionally, government websites and a semi-structured interview were used. A total of 39 sources were referenced for the review. Results: The results of the literature review demonstrated that e-prescribing reduces prescribing errors, increases efficiency, and helps save …

Benefits And Barriers For Adoption Of Personal Health Records, Brittany Vance, Brent Tomblin, Jena Studney, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

A Personal Health Record (PHR) is an electronic, universally available, lifelong resource of health information maintained by individuals. There are numerous potential benefits to PHRs, including improved patient-provider relationships, increased patient empowerment, and enhanced care safety, efficiency, coordination, and quality. However, privacy, security, cost, and adoption issues have been significant barriers to implementation. The purpose of this research was to determine how the use of PHRs affects patient outcomes, as well as to analyze benefits and barriers of adoption of PHRs. The methodology for the examination of the benefits and barriers to PHR implementation was conducted following the basic principles …

Managed Care And Accountable Care Organizations, David P. Paul, Diego Arroyo, Bethany Daniel, Heather Graves, Krisitn Neal, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Managed care generally, and more specifically, accountable care organizations (ACOs) have attempted to provide coordination of patient care in order to eliminate or reduce unnecessary procedures and or test redundancy. The purpose of this research was to study the effects of managed care in accountable care organizations by decreasing health care costs by increasing efficiency in health care.

A State-Sponsored Approach To Quality Improvement In Nursing Homes: Insights From Providers, Kathleen Abrahamson, Priscilla Arling, Greg Arling

Priscilla Arling

In 2006, the Minnesota Performance-based Incentive Payment Program (PIPP) was launched to fund provider-initiated quality improvement (QI) projects addressing a wide range of persistent quality issues in nursing homes (eg, falls, pain, mobility, psychotropic medication reduction, care transitions). In this article, the authors describe the perceptions of nursing home providers who participated in a PIPP-funded QI project and completed a survey addressing a variety of QI-related concerns. Respondents noted the importance of support from top leadership, reported being challenged by resource constraints, and generally thought that their project positively impacted quality within their facility. These findings highlight the importance of …

An Application Of The Socio-Technical Systems Approach To Implementation Of Electronic Evidence Into Practice: The Clinical Practice Model Framework, Kathleen Abrahamson, Priscilla Arling, Bonnie Wesorick, James Anderson

Priscilla Arling

Implementation of electronic evidence into the practice environments of clinical staff is an ongoing challenge in health care organizations. Despite localized efforts to integrate point-of-care technology with clinical practice, system-wide transformation across multiple clinical settings has not commonly occurred. This paper examines a framework designed to guide the implementation of evidence-based practice using technology in health care settings from the theoretical lens of the Socio-Technical Systems (STS) approach. The framework under study is called the CPM Framework™, developed by the Clinical Practice Model Resource Center (CPMRC). The CPMRC is a collaborative consortium of health care providers representing over 300 rural, …

Does Self-Efficacy Influence The Application Of Evidence-Based Practice?, Kathleen Abrahamson, Priscilla Arling, Jenna Gillette

Priscilla Arling

Background: Implementation of Evidence-Based Practice (EBP) is complex and consequently, even within organizations that have made efforts to promote EBP use, EBP is often underutilized by individual clinicians. Purpose: The aim of our study was to better understand the relationship between self-efficacy and EBP implementation in clinical environments that have undergone efforts to increase EBP utilization. We suggest that EBP is a set of behaviors that result from individuals acquiring, applying, and sharing new knowledge with others in the organization. We hypothesize, based upon a social cognitive theoretical approach, that these behaviors are influenced by clinician perception of self-efficacy. Methods: …

State Uses Financial Incentives To Fund Nursing Home–Initiated Quality Improvement Projects Through Competitive Bidding Process, Leading To Better Care, Valerie Cooke, Greg Arling, T. Lewis, Kathleen Abrahamson, Priscilla Arling, H. Davila, C. Mueller

Priscilla Arling

Authorized in 2006 by the State legislature, Minnesota’s Performance-Based Incentive Program funds nursing home–initiated quality improvement projects for 1 to 3 years through increases of up to 5 percent in the operating per diem rate charged to Medicaid and private-pay residents. Funding decisions are made through a competitive bidding process administered annually by the Department of Human Services, with recommendations from a review committee. Program staff provide support to nursing homes during and after the application process. Nursing homes that do not achieve project-specific performance targets can lose up to 20 percent of the incentive payments. The program has engaged …

A Meta-Analysis Of Crew Resource Management/Incident Command Systems Implementation Studies In The Fire And Emergency Services, John C. Griffith, Donna L. Roberts, Ronald T. Wakeham

John Griffith

The presentation will summarize a meta-analysis of studies on Crew Resource Management/Incident Command System implementation in the fire and emergency services. The need for using participative leadership tools such as CRM evolved from an NTSB recommendation that followed United Airlines Flight 173 crash in 1978. NASA, civilian and military aviation communities implemented Crew Resource Management (CRM) training to improve decisionmaking during flight operations. Maintenance Resource Management (MRM) was a variant of CRM and first appeared in a Federal Aviation Administration circular in 2000. CRM was adopted by the medical community in the 1990s, specifically in the surgical and nursing areas, …

A Critical Review Of Electrical Water-Bath Stun Systems For Poultry Slaughter And Recent Developments In Alternative Technologies, Sara J. Shields, A. B. M. Raj

Sara Shields, PhD

Prior to slaughter, most farmed birds move through a constant-voltage, multiple- bird, electrical water-bath stun system. Using this system subjects live birds to stressful and painful shackling, and the potential exists for them to receive prestun electric shocks and induction of seizures while still conscious. The existing elec- trical water-bath stunner settings, particularly those used in U.S. slaughter plants, are not necessarily based on sound scientific data that they produce a consistent, immediate stun, and research indicates that they are not effective in all birds. Further, in multiple-bird, electrical water-bath systems, birds may miss the stunner completely. Evidence suggests that …