Medicine and Health Sciences Commons^™

Post-Acute Care And Vertical Integration After The Patient Protection And Affordable Care Act, Patrick Shay, Stephen Mick

Patrick Shay

The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act—including the proposed adoption of bundled payment systems and the promotion of accountable care organizations—have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care organizations and bundled payment systems in the American post-acute healthcare sector, this article applies economic and sociological perspectives from organization theory to predict that as acute care organizations vary in the degree to which they experience environmental uncertainty, asset specificity, and network embeddedness, their motivation to integrate post-acute care …

Advances In Health Care Organization Theory, 2nd Edition, Stephen Mick, Patrick Shay

Patrick Shay

Advances in Health Care Organization Theory, 2nd Edition, introduces students in health administration to the fields of organization theory and organizational behavior and their application to the management of health care organizations. The book explores the major health care developments over the past decade and demonstrates the contribution of organization theory to a deeper understanding of the changes in the delivery system, including the historic passage of the Patient Protection and Affordable Care Act of 2010. Taking both a micro and macro view, editors Stephen S. Mick and Patrick D. Shay, collaborate with a roster of contributing experts to compile …

Osteopathic Evaluation And Manipulative Treatment In Reducing The Morbidity Of Otitis Media: A Pilot Study, Brian Degenhardt, Michael Kuchera

Michael Kuchera

OBJECTIVE: To study the effects of osteopathic manipulative treatment in routine pediatric care for children with recurrent acute otitis media. STUDY DESIGN: Pilot cohort study with 1-year posttreatment follow-up. At follow-up, subjects' parents or legal guardians and their referring and/or family physicians were contacted to determine recurrence of otitis media since intervention. Subjects: A referred and volunteer sample of pediatric patients ranging in age from 7 months to 35 months with a history of recurrent otitis media (N=8). INTERVENTION: For 3 weeks, all subjects received weekly osteopathic structural examinations and osteopathic manipulative treatment. This intervention was performed concurrently with traditional …

Metastatic Brain Tumors: Current Therapeutic Options And Historical Perspective, Mark Rivkin, Richard Kanoff

Mark Rivkin

Metastatic brain tumors affect more than 150,000 patients annually in the United States. The therapeutic paradigms for these tumors have evolved over the years and currently encompass numerous modalities implemented by treating physicians across several medical disciplines. The armamentarium of brain tumor treatment involves neurosurgical intervention, whole-brain and focused radiation modalities, chemotherapy, and immunotherapy. Patient selection, however, remains critical to achieve maximal therapeutic benefit and depends on functional status, number and location of lesions, and tissue histologic findings. Best outcomes can be expected with a multidisciplinary approach to patient care where state-of-the-art treatment options are readily available.

The Association Between Hospital Obstetrical Volume And Maternal Postpartum Complications, Kathy Kyser, Xin Lu, Donna Santillan, Mark Santillan, Stephen Hunter, Alison Cahill, Peter Cram

Stephen K. Hunter

OBJECTIVE: The purpose of this study was to examine the relationship between delivery volume and maternal complications. STUDY DESIGN: We used administrative data to identify women who had been admitted for childbirth in 2006. Hospitals were stratified into deciles that were based on delivery volume. We compared composite complication rates across deciles. RESULTS: We evaluated 1,683,754 childbirths in 1045 hospitals. Decile 1 and 2 hospitals had significantly higher rates of composite complications than decile 10 (11.8% and 10.1% vs 8.5%, respectively; P < .0001). Decile 9 and 10 hospitals had modestly higher composite complications as compared with decile 6 (8.8% and …

The Association Between Hospital Obstetrical Volume And Maternal Postpartum Complications., Kathy L Kyser, Xin Lu, Donna Santillan, Mark Santillan, Stephen Hunter, Alison G Cahill, Peter Cram

Donna A. Santillan

OBJECTIVE: The purpose of this study was to examine the relationship between delivery volume and maternal complications.

STUDY DESIGN: We used administrative data to identify women who had been admitted for childbirth in 2006. Hospitals were stratified into deciles that were based on delivery volume. We compared composite complication rates across deciles.

RESULTS: We evaluated 1,683,754 childbirths in 1045 hospitals. Decile 1 and 2 hospitals had significantly higher rates of composite complications than decile 10 (11.8% and 10.1% vs 8.5%, respectively; P < .0001). Decile 9 and 10 hospitals had modestly higher composite complications as compared with decile 6 (8.8% and 8.5% vs 7.6%, respectively; P < .0001). Sixty percent of decile 1 and 2 hospitals were located within 25 miles of the nearest greater volume hospital.

CONCLUSION: Women who deliver at very low-volume hospitals have higher complication rates, as do women who deliver at …

A Mandatory Single Blastocyst Transfer Policy With Educational Campaign In A United States Ivf Program Reduces Multiple Gestation Rates Without Sacrificing Pregnancy Rates, Ginny Ryan, Amy Sparks, C. Sipe, Craig Syrop, A. Dokras, Bradley Van Voorhis

Amy E.T. Sparks

OBJECTIVE: To reduce the twin rate in our IVF program. DESIGN: A prospective educational study of infertile couples; a retrospective review of IVF outcomes before vs. after mandatory single embryo transfer (mSBT) policy change. SETTING: University-based infertility center. PATIENT(S): One hundred ten of 120 consecutive new infertile couples completed the educational study. Outcomes of all embryo transfers (n = 693) performed 17 months before and 17 months after mSBT were evaluated. INTERVENTION(S): A 1-page educational summary of comparative risks of twins vs. singletons to maternal and child health. MAIN OUTCOME MEASURE(S): Knowledge of twin risks and desired number of embryos …

Predictive Value Of The Hemizona Assay For Pregnancy Outcome In Patients Undergoing Controlled Ovarian Hyperstimulation With Intrauterine Insemination., Murat Arslan, Mahmood Morshedi, Ebru Arslan, Steve Taylor, Arzu Kanik, E. Duran, Sergio Oehninger

Eyup Hakan Duran

OBJECTIVE: The hemizona assay (HZA) is an established functional test that examines in vitro sperm-zona pellucida binding capacity with high predictive power for fertilization outcome in IVF. The objective of this study was to evaluate the value of the HZA as a predictor of pregnancy in patients undergoing controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI). DESIGN: Prospective clinical study. SETTING: Academic center. PATIENT(S): Eighty-two couples with unexplained or male factor infertility that underwent 313 IUI cycles. INTERVENTION(S): Basic semen analysis and HZA were performed within three months of starting COH/IUI therapy. MAIN OUTCOME MEASURE(S): Hemizona index (HZI) and clinical …

Court-Ordered Obstetrical Interventions., Veronika Kolder, J. Gallagher, M. Parsons

Veronika E.B. Kolder Dr.

In a national survey, we investigated the scope and circumstances of court-ordered obstetrical procedures in cases in which the women had refused therapy deemed necessary for the fetus. We also solicited the opinions of leading obstetricians regarding such cases. Court orders have been obtained for cesarean sections in 11 states, for hospital detentions in 2 states, and for intrauterine transfusions in 1 state. Among 21 cases in which court orders were sought, the orders were obtained in 86 percent; in 88 percent of those cases, the orders were received within six hours. Eighty-one percent of the women involved were black, …

Aium Practice Guideline For The Performance Of Pelvic Ultrasound Examinations., Bradley Van Voorhis

Bradley J Van Voorhis

No abstract provided.

Aium Practice Guideline For Ultrasonography In Reproductive Medicine., Bradley Van Voorhis

Bradley J Van Voorhis

No abstract provided.

A Mandatory Single Blastocyst Transfer Policy With Educational Campaign In A United States Ivf Program Reduces Multiple Gestation Rates Without Sacrificing Pregnancy Rates, Ginny Ryan, Amy Sparks, C. Sipe, Craig Syrop, A. Dokras, Bradley Van Voorhis

Bradley J Van Voorhis

OBJECTIVE: To reduce the twin rate in our IVF program. DESIGN: A prospective educational study of infertile couples; a retrospective review of IVF outcomes before vs. after mandatory single embryo transfer (mSBT) policy change. SETTING: University-based infertility center. PATIENT(S): One hundred ten of 120 consecutive new infertile couples completed the educational study. Outcomes of all embryo transfers (n = 693) performed 17 months before and 17 months after mSBT were evaluated. INTERVENTION(S): A 1-page educational summary of comparative risks of twins vs. singletons to maternal and child health. MAIN OUTCOME MEASURE(S): Knowledge of twin risks and desired number of embryos …

Outcomes From Assisted Reproductive Technology, Bradley Van Voorhis

Bradley J Van Voorhis

The use of assisted reproductive technology (ART) for treating the infertile couple is increasing in the United States. The purpose of this paper is to review the short-term outcomes after ART. Pregnancy rates after ART have shown nearly continuous improvement in the years since its inception. A number of factors affect the pregnancy rate, with the most important being a woman's age. Certain clinical diagnoses are associated with a poorer outcome from ART, including the presence of hydrosalpinges, uterine leiomyomata that distort the endometrial cavity, and decreased ovarian reserve. Multiple gestations are the major complication after ART. New laboratory techniques, …

A Mandatory Single Blastocyst Transfer Policy With Educational Campaign In A United States Ivf Program Reduces Multiple Gestation Rates Without Sacrificing Pregnancy Rates, Ginny Ryan, Amy Sparks, C. Sipe, Craig Syrop, A. Dokras, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To reduce the twin rate in our IVF program. DESIGN: A prospective educational study of infertile couples; a retrospective review of IVF outcomes before vs. after mandatory single embryo transfer (mSBT) policy change. SETTING: University-based infertility center. PATIENT(S): One hundred ten of 120 consecutive new infertile couples completed the educational study. Outcomes of all embryo transfers (n = 693) performed 17 months before and 17 months after mSBT were evaluated. INTERVENTION(S): A 1-page educational summary of comparative risks of twins vs. singletons to maternal and child health. MAIN OUTCOME MEASURE(S): Knowledge of twin risks and desired number of embryos …

Embryo Transfer Practices In The United States: A Survey Of Clinics Registered With The Society For Assisted Reproductive Technology, E. Jungheim, Ginny Ryan, E. Levens, A. Cunningham, G. Macones, K. Carson, A. Beltsos, R. Odem

Ginny L. Ryan

OBJECTIVE: To gain a better understanding of factors influencing clinicians' embryo transfer practices. DESIGN: Cross-sectional survey. SETTING: Web-based survey conducted in December 2008 of individuals practicing IVF in centers registered with the Society for Assisted Reproductive Technology (SART). PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Prevalence of clinicians reporting following embryo transfer guidelines recommended by the American Society for Reproductive Medicine (ASRM), prevalence among these clinicians to deviate from ASRM guidelines in commonly encountered clinical scenarios, and practice patterns related to single embryo transfer. RESULT(S): Six percent of respondents reported following their own, independent guidelines for the number of embryos …

The Pharmaceutical Industry: Friend Or Foe?, Jennifer Niebyl

Jennifer R Niebyl

No abstract provided.

Perinatal Management Of Women With Immune Thrombocytopenic Purpura: Survey Of United States Perinatologists, D. Peleg, Stephen Hunter

Stephen K. Hunter

OBJECTIVE: The aim of the study was to determine how perinatologists in the United States manage the care of women with immune thrombocytopenic purpura with respect to mode of delivery. Study Design: US members of the Society of Perinatal Obstetricians were surveyed with a 4-question questionnaire. Two mailings were sent. Questions 1 and 2 asked for a response regarding the perinatal management of delivery for women with chronic immune thrombocytopenic purpura and new-onset disease. The options were cordocentesis or fetal scalp blood sampling and cesarean delivery if the platelet count was <50,000 cells/microL, cesarean delivery if the maternal platelet count …

The Association Between Hospital Obstetrical Volume And Maternal Postpartum Complications., Kathy L Kyser, Xin Lu, Donna Santillan, Mark Santillan, Stephen Hunter, Alison G Cahill, Peter Cram

Stephen K. Hunter

OBJECTIVE: The purpose of this study was to examine the relationship between delivery volume and maternal complications.

STUDY DESIGN: We used administrative data to identify women who had been admitted for childbirth in 2006. Hospitals were stratified into deciles that were based on delivery volume. We compared composite complication rates across deciles.

RESULTS: We evaluated 1,683,754 childbirths in 1045 hospitals. Decile 1 and 2 hospitals had significantly higher rates of composite complications than decile 10 (11.8% and 10.1% vs 8.5%, respectively; P < .0001). Decile 9 and 10 hospitals had modestly higher composite complications as compared with decile 6 (8.8% and 8.5% vs 7.6%, respectively; P < .0001). Sixty percent of decile 1 and 2 hospitals were located within 25 miles of the nearest greater volume hospital.

CONCLUSION: Women who deliver at very low-volume hospitals have higher complication rates, as do women who deliver at …

Group B Streptococci Causing Neonatal Bloodstream Infection: Antimicrobial Susceptibility And Serotyping Results From Sentry Centers In The Western Hemisphere, J. Andrews, D. Diekema, Stephen Hunter, P. Rhomberg, M. Pfaller, R. Jones, G. Doern

Stephen K. Hunter

OBJECTIVE: Group B streptococcal infection is a common cause of neonatal sepsis. Surveillance of antimicrobial susceptibility and serotype frequencies of invasive group B streptococci is important to ensure the effectiveness of therapeutic regimens and to guide vaccine development. STUDY DESIGN: Prospective surveillance of neonatal bloodstream infection was performed at all Western Hemisphere sites participating in the SENTRY Program. From January 1997 through December 1999, a total of 122 isolates of bloodstream infections with group B streptococci were collected and sent to the University of Iowa for antimicrobial susceptibility testing and serotyping. RESULTS: No isolates were resistant to penicillin. More than …

A Single-Institution Evaluation Of Factors Important In Fallopian Tube Carcinoma Recurrence And Survival., Alireza Shamshirsaz, Thomas Buekers, Koen De Geest, David Bender, Gideon Zamba, Michael Goodheart

Koen De Geest

OBJECTIVE: The aim of this study was to identify prognostic factors and markers that influence clinical outcomes in patients with primary fallopian tube carcinoma at a single tertiary health care center. These prognostic factors may be of clinical importance and can subsequently be included in future clinical trials. MATERIALS AND METHODS: A retrospective review of our Tumor Registry and Gynecologic Oncology database was conducted to include any patients with a diagnosis of fallopian tube carcinoma between the years 1994 and 2005. We identified clinicopathological data to evaluate factors important in recurrence, disease-specific and overall survival. Kaplan-Meier curves were generated, and …

The Sensitivity And Specificity Of A Simple Test To Distinguish Between Urge And Stress Urinary Incontinence., Jeanette Brown, Catherine Bradley, Leslee Subak, Holly Richter, Stephen Kraus, Linda Brubaker, Feng Lin, Eric Vittinghoff, Deborah Grady

Catherine S. Bradley

BACKGROUND: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice. OBJECTIVE: To test the accuracy of a simple questionnaire to categorize type of urinary incontinence in women. DESIGN: Multicenter, prospective study of the accuracy of the 3 Incontinence Questions (3IQ) compared with an extended evaluation to distinguish between urge incontinence and stress incontinence. SETTING: 5 academic medical centers in the United States. PARTICIPANTS: 301 women enrolled from April to December 2004 who were older …

The Sensitivity And Specificity Of A Simple Test To Distinguish Between Urge And Stress Urinary Incontinence, J. S. Brown, Catherine Bradley, L. L. Subak, H. E. Richter, S. R. Kraus, L. Brubaker, F. Lin, E. Vittinghoff, D. Grady

Catherine S. Bradley

BACKGROUND: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice. OBJECTIVE: To test the accuracy of a simple questionnaire to categorize type of urinary incontinence in women. DESIGN: Multicenter, prospective study of the accuracy of the 3 Incontinence Questions (3IQ) compared with an extended evaluation to distinguish between urge incontinence and stress incontinence. SETTING: 5 academic medical centers in the United States. PARTICIPANTS: 301 women enrolled from April to December 2004 who were older …

A Single-Institution Evaluation Of Factors Important In Fallopian Tube Carcinoma Recurrence And Survival., Alireza Shamshirsaz, Thomas Buekers, Koen De Geest, David Bender, Gideon Zamba, Michael Goodheart

David P Bender

OBJECTIVE: The aim of this study was to identify prognostic factors and markers that influence clinical outcomes in patients with primary fallopian tube carcinoma at a single tertiary health care center. These prognostic factors may be of clinical importance and can subsequently be included in future clinical trials. MATERIALS AND METHODS: A retrospective review of our Tumor Registry and Gynecologic Oncology database was conducted to include any patients with a diagnosis of fallopian tube carcinoma between the years 1994 and 2005. We identified clinicopathological data to evaluate factors important in recurrence, disease-specific and overall survival. Kaplan-Meier curves were generated, and …

Asthma In Pregnancy: Pathophysiology, Diagnosis And Management., Abbey Hardy-Fairbanks, Emily Baker

Abbey J Hardy-Fairbanks

Asthma is a common, potentially serious, even life-threatening, chronic medical condition seen amongst nearly all groups of patients, regardless of ethnicity and socioeconomic circumstances. This article addresses the group of pregnant women with symptomatic asthma as well as those whose asthma is asymptomatic as a result of good control. The incidence, the pathophysiologic changes of pregnancy, and the interplay between these changes and asthma are reviewed in this article. The classification of these patients and appropriate management strategies are discussed.

A Comparison Of Hospice In The Us And Uk: Implications For Policy And Practice, Ruth Remington, G Wakim

Ruth Remington

The modern hospice movement in the United States was modeled on the specialized care for dying individuals that was championed by Dame Cicely Saunders, a social worker, nurse, and physician, in London in the 1960s. A collaboration between Saunders and Florence Wald, then at Yale University, led to the establishment of the first hospice in the United States in 1974. Despite similar foundations, the provision of hospice care differs in the United States and the United Kingdom with regard to financing and access. This article reviews these similarities and differences and discusses implications for U.S. hospice policy.

The Independent Nurse Role In Community Care Gerontological Nursing, Deborah Schoenfelder, Janet Specht, Meridean Maas

Deborah P. Schoenfelder

No abstract provided.

Homesafe: Supportive Assistance For Elderly Individuals Through A Nurse-Managed Plan, Deborah Schoenfelder, Meridean Maas, Janet Specht

Deborah P. Schoenfelder

A lack of quality, cost-effective alternatives to nursing home care for community-dwelling older adults exists. The evidence suggests that case management provides quality care in a cost-efficient manner to help older adults remain at home safely and as independently as possible. This article describes HomeSafe, a nurse-managed membership plan that assists older individuals to enhance their health and quality of life, and to age in place in their homes and communities. HomeSafe serves as an innovative model of care and a teaching site for undergraduate and graduate nursing students and nursing faculty at The University of Iowa.

Economics And The Education Of Nurse Anesthetists: Part 1, Cormac O'Sullivan, E. Thompson

Cormac T. O'Sullivan

No abstract provided.

Economics And The Education Of Nurse Anesthetists: Part 2, Cormac O'Sullivan, E. Thompson

Cormac T. O'Sullivan

Economic assumptions and other factors affecting the economics of nurse anesthesia education are presented in Part 2 of this 2-part column. In Part 1, published in the October 2004 issue of the AANA Journal, general economic principles and healthcare economic principles in particular were described, explained, and related to the current US healthcare system.

Evidence-Based Management Assessment Of Return On Investment From Anesthesia Information Management Systems, Cormac O'Sullivan, F. Dexter, D. Lubarsky, M. Vigoda

Cormac T. O'Sullivan

A systematic and comprehensive review of the scientific literature revealed 4 evidence-based methods that contribute to a positive return on investment from anesthesia information management systems (AIMS): reducing anesthetic-related drug costs, improving staff scheduling and reducing staffing costs, increasing anesthesia billing and capture of anesthesia-related charges, and increased hospital reimbursement through improved hospital coding. There were common features to these interventions. Whereas an AIMS may be the ideal choice to achieve these cost reductions and revenue increases, alternative existing systems may be satisfactory for the studied applications (i.e., the incremental advantage to the AIMS may be less than predicted from …