Role of Executive Leadership in Healthcare Transformation

The paper investigates the value of executive leadership in a transformational environment and examines if it requires a different skill set than managing in a more stable operational environment. The authors also look at the critical CEO skill set for leading successful health IT transformational change

Realizing the Value of EHR Systems: Critical Success Factors

Now that a majority of hospitals and primary care physicians have made the transition to electronic health record (EHR) systems, realizing value from this investment has become a major issue. The issue raises two key questions: Why do so many EHR implementations continue to fall short of achieving intended healthcare outcome goals? What differentiates those that succeed from those that fall short? This article builds on prior research using a systems framework to analyze the EHR implementation process. It focuses on ten common themes (CSFs) that appear to differentiate institutions which achieve positive healthcare outcomes from those that do not. Results are highly relevant for healthcare institutions now seeking to focus on realizing the value of their EHR systems

Cervical cancer screening test performance for HIV-infected women: A meta-analysis

Objectives: Screening for cervical intraepithelial neoplasia (CIN) in HIV-infected women is essential to prevent invasive cervical cancer. Visual inspection with acetic acid (VIA) and HPV DNA testing have been proposed as alternatives to traditional cytology (or Papanicolaou [Pap] smears) screening programs. This meta-analysis provides pooled data on test performance (i.e., sensitivity, specificity, positive predictive value, and negative predictive value) of Pap, VIA, and HPV DNA testing with the Hybrid Capture II in HIV-infected women for diagnosing CIN2 or worse (CIN2+). Methods: A meta-analysis of cervical cancer screening test performance for HIV-infected women was conducted following the PRISMA guidelines using PubMed and EMBASE databases. Relevant data were extracted from the articles and analyzed using STATA 13. Results: Six studies met the inclusion criteria and were selected for analysis. The pooled sensitivity of HPV DNA testing was 86.9% (95% CI, 58.3%-97.0%), VIA was 77.6% (95% CI, 73.5%-81.1%), Pap (at a low-grade squamous intraepithelial lesion [LSIL] threshold) 72.8% (95% CI, 41.1%-91.2%) and Pap (at a high-grade SIL [HSIL] threshold) 34.2% (95% CI, 8.7%-74.0%). The pooled specificities were 60.2% (95% CI, 40%-77.5%) for HPV DNA testing, 73.4% (95% CI, 50.5%-88.2%) for VIA, 72.9% (95% CI, 31.6%-94.0%) for Pap (LSIL threshold) and 94.5% (95% CI, 78.0%-98.8%) for Pap (HSIL threshold). Conclusions: HPV DNA screening is a highly sensitive screening technique for HIV-infected women; however, there are still many barriers to its implementation in low-resource settings. VIA-based screening programs are a feasible alternative for HIV-infected women until the required resources (monetary resources and laboratory infrastructure) are committed for HPV DNA based screening programs.Master of Public Healt

Clara Barton: The True Story

This research paper illuminates the true story of Clara Barton's life and exposes a lapse of integrity in the historical record

Mobile and Connected Device Security Considerations: A Dilemma for Small and Medium Enterprise Business Mobility?

Business mobility is rapidly becoming an everyday way of doing business. Mobile technologies, such as smartphones and connected devices, are enabling this business evolution. However, they are also creating new security concerns for the enterprise and its employees. Security experts are studying these increased security concerns to develop more secure practices and policies for the next generation mobile technologies. This paper describes these new mobile security concerns and discusses preliminary expert recommendations to reduce an increasing business risk. Although large enterprises have the resources to implement emerging security recommendations, small and medium enterprises (SMEs) may not be able to adopt the new recommendations because they lack IT resources and capabilities. This paper describes the SME dilemma: Embrace the mobility business strategy and adopt and invest in the necessary security technology, or give up their mobility business strategy to protect enterprise and customer data and information. Finally, the paper identifies future research questions concerning SME security awareness and capability to minimize security threats to develop more viable security practices

Integrating Survivors of Stroke Into Cardiac Rehabilitation

Stroke is the leading cause of disability in the United States (U.S.). Impairments after stroke typically result in reduced physical activity which increases the risk for stroke recurrence and the development or worsening of comorbid health conditions. Physical activity and exercise behaviors can reduce cardiovascular risk factors and improve endurance for survivors of stroke. Despite these known significant benefits, survivors of stroke face barriers to participating in regular physical activity due to limited self-efficacy, safety concerns, environmental restrictions and lack of accessible community programs. Cardiac Rehabilitation (CR) is a structured exercise and behavior modification program for people with cardiovascular disease that is prevalent in health care systems in the U.S. Participation in CR has been shown to increase functional exercise capacity, lower risk of hospital readmissions, and improve health related quality of life for traditional participants. Despite similar cardiovascular risk factors, stroke is not among the covered diagnoses for CR services. The purpose of this mixed methods pilot intervention study was to examine the feasibility and participant impact of integrating survivors of stroke into an existing hospital-based CR program in the southeast U.S. Chapter two assessed feasibility through quantitative assessments of recruitment, uptake, retention, adherence, fidelity, acceptability and safety, and a qualitative evaluation of participant perception of the program. Chapter three evaluated participant impact through pilot effectiveness measures for physical function and other health impacts, and through qualitative evaluation of participant perception of outcomes and future exercise plans. A mixed methods design combined a single group, pre-post, follow-up design, pilot feasibility study with a pragmatic qualitative inquiry. Survivors of stroke were recruited through hospital system providers and the community into a standard 12-week, 36 visit CR program. Fifty-three survivors were referred, 29 started the program and 24 completed the program. Participants were evaluated in effectiveness outcome measures at three timepoints: pre-program, post-program and six-month follow-up. Qualitative interviews occurred at the post-program evaluation. Process variables and feasibility measures were recorded and analyzed throughout the study. Results suggest CR is feasible for survivors of stroke who were able to meet dosage and intensity goals, and perceived the program as needed regardless of their mobility limitations or previous exercise experience. Participants enjoyed the camaraderie and positive environment and felt safe and attended to by staff. CR had significant impacts on cardiovascular endurance and functional strength, which were maintained at six-month follow-up. Most participants continued to exercise in the follow-up period. Challenges focused primarily on managing referral and uptake of the program. Using an existing structured exercise program, that is widely available in the U.S., feasible for stroke survivors, and supported by qualified licensed professionals, has the potential to improve cardiovascular endurance, health status and quality of life for survivors of stroke

Banner News

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Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort.

BackgroundDespite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications.Methods2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA.ResultsIn separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95% CI 0.31, 1.00], p = 0.05).ConclusionsEach common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma.Trial registrationClinicalTrials.gov NCT00608764, first received 1/28/2008