Examining Structural Constraints and Electronic Health Record Use in Acute Care Hospitals

Electronic Health Record (EHR) use is expected to quickly increase in the USA. It is the hope of the federal government and many hospitals that EHR use will not only increase, but also mature from basic applications such as EHR for results viewing (ERV) to more advanced applications such as Computerized Provider Order Entry (CPOE). Today, considerable heterogeneity exists among hospitals with regard to EHR use and the movement toward advanced EHR applications. Examining this heterogeneity is useful as hospitals move toward advanced EHR. Survey data collected from 297 acute care hospitals in 47 states suggests that critical access hospitals may be slow to use EHR, even in the early stages of ERV. Conversely, major teaching hospitals appear to be early adopters, achieving advanced ERH use. These findings are key for hospital executives, Health Information Technology managers, and policymakers facing resource allocation decisions for EHR adoption

Bile acid profiling reveals distinct signatures in undernourished children with environmental enteric dysfunction

Background: Intestinal inflammation and malabsorption in environmental enteric dysfunction (EED) are associated with early childhood growth faltering in impoverished settings worldwide.Objectives: The goal of this study was to identify candidate biomarkers associated with inflammation, EED histology, and as predictors of later growth outcomes by focusing on the liver-gut axis by investigating the bile acid metabolome.Methods: Undernourished rural Pakistani infants (n = 365) with weight-for-height Z score (WHZ) \u3c -2 were followed up to the age of 24 mo and monitored for growth, infections, and EED. Well-nourished local children (n = 51) were controls, based on consistent WHZ \u3e 0 and height-for-age Z score (HAZ) \u3e -1 on 2 consecutive visits at 3 and 6 mo. Serum bile acid (sBA) profiles were measured by tandem MS at the ages of 3-6 and 9 mo and before nutritional intervention. Biopsies and duodenal aspirates were obtained following upper gastrointestinal endoscopy from a subset of children (n = 63) that responded poorly to nutritional intervention. BA composition in paired plasma and duodenal aspirates was compared based on the severity of EED histopathological scores and correlated to clinical and growth outcomes.Results: Remarkably, \u3e70% of undernourished Pakistani infants displayed elevated sBA concentrations consistent with subclinical cholestasis. Serum glycocholic acid (GCA) correlated with linear growth faltering (HAZ, r = -0.252 and -0.295 at the age of 3-6 and 9 mo, respectively, P Conclusions: Dysregulated bile acid metabolism is associated with growth faltering and EED severity in undernourished children. Restoration of intestinal BA homeostasis may offer a novel therapeutic target for undernutrition in children with EED. This trial was registered at clinicaltrials.gov as NCT03588013

Comparing patient characteristics and treatment processes in patients receiving physical therapy in the United States, Israel and the Netherlands. Cross sectional analyses of data from three clinical databases

<p>Abstract</p> <p>Background</p> <p>Many assume that outcomes from physical therapy research in one country can be generalized to other countries. However, no well designed studies comparing outcomes among countries have been conducted. In this exploratory study, our goal was to compare patient demographics and treatment processes in outpatient physical therapy practice in the United States, Israel and the Netherlands.</p> <p>Methods</p> <p>Cross-sectional data from three different clinical databases were examined. Data were selected for patients aged 18 years and older and started an episode of outpatient therapy between January 1^st2005 and December 31^st2005. Results are based on data from approximately 63,000 patients from the United States, 100,000 from Israel and 12,000 from the Netherlands.</p> <p>Results</p> <p>Age, gender and the body part treated were similar in the three countries. Differences existed in episode duration of the health problem, with more patients with chronic complaints treated in the United States and Israel compared to the Netherlands. In the United States and Israel, physical agents and mechanical modalities were applied more often than in the Netherlands. The mean number of visits per treatment episode, adjusted for age, gender, and episode duration, varied from 8 in Israel to 11 in the United States and the Netherlands.</p> <p>Conclusion</p> <p>The current study showed that clinical databases can be used for comparing patient demographic characteristics and for identifying similarities and differences among countries in physical therapy practice. However, terminology used to describe treatment processes and classify patients was different among databases. More standardisation is required to enable more detailed comparisons. Nevertheless the differences found in number of treatment visits per episode imply that one has to be careful to generalize outcomes from physical therapy research from one country to another.</p

Critical Thinking in Nursing Education: Literature Review

The need for critical thinking in nursing has been accentuated in response to the rapidly changing health care environment. Nurses must think critically to provide effective care whilst coping with the expansion in role associated with the complexities of current health care systems. This literature review will present a history of inquiry into critical thinking and research to support the conclusion that critical thinking is necessary not only in the clinical practice setting, but also as an integral component of nursing education programs to promote the development of nurses’ critical thinking abilities. The aims of this paper are: (a) to review the literature on critical thinking; (b) to examine the dimensions of critical thinking; (c) to investigate the various critical thinking strategies for their appropriateness to enhance critical thinking in nurses, and; (d) to examine issues relating to evaluation of critical thinking skills in nursing.</ul

Value co-creation and resource based perspectives for strategic sourcing

Purpose – The purpose of this paper is to develop and illustrate a theoretically grounded framework capable of strategic guidance in making sourcing decisions. Design/methodology/approach – Based on literature review and secondary data from the US operation of 7-Eleven, a large international retailer, this study develops and supports a framework for understanding and undertaking business process sourcing decisions. The framework considers internal core competencies, as well as the role of external actors in value creation, in analyzing sourcing decisions for business processes. Findings – Case analysis reveals that a firm's successful sourcing decisions can be explained by resource based view (RBV) and value co-creation theories. RBV is shown to provide an internal view of the firm considering its core competencies, while value co-creation illuminates the external perspective considering the role of customers when making sourcing decisions. Further, these theories can be decomposed and simplified, thereby providing scholars with new theoretical insights for this phenomenon and practitioners with a decision-making tool for undertaking sourcing decisions. Originality/value – This paper explains in granular detail how effective outsourcing decisions can be made. It employs a rarely considered perspective by combining nascent literature from the value co-creation stream with established beliefs about RBV core competencies to make three contributions. First, it shows how sourcing decisions can be explained not only by the RBV perspective but also by the value co-creation view. Second, in considering the role of value co-creation with the customer, it introduces the perspective of the customer as a decision-making consideration for sourcing. Third, it provides practitioners with a sourcing decision-making tool