Kristiansentilley3153

of Evidence 3.

The formation of regional strategic alliances continues to be a well-evidenced response to a varying array of market forces that are challenging the ability of healthcare institutions to realize their missions. Organizations that serve rural communities especially feel pressure to initiate the formation of these collaborative arrangements.In response to concerns of Pennsylvania legislators regarding the impact of these alliances on rural healthcare entities, the Center for Rural Pennsylvania funded a study of outcomes of regional strategic alliances involving rural healthcare institutions. Although the research focused on outcomes, the data also revealed organizational characteristics and patterns of decisions and actions that separated rural healthcare institutions with greater alliance outcome success from their peers serving other rural communities. Strategic leadership and interorganizational management expertise serve as the foundation for decisions and actions beginning before an active search for an involving rural healthcare institutions, the lessons presented here are transferable to community healthcare organizations regardless of location.

Intensive care unit (ICU) telemedicine has grown exponentially to the point that approximately 10% of U.S. hospitals use such programs. However, no studies have focused on strategic decision tools in the context of rural hospitals. We applied the pervasive balanced scorecard framework and used a sequential, mixed methods design with qualitative and quantitative data sources. We then triangulated them to generate value scorecards for four rural South Carolina hospitals. Four domains, each with numerous components, were identified and compiled to create a composite value scorecard. Domains and numbers of components included organizational (n = 10), clinical (n = 5), financial (n = 8), and strategic (n = 3) effects of ICU telemedicine. When weighting each component within domains and then comparing across hospitals, we identified substantial variation in the relative value derived from ICU telemedicine. Our novel, multidimensional value scorecard could be prospectively applied by hospitals seeking a structuredld be prospectively applied by hospitals seeking a structured approach to decision-making for ICU telemedicine investments.

Medical assistants-key professionals supporting physician practices-have not been studied with regard to burnout and professional fulfillment, which may affect other healthcare professionals. This study examined the factors associated with burnout among medical assistants in an academic healthcare organization while validating the use of a tool previously used to assess burnout in physicians. Using portions of the Professional Fulfillment Index (PFI) and questions designed for this mixed methods study, medical assistants employed across Stanford Health Care were surveyed. The authors assessed demographic characteristics and the impact of control, organizational culture, team knowledge, self-efficacy, and professional fulfillment/meaningfulness on burnout. Of the 505 eligible participants, 261 (52%) completed the survey; 76% were women. The study validated the PFI for use with this population and validated three additional scales. Burnout was found to be low among medical assistants (M = 2.32); professional e, this study could be replicated in other organizations.

Medicare's Hospital Valued-Based Purchasing (HVBP) program measures hospitals' total performance score (TPS); its measurement strategies have changed regularly since its rollout in 2013. Because the program influences care delivery, it is important to examine how the policy has changed hospitals' behavior and how it may inform future policies. The purpose of this study was to assess the relationship between hospitals' performance on TPS annually from 2013 to 2018 and organizational characteristics. Using the HVBP TPS from 2013 to 2018 and associated hospital characteristics-hospital size, teaching hospital status, system membership, ownership type, urban/rural location, average percentages of patients from Medicare and Medicaid, operating margins, percentages of inpatient revenue as a proportion of total revenue, and case mix index-we conducted a retrospective cohort study of all U.S. hospitals participating in the HVBP program. Regression and panel analyses found that organizations that were expected to har greater resource slack to meet these changes.

Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). We report a rare MP complication after microvascular decompression (MVD) surgery in the park-bench position in a patient with hemi-facial spasm.

The patient was a 46-year-old female (height 155 cm, weight 42 kg). She was neither diabetic nor a regular alcohol user. After the first MVD for right hemifacial spasm, her symptom recurred and she underwent a second MVD procedure in the park-bench position that led to the disappearance of her hemifacial spasm. However, she complained of right antero-lateral thigh pain and dysesthesia without motor weakness. The symptom was limited to the LFCN area; pelvic compression test elicited a positive Tinel-like sign. Our preliminary diagnosis was MP. As conservative therapy was ineffective she underwent LFCN block 9 months after the second MVD procedure. Her symptom improved dramatically and we made a definitive diagnosis of MP. There has been no recurrence in the course of 30 months although she reported persistent mild dysesthesia in the LFCN area.

MP is a rare complication after MVD surgery in the park-bench position. Symptom abatement and a definitive early diagnosis can be obtained by LFCN blocks.

MP is a rare complication after MVD surgery in the park-bench position. Symptom abatement and a definitive early diagnosis can be obtained by LFCN blocks.Amyloid light-chain (AL) cardiac amyloidosis is known to result in restrictive cardiomyopathy, which has a poor prognosis. Although electrocardiography (ECG) is useful for its diagnosis and management, there are few reports on the long-term follow-up of electrocardiographic changes. The patient in the present case was a 62-year-old woman who visited our hospital due to palpitation and lower leg edema. A chest radiograph showed cardiac enlargement, and ECG revealed sinus rhythm, first-degree atrioventricular block, low QRS voltage in the limb leads and a pseudomyocardial infarction pattern in the precordial leads. Echocardiography revealed left ventricular hypertrophy with systolic and diastolic dysfunction. Immunoelectrophoresis demonstrated M-protein (IgGλ), and bone marrow biopsy implied IgGλ-type plasmacytoma. Nutlin-3a Myocardial biopsy findings were compatible with cardiac amyloidosis. Based on these findings, we diagnosed the patient with AL cardiac amyloidosis. Melphalan-prednisolone (MP) therapy was performed in conjunction with treatment for non-sustained ventricular tachycardia and congestive heart failure.