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Quality improvement, regulatory, and payer organizations use various definitions of hospital mortality as clinical outcome measures. In this prospective study, the authors evaluated a multicomponent intervention aimed at reducing inpatient mortality in a multistate healthcare delivery system. The project was initiated because of a statistically nonsignificant upward trend in mortality suggested by a six-quarter rise in the observed/expected mortality ratio generated by the Vizient Clinical Data Base and Resource Manager. The design of the mortality reduction plan was influenced by the known limitations of using hospital-wide mortality as a quality improvement measure. The primary objective was to reduce mortality through focused care redesign. The project leadership team attempted to implement standardized system-wide improvements while allowing individual hospitals to simultaneously pursue site-specific practice redesign opportunities. Between Q3, 2015, and Q4, 2017, system-wide mortality reduced from 1.78 to 1.53 (per 100 admissions; p = .01). The actual plan implemented in Mayo Clinic's hospitals is included as Appendix A to this article, published online as Supplemental Digital Content. The authors included it to allow comparison with similar efforts at other healthcare systems, as well as to stimulate criticism and discussion by readers.Usage of hospice services for patients facing life-limiting illness has steadily increased. In these services, hospitals discharge patients to various hospice settings, including the inpatient model, where a patient may remain in the discharging hospital to receive hospice services. In this discharge practice, the patient is considered a hospital survivor and subsequent hospice death. The purpose of the study was to determine if the decline of in-hospital mortality for six common high-volume admission diagnoses could be attributed in part to an increase in discharges to a hospice setting for end-of-life care. In this retrospective study using the National Inpatient Sample database from 2007 to 2011, we identified patients ≥18 years for six acute and chronic diagnoses heart failure, chronic obstructive pulmonary disease, acute myocardial infarction, acute myocardial infarction with cardiogenic shock, septic shock, and lung neoplasm (cancer). We categorized patients according to their hospital discharge disposition as hospice or in-hospital mortality. A total of 10,458,728 patients met our criteria, of which 2.72% were discharged to hospice and 6.38% died. Compared to patients who died in the hospital, hospice patients were older, had a shorter length of stay, and experienced more comorbidities. find more Hospice use was more common in Medicare patients, in nonteaching hospitals, and in the South. White individuals were more likely to be discharged to hospice compared to nonwhites. Among the six selected diagnoses over the 5-year period, hospice use rose as observed mortality decreased. Our findings suggest that variability among hospitals in hospice use will affect benchmarked hospital mortality comparisons and could inappropriately reward or penalize hospitals in their public reporting.This study examined the impact of employee satisfaction with management and coworkers on their performance as medical tourism facilitators. The proposed hypotheses were tested with structural equation modeling based on data collected from major hospitals in South Korea. Results supported assumptions that satisfaction with management is positively correlated with customer orientation and job satisfaction of medical tourism facilitators, as well as with the assumption that satisfaction with coworkers has a direct impact on customer orientation. This study has practical implications as organizations develop effective internal marketing (i.e., communication) strategies to improve the performance of medical tourism facilitators.Graja, A, Kacem, M, Hammouda, O, Borji, R, Bouzid, MA, Souissi, N, and Rebai, H. Physical, biochemical, and neuromuscular responses to repeated sprint exercise in eumenorrheic female handball players effect of menstrual cycle phases. J Strength Cond Res XX(X) 000-000, 2020-Very few studies have been interested in the relationship between ovarian hormones and physiological function in female athletes. The aim of this study was to assess the effect of menstrual phases (MP) on physical, neuromuscular, and biochemical responses after repeated sprint exercise (RSE) in female handball players. Ten eumenorrheic athletes (22.5 ± 1.5 years, 1.70 ± 0.04 m) participated in 3 study visits (follicular phase [FP], luteal phase [LP], and premenstrual phase [PMP]). During each MP, they performed 20 × 5-second cycle sprints interspersed with 25 seconds of rest. Maximal voluntary contraction (MVC) tests of the knee extensor muscles at 90° of knee flexion were performed before and after RSE. Peak force and electromyography (EMG) signals were measured during the MVC tests. Blood samples were collected before and 3 minutes after each session. The percentage of decrement in peak power output over the 20 × 5-second cycle test (i.e., fatigue index) calculated between sprints 1 and 20 decreased significantly during PMP (-43.3% ± 5.7%) but not in LP (-39.2% ± 7.7%) compared with FP (-32.44% ± 6.3%) (p 0.05). Maximal voluntary contraction, neuromuscular efficiency, and median frequency values of vastus lateralis and rectus femoris were significantly decreased in PMP compared with FP and LP (p less then 0.05). Creatine kinase (CK) levels were significantly higher in PMP compared with FP and LP after RSE (p less then 0.05). These findings suggest that RSE induces more peripheral fatigue associated with muscle damage in PMP. This might be attributable to hormonal variation across MP. Therefore, FP seems to be the right time for intense training to improve strength performance.Bartolomei, S, Nigro, F, Malagoli Lanzoni, I, Masina, F, Di Michele, R, and Hoffman, JR. A comparison between total body and split routine resistance training programs in trained men. J Strength Cond Res XX(X) 000-000, 2020-The purpose of the present investigation was to compare the effects of total body (TB) versus split routine (SR) resistance training workouts on maximal strength and muscle hypertrophy in trained men. Twenty-one resistance-trained men were randomly assigned to either a TB (TB age = 24.1 ± 4.4 years; body mass = 78.7 ± 11.3 kg; body height = 177.0 ± 3.9 cm) or the SR group (SR age = 24.9 ± 4.2 years; body mass = 79.2 ± 9.5 kg; body height = 175.2 ± 6.0 cm). Both groups performed a 10-week resistance training program. Isokinetic bench press at 75 and 25 cm·s (ISOK75 and ISOK25, respectively), isometric bench press (ISOBP), isometric squat (ISOSQ), and one repetition maximum BP and SQ assessments were performed before and after training. Muscle thickness of the pectoralis major (PECMT), superior part of trapezius (TRAPMT), and vastus lateralis (VLMT) muscles was also evaluated at the same timepoints using ultrasonography.