Academic Health Science Centre Research Articles

The Utah Primary Care Experience

I appreciate the opportunity to comment on the article by Magill and colleagues,[1][1] which describes a 7-year saga to operate a primary care network for an academic health science center. There are a number of notable things to comment on as one looks from afar. In doing so, I will compare their

Interdisciplinary Collaboration

Nursing faculty often perceive that developing Web-based distance education courses is very time consuming, while others believe they lack the necessary pedagogical skills. This article describes an interdisciplinary collaborative approach to developing a Web-based distance education course in an academic health science center. This strategy effectively supported faculty in learning new skills and resulted in a highly satisfying experience for faculty and students.

Surgical Simulation

Surgical Simulation

Laparoscopic colon surgery performed safely by general surgeons in a community hospital: a review of 154 consecutive cases

The primary end point of this study was documentation of the feasibility, safety, and benefits of laparoscopic colon resection (LCR) performed by general surgeons in a community hospital. The charts of 154 patients who underwent LCR between March 1998 and August 2003 by a group of three surgeons working in a community hospital were reviewed. Data extracted from the charts included patients' demographics, surgical indications and procedures, conversion rate, history, operative time, postoperative recovery time, and complication rates. Of the 154 patients, 70 were men. The mean age of the patients was 60 years. Overall, 62% of the patients had a history of prior abdominal surgery. In the majority of cases (77%), LCR was performed for benign disease. Segmental resection involving the left colon was performed for 122 patients, and right hemicolectomy was performed for 32 patients. The rates of conversion were 9.6% for open surgery and 12% for diverticulitis (n = 83). For LCR, the median operative time was 120 min, and the median hospital stay was 5 days. The complication rate was 21.6% for LCR, and the mortality rate was 2.1%. The outcomes for LCR performed by a team of general surgeons working together in a community hospital are similar to the historical results from academic health science centers.

Leading roles for reference librarians in institutional repositories

PurposeAims to describe one academic health science center library's experience with expanding reference librarian leadership roles in implementing institutional repository initiatives.Design/methodology/approachThe institutional repository project development phases are briefly documented. The rationale for selecting reference librarians to lead the initiative and resultant role changes is discussed.FindingsReference librarians are strategically placed to promote and administer institutional repository initiatives successfully. The professional challenge rests in reference librarians' readiness to become scholarly publishing change agents.Practical implicationsThis case study documents a successful approach to incorporating institutional repository projects into existing library roles in addition to providing new leadership opportunities for reference librarians.Originality/valueReference librarian roles in institutional repository projects and the evolution of organizational roles are not addressed in the heavily technology‐ and marketing‐based institutional repository literature.

Area Health Education Centers

Drawing from the results of an empirical study, we discuss the strengths and challenges of Area Health Education Centers in three domains-mission, programs, and organization--and highlight their implications for Academic Health Science Center leaders.

Thrombophilia and the Risk for Hemodialysis Vascular Access Thrombosis

Vascular access thrombosis is the most common and costly complication in hemodialysis patients. The role of thrombophilia in access thrombosis is not established. A case-control study was conducted of 419 hemodialysis patients to determine whether thrombophilia was associated with arteriovenous fistula or graft thrombosis. Participants were enrolled from three in-center and five satellite dialysis units associated with a Canadian academic health science center that provides dialysis services in a catchment area of one million. Patients were tested for factor V Leiden, prothrombin gene mutation, factor XIII genotype, methylenetetrahydrofolate reductase genotype, lupus anticoagulant, anticardiolipin antibody, factor VIII, homocysteine, and lipoprotein (a) concentrations. Overall, 59 (55%) patients with access thrombosis had at least one thrombophilia compared with 122 (39%) patients without access thrombosis (unadjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.23 to 2.98). After controlling for important risk factors, the association between any thrombophilia and access thrombosis remained (adjusted OR, 2.42; 95% CI, 1.47 to 3.99). For each additional thrombophilic disorder, the odds of access thrombosis increased significantly (adjusted OR, 1.87; 95% CI, 1.34 to 2.61). This study suggests that thrombophilia is associated with access thrombosis in dialysis patients. Large, multicenter, prospective cohort studies are needed to confirm the observations from this case-control study.

ACAHO/ACEN Comment: Patient Safety Culture and Leadership in Canada's Academic Health Sciences Centres

ACAHO/ACEN Comment: Patient Safety Culture and Leadership in Canada's Academic Health Sciences Centres

A technology and nursing collaboration to help older adults age in place

This is an account of an active collaboration between Computer Engineering, Health Informatics, and Nursing within an academic health science center to improve the quality of life of older adults as they "age in place." The Sinclair School of Nursing at the University of Missouri-Columbia has developed a licensed home health agency, Senior Care, to provide the care needed by residents of TigerPlace, a specially designed independent living center near the University. Technology has the potential to help address common problems encountered by older adults related to functional decline. Collaboration between Nursing, Computer Engineering, and Health Informatics is likely on a path to improve the quality of life of seniors.

The Role of Patients in Designing Health Information Systems: The Case of Applying Simulation Techniques to Design an Electronic Patient Record (EPR) Interface

One overall objective of Electronic Patient Records (EPRs) is to improve patient education and to enhance the patient experience through the use of information technology (IT) so as to facilitate the sharing of information between providers and their patients. The research project reported on herein took place at University Health Network (UHN) in Toronto (Canada), which is a large academic health science center with multiple hospital sites in the city. As a first step in this process, we examined the literature to investigate the human factors issues related to healthcare as well as other settings. Subsequently, we interviewed a number of interested stakeholders from two groups: the physicians (both family and attending) and the patients themselves. Finally, using a simulation environment, we explored the content that UHN lung-transplant patients would be interested in having within their own EPRs. In this paper, we report on the research, the methodology and the findings pertaining to the both the content and the design of an electronic patient record.

ACAHO Comment: Securing the Future of Canada's Academic Health Sciences Centres

Although there have been a number of in-depth national, federal, provincial and territorial reviews of the health system in Canada, there has not been a systematic review of the current mission/mandate and future roles and responsibilities of Canada's Academic Health Sciences Centres (AHSCs) since the early 1990s--this despite the fact that the system has experienced profound change. With this in mind, more than 20 national health organizations and others have engaged in discussions about the importance of establishing a national task force to consider and develop recommendations that will focus on the future role of Canada's AHSCs.

Freestanding Psychology: The Only Way in Academic Health Centers

Psychology must assure that its programs, faculty and staff, clinical services, research enterprises, and training programs must be freestanding in Academic Health Science Centers and not organized within any other department except a freestanding Department of Psychology. Without this autonomy, it is argued, Psychology can never reach its full potential as a health care science and profession in hospital and academic health care center settings. This thesis is argued on the basis of issues of finances, credentialing and privileging, role modeling for psychologist trainees, the importance of Psychology's persona within the health science center and in the eyes of the public, and finally, academic freedom.

Patient Safety Culture and Leadership within Canada's Academic Health Science Centres: Towards the Development of a Collaborative Position Paper

Currently, the Academy of Canadian Executive Nurses (ACEN) is working with the Association of Canadian Academic Healthcare Organizations (ACAHO) to develop a joint position paper on patient safety cultures and leadership within Academic Health Science Centres (AHSCs). Pressures to improve patient safety within our healthcare system are gaining momentum daily. Because AHSCs in Canada are the key organizations that are positioned regionally and nationally, where service delivery is the platform for the education of future healthcare providers, and where the development of new knowledge and innovation through research occurs, leadership for patient safety logically must emanate from them. As a primer, ACEN provides an overview of current patient safety initiatives in AHSCs to date. In addition, the following six key areas for action are identified to ensure that AHSCs continue to be leaders in delivering quality, safe healthcare in Canada. These include: (1) strategic orientation to safety culture and quality improvement, (2) open and transparent disclosure policies, (3) health human resources integral to ensuring patient safety practices, (4) effective linkages between AHSCs and academic institutions, (5) national patient safety accountability initiatives and (6) collaborative team practice.

The Administrative Colloquium: Developing Management and Leadership Skills for Faculty

Development of leadership competencies has become a priority for many academic health science centers. However, traditional faculty development has focused almost exclusively on improving teaching skills. The process and outcomes of developing leadership skills for academic health science center faculty has not been extensively studied. The University of Nebraska Medical Center (UNMC) created a year-long course, called the Administrative Colloquium, as a means to enhance faculty leadership skills. Completion of the course required attendance at 8 half-day workshop sessions, each devoted to teaching a leadership competency (eg, leading with vision, managing change) and completing a project with a project report (oral or poster presentation). Course evaluation was multifaceted. Attendees were queried multiple times by a pre- and poststrategy and retrospective pre- and poststrategy concerning their perceptions about knowledge obtained during the course. Paired t testing was used to determine statistical differences between the mean pre- versus postvalues and the retrospective pre- versus postvalues. Project content was qualitatively analyzed for themes. All comparisons of pre- and postdata and retrospective pre- and postdata were statistically significant (P <.05). Three themes arose from the analysis of projects: change, management, and interpersonal communications. The pre- and postknowledge data and the retrospective pre- and postknowledge data demonstrate that learning was significant as well as sustained. Qualitative analysis of the project content demonstrates that the participants were applying the course content to solving real-world problems. These results give preliminary support to the conclusion that the Administrative Colloquium has had an impact on faculty leadership development at UNMC.

A guide to utilisation and sustainment of telemedicine: answering the question, ''What is in it for me?''

Despite a general consensus that many healthcare needs can be addressed through telemedicine, most telemedicine systems remain under-utilised and provision of services are difficult to sustain. Five steps for establishing baseline utilisation and assuring long-term growth and sustainability are outlined along with field-tested techniques for achieving each. The five steps are: identifying strategic partners, developing local champions, engaging the project team, securing executive buy-in, and garnering community support. Techniques for achieving each are based upon over eight years of experience in building telehealth programmes. Founded in exchange theory and reliant upon community development and mobilisation methods, these techniques aim to answer the question, What is in it for me? at the individual, organisational, community, and societal levels. To achieve each step, techniques are described for assessing and responding to the relative value of money, power and prestige for each level and key player. Effectively implemented, this approach assures that, once the deal is sealed, the leadership understands the risks and the opportunities, and the people on the ground floor have the resources and dedication to succeed. Scenarios based in real life experience are presented that demonstrate the ramifications of using and omitting some of these techniques. When fully implemented, these techniques result in projects that are built upon strong partnerships that distribute the risks, share resources and support multiple uses of the technology. In addition, the role of each partner – whether an individual, organisation or community – is aligned with its respective mission and strategic direction. The scenarios presented are based upon three projects for which these techniques were applied. A case study approach is used to describe the real world application of these steps in building strategic alliances between an academic health science centre and three universities. The first telemedicine alliance is being sustained, but is not growing. The second continues to grow and thrive. The third was never implemented.

A greater voice for academic health sciences libraries: the Association of Academic Health Sciences Libraries' vision.

The founders of the Association of Academic Health Sciences Libraries (AAHSL) envisioned the development of a professional organization that would provide a greater voice for academic health sciences libraries, facilitate cooperation and communication with the Association of American Medical Colleges, and create a forum for identifying problems and solutions that are common to academic health sciences libraries. This article focuses on the fulfillment of the "greater voice" vision by describing action and leadership by AAHSL and its members on issues that directly influenced the role of academic health sciences libraries. These include AAHSL's participation in the work that led to the publication of the landmark report, Academic Information in the Academic Health Sciences Center: Roles for the Library in Information Management; its contributions to the recommendations of the Physicians for the Twenty-first Century: The GPEP Report; and the joint publication with the Medical Library Association of Challenge to Action: Planning and Evaluation Guidelines for Academic Health Sciences Libraries.

Measuring practice patterns among acute care nurse practitioners.

This initiative was designed to develop a reliable instrument to measure the activities of acute care nurse practitioners (ACNPs). A sound, standardized method for measuring ACNP productivity will assist nursing leaders and administrators to demonstrate the effectiveness and productivity of ACNPs in and across institutions and systems. Current research on ACNPs uses many different methodologies and research designs, and fails to provide standard definitions to measure practice patterns, making it difficult to generalize across settings. Advisory groups from 2 New York academic health science centers developed a survey that covered the demographic, educational, and employment characteristics of ACNPs, and a 20-item classification of advanced practice nursing activities. Sixty-one ACNPs completed surveys, a 58% response rate. The survey found strong similarities at both institutions. ACNPs spend most of their time in 5 activities involving direct care and 4 activities within indirect care. Strong Cronbach alphas confirmed that the instrument was reliable. The availability of a reliable instrument for measuring ACNP practice patterns provides administrators with a powerful tool to demonstrate the contributions of their ACNPs. In addition, a standardized method for data collection can contribute to healthcare workforce policy discussions.

Canadian nurses' perceptions of patient safety in hospitals.

The topic of patient safety within the health care system is receiving increasing attention. The Academy of Canadian Executive Nurses conducted a national survey on nurses' perceptions of patient safety, using focus groups from Academic Health Science Centres. Over a three month time frame, 22 organizations, and 33 focus groups comprised of 503 nurses provided responses to six questions regarding patient safety in hospitals. The study was designed as a preliminary fact finding initiative resulting in this descriptive report of the concerns as identified within the focus groups. With each issue identification, they were coded and grouped into 23 themes. Nurses overwhelmingly responded that the health care environment, in which they provide care, presents escalating risk to their patients. In particular, Workload/Pace of Work, Human Resources, Nursing Shortage/Staffing, Restructuring/Bed Closures, Patients/Clients, Systems Issues, Physical Environment and Technology/Specialization were themes emphasized as contributing to increased risk in patient care. Health care leaders must play a key role in developing strategies to address the issues nurses have identified and demonstrate a commitment to controlling the situation. This study encourages research into a more explicit understanding of the issues and identification of strategies to address patient safety in health care.

Evaluation of an Innovative Pediatric Hospitalist Program in an Academic Health Sciences Centre in Toronto, Canada

Evaluation of an Innovative Pediatric Hospitalist Program in an Academic Health Sciences Centre in Toronto, Canada

Letters: Academic Health Sciences Centres: Several Perspectives Missed

Letters: Academic Health Sciences Centres: Several Perspectives Missed