Service Center Research Articles

Effectiveness of foot skin protection technology in elderly patients with diabetic peripheral neuropathy.

The aim of this study is to assess the effectiveness of foot skin protection technology in elderly patients with diabetic peripheral neuropathy. The foot skin protection technology was developed based on a comprehensive literature review and preliminary research conducted by our research team. Subsequently, 88 elderly patients with diabetic peripheral neuropathy and experiencing foot skin problems were recruited from two community health service centers in Shanghai. Using a random number table, the participants were randomly assigned to either the control group or the experimental group. Patients in the experimental group received foot skin protection technology interventions, while those in the control group received standard community nursing guidance for a duration of 3 months. The incidence, severity, and discomfort associated with foot skin problems were evaluated before and after the intervention period in both groups. The incidence, severity, and discomfort of foot skin problems notably reduced in the experimental group (all P< 0.05). The foot skin protection technology demonstrates significant potential in enhancing foot skin condition.

Evaluating industry payments to editorial board members of otolaryngology journals

ObjectiveTo evaluate the extent of payments from medical device and pharmaceutical companies to editorial board members of leading otolaryngology journals. MethodsEditorial board members of the top 10 otolaryngology journals from Google Scholar rankings were identified in this cross-sectional study.Payments between 2017 and 2022 were identified via the Open Payments Database from the Centers for Medicare and Medicaid Services. All payment data was adjusted for inflation in 2022 US dollars. Descriptive analyses were performed and journal websites were evaluated for individual editor disclosures. ResultsOut of 581 board members, 306 (53 %) received industry payments between 2017 and 2022, median journal percentage 55 % (interquartile range: 26.5 %–73.5 %). A sum of $45.8 million was paid out between 2017 and 2022, comprising $32.0 million in associated research funding, $1.2 million in research payments, $1.4 million in ownership and investment interests, and $11.2 million in general payments. The largest general payments were made out for “services other than consulting and speaking” ($3.9 million), “consulting” ($3.8 million), “travel and lodging” ($0.99 million), “education” ($0.87 million), “royalty or license” ($0.56 million), and “food and beverage” ($0.55 million). Individual editor disclosures were only available for International Forum of Allergy and Rhinology (9 % of all included editors). ConclusionsIndustry payments to editors of otolaryngology journals are not uncommon. We highlight the need for improved reporting of individual editor disclosures for transparency to journal readers and for minimizing biased editorial decisions.

Dialysis More Available Than Patient Education in Counties With High Diabetes Prevalence.

Poorly controlled diabetes is a principal cause of end stage renal disease (ESRD), generating an estimated 44% of new cases. Diabetes self-management education and support (DSMES) has been documented to reduce adverse outcomes such as ESRD. Helping patients better manage their condition could ultimately reduce ESRD prevalence. We compared the county-level availability of DSMES and dialysis as of November 2022 sorted by the estimated prevalence of diabetes among residents aged 18 years or older. The locations of DSMES programs and ESRD dialysis facilities were obtained from 2 professional organizations and the Centers for Medicare & Medicade Services. Estimated diabetes prevalence was obtained from the Centers for Disease Control and Prevention's PLACES data set. Counties were considered to have high diabetes prevalence if they fell into the top quartile for diabetes prevalence in 2019 (≥14.4% of adults). Analyses were conducted in 2023. DSMES was available in 41.0% of counties but in only 20.7% of counties with high diabetes prevalence versus 47.9% of low prevalence counties. Dialysis facilities were present in 59.2% of all counties, in 52.8% of all high diabetes prevalence counties, and in 61.4% of other counties. DSMES availability was linked to the presence of a hospital in the county, with only 6.3% of counties without a hospital offering the service. DSMES could play a role in reducing the prevalence of ESRD. Public health professionals need to be aware of the differing levels of local availability of this service and work to develop partnerships to provide DSMES in high-prevalence areas not currently served.

Female Leadership in Pediatric Ophthalmology: A Descriptive Analysis.

To examine female representation among current chiefs of pediatric ophthalmology services of academic medical centers and children's hospitals, as well as program directors of ophthalmology residency and pediatric ophthalmology fellowship programs in the United States. Data collection for this cross-sectional study occurred between December 2023 and February 2024, using publicly available sources to compile a list of academic medical centers and children's hospitals, as well as ophthalmology residency programs and pediatric ophthalmology fellowship programs that participated in the 2023-2024 San Francisco Match. Chi-squared analyses were performed using Excel 2021 software, where a P value less than .05 was considered statistically significant. Of the dedicated pediatric ophthalmology services across academic medical centers and children's hospitals in the United States, 38.3% (64/167) are led by a female chief. Female representation was greater at children's hospitals (40.0%, 36/90) than at academic medical centers (36.4%, 28/77), although no significant difference was observed (P = .69). Gender distribution was near equivalent at both academic training program levels, with slightly more female directors of fellowship programs (45.7%, 21/46) than ophthalmology residency programs (42.3%, 52/123) (P = .33). The authors report near equivalent female representation in the leadership of academic training programs at the residency and fellowship level. However, the proportion of female pediatric ophthalmology division chiefs lags behind the actual gender composition of the workforce. Given the increasing prevalence of female pediatric ophthalmologists, promotion of concordant representation in leadership is necessary to reflect the changing sociocultural landscape and to close the gender gap. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Will the situation of Left-Behind children improve when their parents Return? evidence from China

Based on Grossman’s (1972) health model and Becker and Tomes’ (1979, 1986) cognitive ability family decision-making model, this study examines the impact and mechanisms of children’s left-behind status and parental return on the accumulation of children’s health and cognitive human capital. By extending these models, we derive that changes in left-behind status have both income and separation effects on children’s human capital accumulation. Using data from the China Family Panel Studies (CFPS), we employ a Propensity Score Matching with Difference-in-Differences (PSM-DID) model to investigate the impact of changes in left-behind status (either remaining left-behind or experiencing parental return) on children’s human capital accumulation. The research findings reveal the following: (1) Compared to non-left-behind children, left-behind status significantly decreases children’s health levels by 11.81%. In contrast, parental return significantly improves children’s health levels by 13.04% compared to children whose parents are away. All results are statistically significant. (2) The negative impact of left-behind status is more pronounced for primary school children, those residing in rural areas, and those with parents of lower educational levels, especially in western regions. In contrast, parental return has a more substantial positive impact on junior high school children, those living in rural areas, and those with parents of lower educational levels, particularly in western regions. (3) When analyzing the impact mechanisms, we find that although parental migration for work increases household income, leading to a positive income effect on children’s health, it does not fully offset the negative separation effect caused by parental absence. As a result, the overall effect remains negative. Based on these findings, for migrant worker parents, we propose tiered recommendations: ideally, parents should return home; alternatively, children should follow their parents. For the government, we suggest establishing comprehensive service centers for left-behind children based on actual needs. We recommend designing a holistic plan aimed at addressing the health issues of left-behind children through multi-level support measures.

Examining the Impact of Certificate of Need Laws on the Utilization and Reimbursement of Cataract Surgeries Among Medicare Beneficiaries.

Background: Cataract surgery is an effective and commonly utilized procedure and can significantly improve quality of life and restore economic productivity. Certificate of need (CON) laws aim to regulate healthcare facility expansion and equipment acquisition to curtail costs, enhance quality, and ensure equitable access to care. However, little is known about the impact of CON laws on cataract surgery utilization and reimbursement. Objectives: To compare utilization and reimbursement for non-complex cataract surgery in CON and non-CON states. Methods: This retrospective database review analyzed publicly available data from the Centers for Medicare and Medicaid Services from 2017 to 2021 to identify the Medicare beneficiaries who underwent non-complex cataract surgery using Current Procedural Terminology code 66984 in Medicare outpatient hospitals. Utilization and reimbursement patterns were analyzed in states with and without CON laws using the compound annual growth rate, with reimbursement adjusted by the US Bureau of Labor Statistics Consumer Price Index. Results: The Centers for Medicare and Medicaid Services reported 893 682 non-complex cataract surgeries in the study period; of these, 609 237 were in CON and 280 215 in non-CON states. Inflation-adjusted reimbursement increased in both CON (1.17%) and non-CON (1.83%) states, while the reimbursement in non-CON states was greater than the national average adjusted reimbursement (1.67%). Utilization of non-complex cataract surgery declined during the study period in both CON and non-CON states. A larger decline in utilization was observed in CON states (-7.32%) than in non-CON states (-6.49%). Utilization was slightly higher in non-CON than in CON states for each year except 2019. Discussion: Utilization of non-complex cataract surgery by Medicare beneficiaries declined over the study period in both CON and non-CON states, possibly impacted by the COVID-19 pandemic. Inflation-adjusted reimbursement adjusted for Consumer Price Index increased more in non-CON than CON states, possibly reflecting shifts in market dynamics in CON-regulated states. Conclusions: Surgeons and policymakers should consider the implications of CON laws on the utilization and reimbursement of cataract surgery. Further study is necessary to ascertain whether these trends persist beyond 2021.

Enhancing Maternal Knowledge About Tuberculosis in Toddlers Through Booklet Based Health Education in Surabaya

Tuberculosis causes an increase in morbidity, death, and disability in toddlers. The importance of knowledge to mothers to prevent the transmission of Tuberculosis in toddlers. This study aims to determine the Effect of the Health Education Media Booklet on Maternal Knowledge about Tuberculosis in Toddlers in the Working area of Puskesmas Perak Timur Surabaya. This research uses the Quasy Experimental method with a One Group Pre-Post Test Design approach. This research was conducted on mothers who have toddler-age children in Perak Timur and Bongkaran villages. Before the intervention, the mother's knowledge level was found to be in the sufficient category, and after the intervention, it was found that the mother's knowledge level (95.58%) was in the good category. p = 0.000 p&lt; α = 0.05 was the outcome of the Wilcoxon Sign Rank Test analysis. The results of statistical tests show that there is an influence of health education media booklets on maternal knowledge in the working area of the Perak Timur Surabaya Health Center. Booklet media is very effective and easy to learn, so this media can be continued in the next research. Following the results of the research obtained, it was concluded that the provision of Health Education is very important, especially for areas far from the center of public health services, regular provision of Health Education should be carried out by medical officers in charge of the area.

Quality Measurement in Oncology: Time to Take the Next Step!

Oncology is a complex clinical specialty often requiring the close interaction of teams of different medical specialists for a successful outcome. The field is rapidly evolving scientifically, with successive discoveries of oncologic driver mutations soon followed by therapeutic agents able to interrupt the neoplastic process. Unfortunately, objective quality measurement demonstrates that many patients are not receiving optimal care, from diagnostic accuracy, therapeutic, or end-of-life perspectives. Quality measurement, reporting, and payment programs have the potential to focus attention on these care gaps and drive improvement. The federal government, as the largest single payer of health care services in the United States, has a compelling national interest to ensure that the medical care of Americans is at the highest level achievable. Accordingly, quality reporting and payment programs have been established in federal health care payment programs to drive improvements in care. This article reviews the science of quality measurement, documented gaps in oncology care, and ways to use new information technologies to decrease clinician burden associated with quality reporting. The article reviews how a measure is developed and incorporated into a Centers for Medicare & Medicaid Services (CMS) program. It also summarizes federal programs relevant to oncology care and the individual measures used in these programs. CMS looks forward to working jointly with the oncology community to drive continuous improvements in care.

“Is She Imminently Fleeing?”: How Discursive Practices Shape Crisis Center Service Delivery and Exacerbate Existing Vulnerabilities for Survivors

“Is She Imminently Fleeing?”: How Discursive Practices Shape Crisis Center Service Delivery and Exacerbate Existing Vulnerabilities for Survivors

Effectiveness of a nurse-led peripherally inserted central catheter service: A retrospective cohort study.

A multitude of challenges arises from the growing utilisation of peripherally inserted central catheters (PICCs), including the ability to provide timely, effective and safe insertion, which must be ensured and prioritised in patient care. A nurse-led model of care has become more prevalent as PICCs become extensively needed due to their applications. However, despite their widespread use, such intervention is yet in its inception in Saudi Arabia, and thereby, evaluating the outcomes of this service is of utmost importance to support patient safety initiatives and quality of care. This research aims to assess the effectiveness of a nurse-led PICC placement service. A quantitative retrospective cohort design was used. The sample of this study was 333 random subsets of records on PICC insertion for adult patients between 1st April 2019 and 31st March 2023 in a tertiary medical facility in Riyadh, Saudi Arabia. A nurse-led PICC service demonstrated an overall successful placement of 330 cases (99.1%), out of which 323 PICCs (97%) were successfully inserted under intra-cavitary electrocardiogram (IC-ECG) guidance, while 7 PICCs (2.1%) were successfully inserted with fluoroscopy. The overall complication rate was 2.35 occurrences per 1000 CL days, whereas the complication rate within the first 10 days after PICC insertion was 0.42 per 1000 CL days. A nurse-led model for PICC insertion has remarkably high success rates and low rates of complication, highlighting the pivotal role of a specialised PICC team. This service boasted a commendable track record of achieving a high rate of success in its implementation, implying that a nurse-led PICC service operates effectively to improve the patient experience by delivering timely and high-quality healthcare service.

2020 CMS prior authorization for hospital outpatient departments: Associated surgical volume impact

BackgroundPrior authorization is common for privately administered Medicare Advantage plans but is rarely used for surgical care when considering publicly administered plans. A 2020 Centers for Medicare and Medicaid services (CMS) policy, CMS-1717-FC, requires prior authorization for Medicare Fee-for-Service beneficiaries undergoing select procedures (blepharoplasty, abdominoplasty, botulinum toxin injection, rhinoplasty, and vein ablation) in hospital outpatient departments. The impact of this policy on surgical volume at hospital outpatient departments and shifts in care to ambulatory surgery centers is unknown. MethodsThis study used a segmented interrupted time series and pre-post logistic regression model. This study was a retrospective cohort study using data from the Healthcare Cost and Utilization Project state ambulatory surgery database and state inpatient database. ResultsFrom 2016 through 2021, a total of 272,879 patients underwent the affected procedures. Pre–CMS-1717-FC, a trend of decreasing hospital outpatient department utilization was found for Medicare Fee-for-Service beneficiaries (–10.82, 95% confidence interval: –18.32 to –3.33, P = .01). In the post-implementation period, no change in the rate of decreasing hospital outpatient department utilization was found for Medicare Fee-for-Service beneficiaries (–3.45, 95% confidence interval: –36.15 to 29.25, P = .83). In the pre-policy period, Medicare Fee-for-Service beneficiaries were 46% less likely to use freestanding ambulatory surgery centers but 27% less likely to use hospital-owned ambulatory surgery centers. ConclusionCMS-1717-FC was not associated with significant changes in hospital outpatient department volume beyond baseline trends. Policy aiming to right-size prior authorization for these procedures and considering site-of-service will balance the need to ensure medical necessity while constraining costs.

Staff Confidence in Supporting Student Mental Health: Outcomes from a Survey

(1) Background: The number of university students experiencing mental health problems has been a growing concern over recent decades, and support for them is now considered an inevitable part of the role of an academic. Research into the role of the academic reveals ambiguous expectations and weak support regarding their pastoral responsibilities, leading to a lack of confidence when dealing with student mental health concerns. (2) Methods: Following previous research, the present preliminary study employed an online survey (N = 43) in three schools at a university in the East of England to identify academics’ current confidence in supporting student mental health. This addressed four subscales: (i) identifying mental health concerns in students, (ii) approaching and discussing mental health concerns with students, (iii) academics’ knowledge concerning the central support services available within the university, and (iv) academics’ skills in providing ongoing support for student mental health and wellbeing. (3) Results: Female respondents scored higher than males on their knowledge concerning the central student mental health support services within the university, and 60+-year-old lecturers were least confident in identifying mental health concerns compared to 40–49- and 50–59-year-olds. (4) Conclusions: Recommendations for interventions include mental health awareness training, policy development, and a precise and nuanced description of an academic’s pastoral role and responsibilities to ensure that students receive appropriate and sufficient psychological support.

Medicare-mandated shared decision making for left atrial appendage closure in clinical practice.

The Centers for Medicare & Medicaid Services (CMS) required a shared decision-making (SDM) interaction, with an "independent" physician, before left atrial appendage closure (LAAC). The purpose of this study is to better understand how this requirement is implemented in clinical practice. We surveyed LAAC-performing centers. The characteristics of respondent and nonrespondent hospitals were compared using the CMS Provider of Services File for 2017. We received 86 responses out of 269 surveys mailed (32%). Respondent and nonrespondent hospital affiliations were similar: mean hospital size 525 beds, 15% for-profit, and 34% teaching hospitals. Thirty-four respondents (39.5%) stated that the implanting physician conducts some or all of the SDM interactions. The percentage of patients who decide not to undergo LAAC after the SDM interaction was estimated at 8.1%. Out of 72 responses to an open-ended question about the benefit of the SDM interaction, 44 (61%) described the requirement in negative terms, of which most felt the requirement was burdensome for patients and providers. Only 28 respondents (39%) described the requirement in positive or mixed terms. In violation of the letter of the CMS policy for LAAC, implanting physicians perform the SDM interaction at nearly 40% of responding hospitals. Most respondents felt the SDM requirement was burdensome for patients. More detailed guidance from CMS on how to comply with the policy may result in better alignment between the intent of the policy and how it is implemented.

Dwindling dollars: The inflation-adjusted decline of Medicare reimbursement in endocrine surgery (2003–2023)

Medicare determines reimbursement rates for medical services, often setting a benchmark that is followed by private insurers. Across various medical specialties, decreases in Medicare reimbursement have been observed. However, the extent of Medicare reimbursement for endocrine surgery remains unexplored. This study investigates the trajectory of reimbursement rates for endocrine surgical procedures. Data spanning 2003 to 2023 were gathered from the Physician Fee Schedule Look-Up Tool for 16 endocrine operations and procedures. Each operation's or procedure's relative value units and conversion factor, which accounts for geographic variation in relative value units, are determined annually by the Centers for Medicare and Medicaid Services. The total annual Medicare reimbursement for each operation or procedure was determined by multiplying procedure-specific relative value units with the conversion factor. Raw yearly percentage changes in reimbursement were computed and compared to changes in the general consumer price index. All data were then corrected for inflation. The compound annual growth rate for each procedure was calculated using inflation-adjusted data. From 2003 to 2023, the mean unadjusted percentage change for all queried procedures was+14.14% (standard deviation 0.28). During this same time, the consumer price index increased by 69.15% (P < .001). After adjusting for inflation, the mean total adjusted percentage change for all queried procedures over the entire study period was -31% (standard deviation 0.17). The adjusted average yearly compound annual growth rate was -1.93% (standard deviation 0.92). Only 1 procedure showed an increase in reimbursement (image-guided fine-needle aspiration,+32%). Inflation-adjusted Medicare reimbursement rates for endocrine surgical procedures have consistently declined. Stakeholders must address these trends to ensure access to quality surgical endocrine care in an evolving health care landscape.

Economic Costs Attributed to Diagnosed Diabetes in Each U.S. State and the District of Columbia: 2021.

To update state-specific estimates of diabetes-attributable costs in the U.S. and assess changes in spending from 2013 to 2021. We used an attributable fraction approach to estimate direct medical costs of diagnosed diabetes using the 2021 State Health Expenditure Accounts, the 2021 Behavioral Risk Factor Surveillance System, and the Centers for Medicare and Medicaid Services 2018-2019 Minimum Data Set. We estimated diabetes-attributable productivity losses from morbidity and mortality using the 2016-2021 National Health Interview Survey and the 2021 mortality data from the Centers for Disease Control and Prevention. Costs were adjusted to 2021 U.S. dollars. Total diabetes-attributable cost in 2021 was $640 billion ($335 billion in direct medical costs and $305 billion in indirect costs). The median state-level total diabetes-attributable cost was $8.2 billion (range $842 million to $81 billion). The median state-level per-person cost was $21,082, ranging from $17,452 to $37,090. Total diabetes-attributable cost increased by a median of 33% between 2013 and 2021, ranging from 16 to 68% across states. Medical costs increased by 50% overall (range 33-79%) and by 27% (range 15-41%) for per person with diabetes. Costs paid by Medicaid experienced the highest increase between 2013 and 2021 (median 153%; range 41-483%). State economic costs of diagnosed diabetes are substantial and increased over the last decade. These costs and their growth vary considerably across states. These findings may help state policy makers in developing evidenced-based public health interventions in their respective states to prevent and control the prevalence of diabetes.

Clinical and Epidemiological Profile of Deep Second Degree Burn Patients Treated with Platelet Lysate

The wound healing process in burn victims is still a problem today despite the advances made in the management of these patients with the different resuscitation regimens, the advent of antibiotic therapy as well as the different local treatments used. The local application of a high concentration of growth factor through the use of halogenic platelet concentrates lyzed by freezing- thawing has been done in the past with the aim of accelerating the healing process of the various wounds. The aim of this work is to describe Clinical and epidemiological profile of deep second degree burn patients treated with platelet lysate. A longitudinal and prospective study was carried out in 30 adult patients with deep second-degree burns with boiling water with a burned body surface area ≤ 5%, treated locally with allogeneic platelet lysate in the Burn centre and Plastic Surgery Service of the General Hospital “Dr. Juan Bruno Zayas Alfonso” in Santiago de Cuba, during the period of February 2015 to February 2016.A total of 30 adult patients have been studied. The mean age was 33.93. Female sex predominated with a male/female ratio of 1/2. The most frequent location of burns was in the lower limbs accounting for 36.6% of patients, followed by the upper limbs and anterior trunk at 26.7% in both cases. For the study group, the epitelization time was less than 21 days and in the majority of cases (66.7%) this time was 7-13 days. Non-relevant side effects were observed in 80% of patients and included pruritus (50%), perilesional erythema (8.3%) and pain in 29.2% of patients. Apart from these side effects, no complications have been observed in our patients. The promising results reported in this study and in the literature warn that platelet lysate may become a potential therapeutic candidate for deep second- degree burns from boiling water.

Telemedicine in Italy: Healthcare authorization profiles in the modern medico-legal reading.

The ruling n. 38485, 20 June 2019, of the Italian Supreme Court, III criminal section, addressed by the perspective of the law the very sensitive and new issue of telemedicine. This commentary deals with the issue of authorization of telemedicine activities by the health authority, starting from the Italian Court of Criminal Cassation, III section, decision n. 38485/2019. The case law explored the authorization of a health point, which carries out telemedicine services. Starting from the perspective discussed by Italian health regulations, the paper examines how the health act could be defined, with the possibilities offered by telecommunications, and how it now relates legally to the physical place where it takes place. Even if telemedicine opens the way to virtual spaces of health practice, the Ministry of Health Italian Guidelines pose functional and logistical issues to guarantee users' safety and health care system accountability. Then, functional requirements for health legitimate practice, and their continuous monitoring, together with the responsibilities of the service centers, health professionals and health facilities, are discussed. The questioning of States' health law, in a broad health system such as that of the Europe, characterized by autonomous health regulations, is extremely important for cross-border health policy with telemedicine, as overall regulatory compliance in health care is the ground criterion for risk prevention and patient safety, to be properly verified.

Penanganan Guest Request oleh Guest Service Center di Department Front Office Hotel Sheraton Mustika Yogyakarta Resort &amp; Spa

Handling Guest Requests by the Guest Service Center in the Front Office Department at Sheraton Mustika Yogyakarta Resort &amp; Spa.In the era of globalization and rapid growth in the tourism industry, hotel service has become a crucial aspect in ensuring customer satisfaction. The COVID-19 pandemic has changed the dynamics of the hospitality industry, and as recovery progresses, it is important for hotels to enhance the quality of their services to attract customers back. Sheraton Mustika Yogyakarta Resort &amp; Spa, with its unique architecture and luxurious facilities, has seen an increase in occupancy post-pandemic, especially during high seasons like religious celebrations and major holidays. The task of ensuring customer satisfaction is handled by the Guest Service Center, and it is not an easy task. This department serves as the hub for all guest information and requests, acting as the front line in direct contact with hotel guests. Every agent in the Guest Service Center must possess skills such as proper speaking etiquette, telephone etiquette, quick response, and diplomatic actions to achieve a good image, ensuring that guests are satisfied with the service provided. The purpose of this research is to analyze the request handling process, identify the challenges, and find the solutions implemented by the Guest Service Center at Sheraton Mustika Yogyakarta Resort &amp; Spa. The results of this research are expected to be used to improve service quality and has been assisted with a good customer complaint handling system.

The Effect of Job Training and Attendance on Employee Performance at Pt Bank Central Asia Regional Office IV Denpasar Area Service Center

Abstract: The problem of cultivating Skills and absenteeism is important to study, because these two things are the fundamental factors that affect employee performance. Job training and attendance are the initial basis for an employee to become skilled in their field and achieve increased performance. So, in this study the authors formulate the main problem, how much job training affects the performance of BCA Regional Office IV Denpasar Service Centre employees, how much Absenteeism affects the performance of BCA Regional Office IV Denpasar Service Centre employees, and how much Job Training and Absentee-ism affect BCA employee performance Kanwil IV Denpasar Service Centre. Data collection methods used are observation, questionnaires and literature study. The samples in this study were 66 employees. The analysis technique used is multiple linear regression analysis. The results of the study show that job training and work absences have a simultaneous effect on performance by 65.5%. The correlation coefficient between job training and absenteeism on performance is a very strong relationship of 0.809. The output of this study is in the form of posters that motivate employees to continue to improve their abilities through job training and maintain discipline through work attendance

Can you know before you go? Information about disability accommodations on UShospital websites.

People with disability (PWD) face challenges accessing healthcare. Websites are a public-facing resource that can help PWD determine if a hospital can accommodate their needs, yet few studies have described whether hospital websites contain adequate accommodation information. To characterize the extent to which information about disability accommodations is available on UShospital websites. We manually reviewed hospital websites using a structured extraction form. We used the Centers for Medicare and Medicaid Services'Hospital General Information Data set to identify a stratified random sample of 600 nonspecialty hospitals in the United States. We excluded hospitals that shared a website with a previously reviewed hospital for a final sample of 445. We recorded(1) content about specific disability accommodations (in 11 predetermined categories); (2) descriptions of hospital policy mentioning disability; and (3) the point of contact to obtain more information about accommodations. About two-thirds (65.6%) of sampled hospitals were acute care hospitals (vs34.4% critical access); 53.5% had 26-299 beds. Overall, 73.7% websites had information about accommodations; of these, 36.3% had information solely within hospital policies. Of the 47.0% websites with accommodation information beyond hospital policies, the mean number of accommodations listed (excluding policy statements) was 2.37 (of 11 possible). Hospitals with 300+ beds had higher odds of listing any nonpolicy accommodations than those with 1-26 beds (odds ratio = 2.768, p = .02). Less than half (40.5%) hospitals listed a contact person. Information about disability accommodations is sparse on hospital websites. Comprehensive and actionable communication about accommodations is needed to better protect PWD's rights to accessible healthcare.