Healthcare Board Research Articles

A low FODMAP diet plus traditional dietary advice versus a low-carbohydrate diet versus pharmacological treatment in irritable bowel syndrome (CARIBS): a single-centre, single-blind, randomised controlled trial

Dietary advice and medical treatments are recommended to patients with irritable bowel syndrome (IBS). Studies have not yet compared the efficacy of dietary treatment with pharmacological treatment targeting the predominant IBS symptom. We therefore aimed to compare the effects of two restrictive dietary treatment options versus optimised medical treatment in people with IBS. This single-centre, single-blind, randomised controlled trial was conducted in a specialised outpatient clinic at the Sahlgrenska University Hospital, Gothenburg, Sweden. Participants (aged ≥18 years) with moderate-to-severe IBS (Rome IV; IBS Severity Scoring System [IBS-SSS] ≥175) and no other serious diseases or food allergies were randomly assigned (1:1:1) by web-based randomisation to receive a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) plus traditional IBS dietary advice recommended by the UK National Institute for Health and Care Excellence (hereafter the LFTD diet), a fibre-optimised diet low in total carbohydrates and high in protein and fat (hereafter the low-carbohydrate diet), or optimised medical treatment based on predominant IBS symptom. Participants were masked to the names of the diets, but the pharmacological treatment was open-label. The intervention lasted 4 weeks, after which time participants in the dietary interventions were unmasked to their diets and encouraged to continue during 6 months' follow-up, participants in the LFTD group were instructed on how to reintroduce FODMAPs, and participants receiving pharmacological treatment were offered diet counselling and to continue with their medication. The primary endpoint was the proportion of participants who responded to the 4-week intervention, defined as a reduction of 50 or more in IBS-SSS relative to baseline, and was analysed per modified intention-to-treat (ie, all participants who started the intervention). Safety was analysed in the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02970591, and is complete. Between Jan 24, 2017, and Sept 2, 2021, 1104 participants were assessed for eligibility and 304 were randomly assigned. Ten participants did not receive their intervention after randomisation and thus 294 participants were included in the modified intention-to-treat population (96 assigned to the LFTD diet, 97 to the low-carbohydrate diet, and 101 to optimised medical treatment). 241 (82%) of 294 participants were women and 53 (18%) were men and the mean age was 38 (SD 13). After 4 weeks, 73 (76%) of 96 participants in the LFTD diet group, 69 (71%) of 97 participants in the low-carbohydrate diet group, and 59 (58%) of 101 participants in the optimised medical treatment group had a reduction of 50 or more in IBS-SSS compared with baseline, with a significant difference between the groups (p=0·023). 91 (95%) of 96 participants completed 4 weeks in the LFTD group, 92 (95%) of 97 completed 4 weeks in the low-carbohydrate group, and 91 (90%) of 101 completed 4 weeks in the optimised medical treatment group. Two individuals in each of the intervention groups stated that adverse events were the reason for discontinuing the 4-week intervention. Five (5%) of 91 participants in the optimised medical treatment group stopped treatment prematurely due to side-effects. No serious adverse events or treatment-related deaths occurred. Two 4-week dietary interventions and optimised medical treatment reduced the severity of IBS symptoms, with a larger effect size in the diet groups. Dietary interventions might be considered as an initial treatment for patients with IBS. Research is needed to enable personalised treatment strategies. The Healthcare Board Region Västra Götaland, the Swedish Research Council, the Swedish Research Council for Health, Working Life and Welfare, AFA Insurance, grants from the Swedish state, the Wilhelm and Martina Lundgren Science Foundation, Skandia, the Dietary Science Foundation, and the Nanna Swartz Foundation.

Assessment of Kaduna State Primary Health Care Board Financial Management Capacity on Primary Health Care Service Delivery in Kaduna State, Nigeria

The establishment of the Kaduna State Primary Healthcare Board was passed into law in 2015 to tackle fragmentation in primary healthcare and ensure preventive healthcare services are accessible and affordable to all. The institutional capacity of the SPHCB is aimed at tackling several issues, including poor release of funding, poor infrastructural services, inadequate health personnel capacity, poor supply of essential drugs and other commodities, poor referral system, poor monitoring, and supervision affecting the PHCs across the state. The paper specifically assesses the financial management capacity of the SPHCB in ensuring the funding of PHC services across the health centres. Both primary and secondary data were used and analysed using descriptive and inferential statistical tools. Linear regression analysis was used in testing the hypothesis postulated. It was revealed that the financial capacity has improved the funding for routine immunisation and family planning programmes at the PHCs in the LGAs. A timelier release of funds is necessary to ensure efficiency and transparency in PHC service delivery. Keywords: Financial management, PHC, service delivery, funding.

The impact of walk advice and exercise strategies on daily physical activity in patients with intermittent claudication - a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Research and Development Council for Southern Gothenburg and Bohuslän and the Healthcare Board, Region Västra Götaland, Sweden. The Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement. Introduction Exercise is a first-line treatment in intermittent claudication (IC). However, as the real impact of exercise interventions on daily physical activity (PA) behaviour remains largely undetermined, it is important to include objectively measured PA as an additional endpoint in clinical trials. Purpose The aim of this study was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) with 1year follow up, on daily PA in patients with IC. Methods In this pre-specified analysis from an RCT, a total of 166 patients with IC (mean age 72 (7.4), 41% women) were randomized to three IC-treatment strategies: WA, WA+SEP or WA+HSEP. All patients received Nordic poles and the advice to walk for 30 min, 3 times weekly (WA strategy). Patients allocated to HSEP, and SEP were offered to participate in an additional 6 month exercise program with muscle resistance and aerobic walking exercises. During the following 7-12 months, patients continued with the exercise program at home, with no further feedback. PA was measured through wearable accelerometer recordings for 7-days consecutive periods at baseline, 3, 6, and 12 months. Studied PA outcomes were steps/day, time spent within a stepping cadence ≥100 steps/min, time spent in upright position (standing still and stepping), number of sit to stand transitions, number of sitting bouts of >30 min and >60 min. Intergroup comparisons were performed with one-way analysis of variances ANOVA and intragroup comparisons by paired sample t-test. Results No statistically significant intergroup differences were observed in steps/day over time. HSEP and SEP numerically improved in steps/day at 3 months (HSEP: +472 steps, 95% CI: -146 to 1090; SEP: +241 steps, 95% CI: -282 to 764) but again declined at 6 and 12 months, while WA improved in steps/day at 1year (+89 steps, 95% CI: -568 to 747). At 3 months, a significant improvement were observed in favour of HSEP vs. WA in time spent within a stepping cadence ≥100 steps/min (P=.01) and at 6 months, a significant decrease in favour of SEP vs. WA in number of sitting bouts (>60 min; P=.01). Conclusion Compared to WA alone, receiving additional exercise strategies resulted in a trend toward increased steps/day and time spent within a stepping cadence ≥100 steps/min at 3 months. The opposite pattern occurred at 1year follow-up with a trend for WA to increase in steps/day, while the exercise strategies declined. No firm conclusions can be drawn on the impact of HSEP, SEP and WA strategies on daily PA, and future studies should focus on elaborating on factors that increase daily PA levels in patients with IC. Such studies also need to attach a high priority to develop exercise interventions that translate to more sustainable improvements in daily PA levels in this target population.

The impact of healthcare board characteristics on NHS trust performance

IMPACT This article provides insights for NHS foundation trusts (FTs) that have adopted, or are planning to adopt, changes to their boards’ style and structure to improve their governance and performance. Results revealed that, to improve performance, FTs should try to minimize turnover on the board of directors; improve attendance at board meetings; and increase the number of non-executive directors on the board. Further, increasing clinical expertise on the board would benefit financial performance and produce a better Care Quality Commission (CQC) score. Such implications are also relevant to other healthcare settings which have similar institutional setups, particularly those in Europe.

Applying a Client-centered Approach to Maternal and Neonatal Networks of Care: Case Studies from Urban and Rural Nigeria

ABSTRACT In Nigeria, two maternal and neonatal health Networks of Care (NOC) focus on extending the reach and quality of routine and emergency maternal and neonatal health services tailored to the different contexts. This paper uses the four domains of the NOC framework—Agreements and Enabling Environment, Operational Standards, Quality, Efficiency and Responsibility, and Learning and Adaptation—to describe the NOC, highlighting how each developed to address specific local needs. In Northern Nigeria, the NOC were established in collaboration among Clinton Health Access Initiative and the government to reduce maternal and neonatal morbidity and mortality. Health centers and communities in the network were supported to be better prepared to provide maternal and neonatal care, while birth attendants at all levels were empowered and equipped to stabilize and treat complications. The approach brought services closer to the community and facilitated rapid referrals. The NOC in Lagos State extended the reach of routine and emergency maternal and neonatal health services through organically developed linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. Traditional birth attendants are registered, trained, and monitored by Apex Community Health Officers, whose responsibilities include collection and review of data and ensuring linkages to postpartum services, such as family planning and immunizations. While differing in their approaches, both NOC provide locally appropriate, pragmatic approaches to supporting women birthing in the community and encouraging institutional delivery to ensure that women and their babies have access to timely, appropriate, and safe services.

Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment.

HomeCirculationVol. 141, No. 24Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBConsiderations for Drug Interactions on QTc in Exploratory COVID-19 Treatment Dan M. Roden, MDCM, Robert A. Harrington, MD, Athena Poppas, MD and Andrea M. Russo, MD Dan M. RodenDan M. Roden Dan M. Roden, MDCM, Vanderbilt University School of Medicine, 1285B Medical Research Building-IV, 2215B Garland Avenue, Nashville, TN 37232. Email E-mail Address: [email protected] Division of Cardiovascular Medicine and Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN (D.M.R.). Search for more papers by this author , Robert A. HarringtonRobert A. Harrington Department of Medicine, Stanford University, CA (R.A.H.). Search for more papers by this author , Athena PoppasAthena Poppas Cardiology Division, Brown University School of Medicine, Providence, RI (A.P.). Search for more papers by this author and Andrea M. RussoAndrea M. Russo Electrophysiology and Arrhythmia Services, Cooper University Hospital, Camden, NJ (A.M.R.). Clinical Cardiac Electrophysiology Fellowship Program, Cooper Medical School of Rowan University, Camden, NJ (A.M.R.). Search for more papers by this author Originally published8 Apr 2020https://doi.org/10.1161/CIRCULATIONAHA.120.047521Circulation. 2020;141:e906–e907Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: April 8, 2020: Ahead of Print Hydroxychloroquine and azithromycin have been touted for potential prophylaxis or treatment for coronavirus disease 2019 (COVID-19). Both drugs are listed as definite causes of torsade de pointes on crediblemeds.org. There are occasional case reports of hydroxychloroquine prolonging the QT interval and provoking torsade de pointes1–4 when used to treat systemic lupus erythematosus. Antimalarial prophylactic drugs, such as hydroxychloroquine, are believed to act on the entry and postentry stages of SARS-CoV (severe acute respiratory syndrome coronavirus) and SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection, likely through effects on endosomal pH and the resulting underglycosylation of angiotensin-converting enzyme 2 receptors that are required for viral entry.5The widely used antibiotic azithromycin is increasingly recognized as a rare cause of QT prolongation,6,7 serious arrhythmias,8,9 and increased risk for sudden death10; advanced age and female sex have been implicated as risk factors. It is interesting that azithromycin also can provoke nonpause-dependent polymorphic ventricular tachycardia.11,12 The US Food and Drug Administration Perspective supported the observation that azithromycin administration leaves the patient vulnerable to QTc interval prolongation and torsade de pointes.13Basic electrophysiologic studies suggest that both hydroxychloroquine and azithromycin can provoke proarrhythmia by mechanisms beyond blockage of IKr implicated in usual cases of torsade de pointes.14,15 The effect of the combination of these agents on QT or arrhythmia risk has not been studied. There are limited data evaluating the safety of combination therapy. Multiple randomized trials are currently being initiated.Seriously ill patients often have comorbidities that can increase the risk of serious arrhythmias. These include hypokalemia, hypomagnesemia, fever,16 and an inflammatory state.17 Mechanisms to minimize arrhythmia risk include the following:Electrocardiographic/QT interval monitoringWithhold the drugs in patients with baseline QT prolongation (eg, QTc ≥500 ms) or with known congenital long QT syndrome.Monitor cardiac rhythm and QT interval; withdraw the drugs if QTc exceeds a preset threshold of 500 ms.In critically ill patients with COVID-19, frequent caregiver contact may need to be minimized, so optimal electrocardiographic interval and rhythm monitoring may not be possible.Correction of hypokalemia to >4 mEq/L and hypomagnesemia to >2 mg/dLAvoidance of other QTc-prolonging agents5 whenever feasibleSafety considerations for use of hydroxychloroquine and azithromycin in clinical practice have been described.18Some of the current drugs repurposed for COVID-19 treatment are listed in the Table.Table. TdP Potential and Postmarketing Adverse Events Associated With Possible COVID-19 Repurposed PharmacotherapiesPossible COVID-19 TreatmentCredibleMeds.org ClassificationVT/VF/TdP/LQTS in FAERSCardiac Arrest in FAERSRepurposed antimalarial agents ChloroquineKnown risk7254 HydroxychloroquineKnown risk222105Repurposed antiviral agent Lopinavir/ritonavirPossible risk2748Adjunct agent AzithromycinKnown risk396251COVID-19 indicates coronavirus disease 2019; FAERS, US Food and Drug Administration Adverse Event Reporting System; LQTS, long QT syndrome; TdP, torsade de pointes; VF; ventricular fibrillation; and VT, ventricular tachyarrhythmia. Modified from Giudicessi et al5 with permission from the publisher. Copyright © 2020 Mayo Foundation for Medical Education and Research.DisclosuresDr Roden has nothing to disclose. Dr Harrington is the president of the American Heart Association (unpaid) and served on the Stanford Healthcare Board of Directors from 2016 to 2018 (unpaid). Dr Poppas is the president of the American College of Cardiology. Dr Russo is the president of the Heart Rhythm Society; receives research study support from Boehringer Ingelheim, Boston Scientific, and Medilynx (all funding to the hospital); and serves on the Research Steering Committee for Boston Scientific and the Apple Heart Study (no honoraria).FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circDan M. Roden, MDCM, Vanderbilt University School of Medicine, 1285B Medical Research Building-IV, 2215B Garland Avenue, Nashville, TN 37232. Email dan.[email protected]org

Roles and behaviours of diligent and dynamic healthcare boards.

Variation persists in the quality of board-level leadership of hospitals. The consequences of poor leadership can be catastrophic for patients. The year 2019 marks 50 years of public inquiries into healthcare failures in the UK. The aim of this article is to enhance our understanding of context-specific effectiveness of healthcare board practices, drawing on an empirical study of changes in hospital board leadership in England. The study suggests leadership behaviours that lay the conditions for better organisation performance. We locate our findings within the wider theoretical debates about corporate governance, responding to calls for theoretical pluralism and insights into the effects of discretionary effort on the part of board members. We conclude by proposing a framework for the ‘restless’ board from a multi-theoretic standpoint, and suggest a repertoire specifically for healthcare boards. This comprises a suite of board roles as conscience of the organisation, sensor, shock absorber, diplomat and coach, with accompanying dyadic behaviours to match particular organisation aims and priorities. The repertoire indicates the importance of a cluster of leadership practices to fulfil the purposes of healthcare boards in differing, complex and challenging contexts.

Shawn Coughlin named New NABH president, CEO

The National Association for Behavioral Healthcare (NABH) board of trustees has appointed Shawn Coughlin as its president and CEO beginning in January 2020, according to an Oct. 2 NABH news release. Coughlin succeeds Mark Covall, who is retiring after more than 35 years with the association and 24 years as its president and CEO. Coughlin has served as NABH's executive vice president for government relations and public policy since January 2017. Before then, he served as one of the association's chief lobbyists on Capitol Hill. “It has been a privilege to work closely for decades with the people who manage and provide life‐saving behavioral health care services to some of the most vulnerable citizens in our country,” Covall said. “The association is well‐positioned to tackle America's serious mental health and substance use disorder challenges, and Shawn Coughlin has the energy, experience, commitment and personality to take NABH to the next level.” Covall will retire on Dec. 31, 2019, and will serve on NABH's board for a two‐year term.

NABH Access to Care resolution to address unfair managed care practices

Developing guiding principles to ensure that patients receiving behavioral health care services have genuine access to the entire behavioral health care continuum is the mission behind the new Access to Care resolution adopted by the National Association for Behavioral Healthcare (NABH) board of trustees last month.

Assessment of Neurological Diagnoses in Patients Applying to the Health Board

O bjective: This study aims to identify disability rate cases due to neurological diseases obtained from the neurological healthcare board at Adiyaman University Faculty of Medicine. Patients and Methods: As for participants of the study, the data of the cases applied to the Neurological Health Board of Adiyaman University Faculty of Medicine between January 2017 and December 2017 were evaluated retrospectively. The diagnosis, age, sex, disability rates and interrelationships of the cases were studied. The obtained data was analyzed. Results: 958 cases were evaluated in total. 469 (49%) of these cases were male and 488 (51%) were female. The mean age of all cases was calculated to be 54.70 ± 28.8 (1-114) years, the mean age of men was lower (p <0.01) than that of women. The most common diagnoses were observed as dementia, epilepsy and cerebrovascular disease. Conclusion: Determining the data of cases evaluated by the neurology healthcare board will help prevent disability and will contribute to the future studies on disability.

Baccalaureate Education: The Foundation for Healthcare Board Participation.

The governance of healthcare organizations is becoming more complex and is prompting changes in board structure and membership. The presence and contributions of nurses on governance structures will favorably influence the future of health care. The essentials of baccalaureate nursing education, along with the general education curriculum, provide learning opportunities that result in nursing students developing the leadership skills needed to serve on hospital and healthcare boards. The purpose of this article is to present the perspective that graduates of baccalaureate nursing programs possess the foundation to participate as members of hospital and healthcare boards. This perspective is supported by the results of a survey of nursing faculty, many who have served or currently serve on healthcare boards and who provided overwhelming agreement that the foundational skills required for board participation are provided by the nursing curriculum.

Effective Conservative Treatments for De Quervain's Tenosynovitis: A Retrospective Study

Effective Conservative Treatments for De Quervain's Tenosynovitis: A Retrospective Study

Another Look at Respecting Patients’ Autonomous Choices – In India

Although medicine based on scientific principles is gaining ground, in India, the efforts to advance the ethical principle of respect for patients’ autonomous choices appear to lag behind. Illiteracy, poverty and inexperience in making autonomous choices were given as the reasons. When the same reasons were not impediments in choosing and participating in a representative form of government, why should they matter in making autonomous choices and participating in medical decisions – jointly with health-care practitioners?Autonomy or self-determination is a Human Right. Legally, it is upheld by most constitutions around the world; ethically, it continues to receive worldwide approbation. By the virtue of this right, health-care providers are obliged to breakdown medical information enabling patients – individually or collaboratively – to choose and authorise a course of action or entrust it to the good judgment of others. Inexperience or illiteracy, as India's grand experiment in democracy proves, may be overcome by reaching out to the patients: Taking time to talk with them (instead of speed-reading) or to the extended family members and including them in crucial conversations. It is obvious that the ideals of autonomic expression and full democratic participation are yet to be realised. Our immediate obligation, it seems, is to understand the reasons why we lag behind respecting patients’ autonomous choices; at the same time, institute reasonable controls which, when conjoined with our knowledge of its binding principles, would lead us to make apposite decisions were we to apply them uniformly. A few examples are as follows: (a) a signature-line in the consent form to capture family agreement to patient's choices, (b) mandatory International Conference on Harmonisation/Good Clinical Practice training for entire teamof health-care practitioners and Institutional Review Board (IRB)/Independent Ethics Committee (IEC) members involved in research on humans and (c) empower IRB/IEC to audit clinical trials and certify compliance with Indian Council On Medical Research standards. Anything less, than this, would seem to be unethical.

Interview With Richard J. Umbdenstock, FACHE, President and CEO of the American Hospital Association

Richard J. Umbdenstock has served as president and CEO of the American Hospital Association (AHA) since January 1, 2007, and is stepping down from this role at the end of 2015. In 2006, he was elected AHA board chair. Mr. Umbdenstock's career includes experience in hospital administration; health system governance, management, and integration; association governance and management; health maintenance organization (HMO) governance; and healthcare governance consulting. He has written several books and articles for the healthcare board audience and national survey reports for AHA, Health Research & Educational Trust, and ACHE. Mr. Umbdenstock has served as vice chair of the National Quality IH'orum, on the board of Enroll America, and on the National Priorities Partnership. Mr. Umbdenstock recently received ACHE's 2015 Gold Medal Award, the American Organization of Nurse Executives 2015 Honorary Member Award, and the Federation of American Hospitals Inaugural Health Care leadership Award.Dr. Kash: As a servant leader, what do you see as your legacy? How can emerging healthcare leaders, such as students and early careerists, learn from your experience?Mr. Umbdenstock: I am proud of having played a role in extending coverage to about 17 million Americans who did not have it before the Affordable Care Act (ACA)-to be part of something that has provided better access to care for millions of Americans. I am proud that it has happened without increased utilization busting the banks. Dire predictions that physicians' offices and emergency departments would be swamped because of the new coverage haven't happened. 1 think this shows that major change is possible without completely upsetting the existing system. We are, of course, in only the second year of this extended coverage, so we can't declare total victory-but so far, so good.I also hope I have left some mark on the system, and something for early careerists to be thinking about is in the area of performance improvement. As a trade association, AHA has become much more focused on helping members improve their performance. We embraced public reporting a long time ago, and when you do that, you hope that your members will look as good as possible. At the same time, I believe that our public policy credibility hinges on the height of the bar that AHA set for quality and safety. In a more transparent advocacy world, you want to eliminate your vulnerabilities, which means you have to get better faster and address any performance issues you may have.Performance improvement is the right thing for patients. None of us wants to see anybody harmed. There was a time in my career when people thought that they were doing extremely well if they achieved a 90% safety rate in some areas. Our thinking has changed. Many organizations reach a 100% rate-orzero harm-on certain measures because nothing less than that is satisfactory. I feel good about having promoted performance improvement, quality, and transparency.Finally, I hope I have helped our field see the value of moving on the path toward a more integrated system of care. 1 have spent time in such systems as both a board member and a patient, and those experiences have helped me chart a course for members interested in moving in this direction. Thirty years ago, many believed that HMOs were evil-they seemed so counter-cultural! Today, people want to see that kind of integration in healthcare.Dr. Kash: Tell us about the most challenging aspect of your term as CEO of AHA.Mr. Umbdenstock: The greatest challenge is how to reform the healthcare system in the long term. The AHA does three big things. First, we advocate for our members in the public policy realm. Second, we try to shape the long-term direction of the health system, which means creating a shared vision of where it should go, determining where forces are taking it, and then helping our members get from here to there. Third, we support our members in performance improvement. …

INSIDE INDUSTRY

BAYER HealthCare and Economic Development Board to foster translational and clinical research for diseases prevalent in Asia Ludwig Cancer Research and University of Oxford launch Cancer Immunotherapy Spinout OmniComm Systems® Announces Reseller Agreement with Tri-I Biotech Shanghai Inc. Market Leading Life Sciences Consultancy to Resell OmniComm’s TrialOne® eSource Solution Resverlogix Closes License Agreement and Enters Into Definitive Stock Purchase Agreement with Hepalink Immunovaccine and PharmAthene Sign Exclusive Worldwide License Agreement to Develop and Commercialize an Anthrax Vaccine Formulated in DepoVax™ Commonwealth Financing Authority Announces New Alternative, Clean Energy Investment ContraFect Corporation Announces Issuance of Key Patent Covering Novel Lysin Technology M Pharmaceutical Inc. Rebrands Itself to Better Reflect Growing Family of Biomedical Technologies Sustainable Apparel Coalition Recognizes SCS Global Services as Approved Verifier for New Pilot Program StemCell United Announces Plans for PO and Listing on ASX Roche Diagnostics Strengthens Footprint in Asia Pacific

Reembursing health-care service provider networks

Health-care service provider networks are regarded as an important instrument to overcome the widely criticised fragmentation and sectoral partition of the German health-care system. The first part of this paper incorporates health-care service provider networks in the field of health-care research. The system theoretical model and basic functions of health-care research are used for this purpose. Furthermore already established areas of health-care research with strong relations to health-care service provider networks are listed. The second part of this paper introduces some innovative options for reimbursing health-care service provider networks which can be regarded as some results of network-oriented health-care research. The origins are virtual budgets currently used in part to reimburse integrated care according to §§ 140a ff. SGB V. Describing and evaluating this model leads to real budgets (capitation) - a reimbursement scheme repeatedly demanded by SVR-Gesundheit (German governmental health-care advisory board), for example, however barely implemented. As a final step a direct reimbursement of networks by the German sickness fund is discussed. Advantages and challenges are shown. The development of the different reimbursement schemes is partially based on models from the USA.

Accountability in Healthcare Organizations and Systems

Accountability in Healthcare Organizations and Systems

New Evidence in Nursing Regulation

KMLS, LLC, Glendale, Arizona; ASU College of Nursing and Health Innovation, Phoenix, Arizona; the Ohio State University, Columbus; API Healthcare, Hartford, Wisconsin; and Arizona State Board of Nursing, Phoenix. Correspondence: Kathy Malloch, PhD, MBA, RN, FAAN, KMLS, LLC, 7116 W Behrend Dr, Glendale, AZ 85308 ([email protected]). The author declares no conflict of interest.

Healthcare board governance

In the light of failings of the board highlighted by the mid Staffordshire NHS Foundation Trust public inquiry, this paper seeks to offer insights about how boards in general might develop in order to discharge their responsibilities for quality and safety in health care more consistently in the future. The paper also proposes to examine wider questions about the role, purpose, and impact of boards on organisations. The paper draws on literature from across the social sciences to assess the evidence for effective board working using a contingency and realist approach. The examination leads to the identification of three key issues surrounding the construction and the development of boards. First, there is no evidence or consensus about an "ideal" board form. The rationale and evidence-base, for example for the 1991 model for NHS boards in the English NHS, has never been set out in an adequate manner. Second, the evidence about effective board working suggests that there are some key principles but also that local circumstances are really important in steering the focus and behaviours of effective boards. Third, there is an emerging proposition that boards, including in healthcare, need to embody a culture of high trust across the executive and non executive divide, together with robust challenge, and a tight grip on the business of delivering high quality patient care in a financially sustainable way (high trust - high challenge - high engagement). The paper argues that it is advisable to move away from a tendency to faith-based and exhortative approaches to guidance, training and development of boards and that it is time for a root-and-branch inquiry into the composition, structure, processes and dynamics of healthcare boards in the interests of assuring patient safety.

Nurse Leaders in the Boardroom: A Fitting Choice

Take a look at the makeup of most hospital and health system boards of directors. You might find a community philanthropist, a banker, a partner in a prestigious law firm, several successful business executives, and perhaps a physician. But chances are you won't find a nurse.While nurses act in leadership roles in many healthcare settings, they remain largely overlooked for board - the highest level of organizational leadership. A recent survey of more than 1,000 hospital boards (AHA 201 1) found that just 6 percent of board members were nurses; 20 percent were physicians.The reasons behind this omission are worth exploring. After reviewing the board leadership of more than 200 health systems and interviewing many of their members, researcher Lawrence Prybil (2009) theorized that gender bias, the outdated perception that nurses do not have leadership skills, and lack of understanding of nurses' roles in determining care quality could be preventing decision makers from considering nurses as board members. Another factor may be concerns that nurses are largely focused on their profession and will act more as employee representatives than in the interest of their healthcare institution (Prybil 2009), although the appointment of physicians does not appear to arouse such fears.In a field facing an astonishing rate of change, that healthcare systems appear reluctant to welcome nurse leaders in the boardroom is short-sighted. Comprehending that a significant cadre of our nation's nurses possesses the experience and skills to serve in leadership is one change long overdue.Other research has found the same misperceptions as Prybil's work did. Opinion leaders in a Gallup poll conducted for the Robert Wood Johnson Foundation reported that they believe nurses are seldom viewed as leaders in the development of healthcare systems and delivery (Khoury et al. 201 1). The survey results identified perception as the greatest barrier; the 1,500 opinion leaders polled said nurses were not seen as important healthcare decision makers compared to physicians.However, in the same poll these opinion leaders said nurses should have more influence in reducing medical errors (90 percent agreed), increasing quality of care (89 percent), promoting wellness and expanding preventative care (86 percent), and improving healthcare efficiency and reducing costs (84 percent). Respondents also believed that nurses should have more input and impact in planning, policy development, and management (Khoury et al. 201 1).A SKILL SET THAT FITSThe Institute of Medicine's 2011 landmark report The Future of Nursing: Leading Change, Advancing Health emphasizes the importance of nurse leadership in improving America's healthcare system:By virtue of its numbers and adaptive capacity, the nursing profession has the potential to effect wide-reaching changes in the healthcare system. Nurses' regular, dose proximity to patients and scientific understanding of care processes across the continuum of care give them a unique ability to act as partners with other health professionals and to lead in the improvement and redesign of the healthcare system and its many practice environments. (IOM2011)The report calls for healthcare decision makers to ensure that leadership are available to, and filled by, nurses: Private, public, and governmental healthcare decision makers at every level should include representation from nursing on boards, on executive management teams, and in other key leadership positions (IOM 201 1).How can this goal be brought to fruition? One way may be for health systems to embrace the literature that outlines the knowledge and skills necessary for successful healthcare board leadership. In its research-based report Competency-Based Governance: A Foundation for Board and Organizational Effectiveness (2009), the American Hospital Association's Center for Healthcare Governance details a series of core competencies and personal capabilities that healthcare boards should seek in their members. …