Hospital Medical Directors Research Articles

Innovative Regional Services and Heterogeneous Communication Channels: Results from the Nationwide German egePan Project for Pandemic Management

Background: In the COVID-19 pandemic, novel regional services and communication channels emerged across all sectors of the German healthcare system. To contribute to pandemic preparedness, this study aims to describe newly established services in response to the COVID-19 pandemic from a stakeholder perspective and to examine the interprofessional communication channels, applying a nationwide cross-sectional approach. Methods: A nationwide sample of German healthcare stakeholders comprising general practitioners, associations of statutory health insurance physicians, hospital medical directors, local health departments, rescue coordination centres, medical directors of emergency services, outpatient nursing services, nursing homes, community care access centres, and hospital nursing managers was surveyed. A web-based questionnaire asked for their level of participation in newly implemented regional COVID-19 services and communication channels. Stakeholders’ level of recommendation was measured using the Net Promotor Score (NPS), a metric that assesses their satisfaction towards the services surveyed. Results: In total, 1312 healthcare stakeholders participated in the survey. Diagnostic centres (23.0–90.9%), COVID-19 wards in hospitals (40.5–92.1%), emergency medical vehicles designated solely for COVID-19 patients (16.5–68.4%), and crisis intervention teams (11.6–30.6%) exhibited the highest rates of engagement. The services receiving the highest recommendation for future use were COVID-19 focus practices (NPS: 33.4–43.7), COVID-19 wards in hospitals (NPS: 47.6–84.4), transportation of COVID-19 patients exclusively by predefined professional groups (NPS: 12.5–36.4), and newly implemented digitally supported nursing services (NPS: 58.3–100.0). Telephones emerged as the most frequently used communication channel (58.0–96.7%), while email was the primary digital channel (23.7–81.5%). Conclusions: During the COVID-19 pandemic, Germany experienced significant variation in the implementation of pandemic-related services across healthcare sectors, with stakeholders prioritising services built on existing healthcare structures. Developing a proactive digital infrastructure to connect healthcare professionals from different sectors is crucial for better future pandemic management.

Variation in Trauma Team Response Fees in United States Trauma Centers: An Additional Undisclosed Variable Cost in Trauma Care.

Background: The rising costs associated with trauma care in the United States is an important topic in today’s healthcare environment. Factors such as innovations in technology, increasing governmental and organizational regulations, and the specialization of care have led to increasing costs to the patient. A component of trauma cost is the one-time trauma team response fee (TTRF). The determination process of the TTRF’s dollar amount is elusive as no apparent standardized process exists and the literature is scant regarding this aspect of trauma care.Methods: A nationwide cross-sectional convenience sample was conducted using SurveyMonkey. Surveys were sent to 525 trauma centers in the continental United States, including Alaska and Hawaii, between October 8, 2019 and March 11, 2020. Additionally, hospital medical directors and trauma medical directors were queried on their knowledge of their facility’s TTRF amount.Results: Only 46 out of 525 trauma centers, or 8.8% of those surveyed shared their scheduled fees. Comparisons of TTRFs among different trauma centers, activation levels, and geographical locations were not statistically significant.Conclusions: Understanding the true costs of trauma care and fees for patients in the United States remains elusive due to inadequate data and low response rates. Trauma centers struggle to maintain financial viability as regulatory agencies and the public push for transparency of TTRFs. Collaboration between trauma centers and regulatory agencies is needed to ensure a balance between providing quality trauma care with justified associated charges and financial sustainability.

Towards an Integrative “Lightness” of Being

Towards an Integrative “Lightness” of Being

Reducing pharmacy medication errors using Lean Six Sigma: A Thai hospital case study

Hospital medication errors are costly and contribute to patient mortality, morbidity, and decreased health care quality. Errors result from poor systems design more commonly than from healthcare staff performance. As such, a focus should be directed to process design. This action research study examines the application of Lean Six Sigma to reduce inpatient pharmacy dispensing errors in a Thai public hospital. Through the successful application of multiple Lean Six Sigma tools, the implementation of Lean Six Sigma reduced monthly dispensing errors from 29 incidents to 6 incidents over 14,000 total inpatient days between March 2018 and November 2019, and improved patient safety. Lean Six Sigma tools used in this study were cause-and-effect diagrams, spaghetti diagrams, five-why analysis, project charters, brainstorming, control charts, and hypothesis testing. This case study can improve hospital manager and medical director awareness of Lean Six Sigma and its benefits relative to the prevention and reduction of medication errors.

Managing a Tertiary Orthopedic Hospital during the COVID-19 Epidemic, Main Challenges and Solutions Adopted.

The present paper is a review of the main challenges faced by the management of a tertiary specialty hospital during the COVID-19 pandemic in the northern Italian region of Lombardy, an area of extremely high epidemic impact. The article focuses on the management of patient flows, access to the hospital, maintaining and reallocating staffing levels, and managing urgent referrals, information, and communications from the point of view of the hospital managers over a seven-week period. The objective of the article is to provide beneficial insights and solutions to other hospital managers and medical directors who should find themselves in the same or a similar situation. In such an epidemic emergency, in the authors’ opinion, the most important factors influencing the capability of the hospital to maintain operations are (1) sustaining the strict triage of patients, (2) the differentiation of flows and pathways to create what could be regarded as “a hospital inside a hospital”, (3) tracing and sharing all available information to face the rapidly changing environment, (4) being able to maintain staffing levels in critical areas by flexibly allocating the workforce, and (5) from a regional perspective, being organized along a hub-and-spoke system for critical and time-sensitive networks was key for focusing the hospital’s resources on the most needed services.

An Orthopaedic Department's Response to the COVID-19 Health-Care Crisis: Indirect and Direct Actions with Thoughts for the Future.

An Orthopaedic Department's Response to the COVID-19 Health-Care Crisis: Indirect and Direct Actions with Thoughts for the Future.

Achieving self-sustainability of service delivery in an eye care program in Madagascar using time-driven activity based costing

BackgroundIn the absence of adequate and reliable external funding, eye care programs in developing countries need a high level of financial self-sustainability for maintenance and growth. To cope with these cost pressures, an eye care program in Sava, Madagascar adopted a Time-Driven Activity Based Costing (TDABC) methodology to better manage the cost of, and to improve revenue associated with, their three principle activities: consultation visits, cataract operations, and sale of glasses.MethodsDirect (variable) and indirect (fixed) cost estimates and revenue sources were gathered by activity (consultation, cataract operation, sale of glasses) and location (hospital or outreach) and TDABC models were established. Estimates were made of the proportion of the ophthalmologist’s time (by far the scarcest and most expensive resource) dedicated to consultation, cataract operation, or sale of glasses. These proportions were used to attribute costs by activity. The hospital manager and medical director modified staff roles, program activities, and infrastructure investments to reduce costs and expand revenue sources by activity while monitoring activity specific efficiency and profit.ResultsThe TDABC model for patient consultations showed that they were time consuming for the ophthalmologist and only resulted in net profit for the institution if the ophthalmologist converted most cataract patients into accepting surgery and refractive error patients into purchasing glasses from the hospital optical shop. The TDABC model for cataract surgery showed the programs needed to reduce the cost of imported consumable surgical products, reduce operation time, and, most importantly, reduce the number of very costly surgical camps providing essentially free surgery. In addition the model pushed the hospital to train staff in marketing skills so that a higher proportion of cataract cases come directly to the hospital willing to pay for surgery. The TDABC model provided the optical shop manager, for the first time, data on both the cost of supplies (frames and lenses) and the price of glasses sold resulting in strategies to maximize profit through preferential product presentation and customer experience. The eye program in the Sava region in northern Madagascar improved its cost recovery from 68 to 102% through patient revenue.ConclusionsTDABC models helped the Sava eye care program develop more efficient service delivery and increase revenue in excess of steadily increasing costs.

P028: Self-directed learning in advanced care paramedics: perceived deficits and completed activities

Introduction: In Ontario, Advanced Care Paramedics (ACPs) are required to perform a minimum of 24 educational credits per year of Continuing Medical Education (CME). Of these 24 credits, 12 are chosen by the paramedic, while 12 credits are mandated by the Base Hospital. The combined mandatory and optional CME frame is used so paramedics can target their personal needs appropriately, while ensuring new medical directives and global knowledge deficits identified by Quality Assurance (QA) means can be addressed by the Base Hospital. Objective: To determine if there is a difference between what ACPs identify as their knowledge deficits and what CME they complete. Methods: Methods: Request for participation in a written survey was delivered to all ACPs in an Ontario Base Hospital, prior to the CME cycle for the year. Respondents were asked to identify deficits from a 37-point, organ systems-based list, with free-text option for any deficits not itemized. Following the annual cycle, CME credits were evaluated by the Regional Base Hospital education coordinator, and Base Hospital medical directors for content. The deficits identified prior to the CME cycle were then compared to the CME attended for each respondent. In order to best represent the individual ACP response to their perceived deficits, a percentage of deficits identified and addressed was chosen. Respondents were not aware that their responses would be compared to the credits obtained for the year, to minimize bias in CME selection. Results: Of the 140 ACPs in the region, 42 (30%) completed the survey. From the 37-point list, the median number of perceived deficits identified was 7.00 (IQR 3.00-10.00). The median number of CME events that addressed perceived deficits was 2.00 (IQR 1.00-3.00). The median number of perceived deficits addressed by either paramedic-chosen or mandatory CME were identical at 1.00 (IQR 0.00-2.00). The percentage of perceived deficits identified and addressed via CME was 35.07% (range 0-100%). Paramedic-chosen CME covered 22.48% (range 0-100%) of perceived deficits, while mandatory CME covered 20.14% (range 0-100%) of perceived deficits. Conclusion: In the current system, only 35.07% of perceived deficits were addressed through mandatory and paramedic-chosen CME. Further information regarding barriers to paramedics obtaining CME that meets their perceived deficits needs to be elucidated.

Medical directors’ perspectives on strengthening hospital quality and safety

PurposeThe purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a setting of devolved governance.Design/methodology/approachThis qualitative study used thematic analysis of interviews with public hospital medical directors. For additional context, findings were framed by themes from a review of hospital safety and quality in the same jurisdiction.FindingsVarying approaches and levels of complexity were described about what and how performance data are reviewed, prioritised, and quality improvements implemented. Although no consistent narrative emerged, facilitators of improvement were suggested relating to organisational culture, governance, resources, education, and technologies. These hospital-level perspectives articulate with and expand on the system-level themes in a state-wide review of hospital safety and quality.Research limitations/implicationsThe findings are not generalisable, but point to an underlying absence of system-wide agreement on how to perceive, retrieve, analyse, prioritise and action hospital performance data.Practical implicationsLack of electronic medical records and an inefficient incident reporting system limits the extent to which performance and incident data can be analysed, linked and shared, thus limiting hospital performance improvement, oversight and learning.Social implicationsVariable approaches to quality and safety, standards of care, and hospital record keeping and reporting, mean that healthcare consumers might expect inconsistency across Victorian hospitals.Originality/valueThe views of medical directors have been little researched. This work uses their voice to better understand contextual factors that situate and impact on hospital quality and safety towards understanding the mixed effectiveness of hospital quality improvement strategies.

Distributed leadership in action; the chief registrar

The chief registrar is an exciting new role for trainee physicians, inspired by recommendations in the ground breaking Future Hospital Commission report.1 Patient safety, clinical outcomes and the quality of the patient experience will be at the forefront of the registrars’ work, enabling them to make real change on the ‘shop floor’. The role focuses on the ‘vertical’ development of clinical leadership skills. In a previous issue of Future Hospital Journal , Peter Lees, chief executive and medical director of the Faculty of Medical Leadership and Management, called for a ‘relentless, systematic drive to identify, support and develop good medical leaders’.2 He further described a tripartite set of responsibilities for every individual clinician:

Abstract WP382: Primary Stroke Centers - What Should We Measure?

Background and Issues: Primary stroke centers are struggling to find their voice in the spectrum of stroke care. It is not feasible for all of us grow into Comprehensive Stroke Centers or even offer endovascular intervention. Victims of our own success, 7 of the 8 stroke Core Measures are discontinued by CMS. Meanwhile we must find other measures to continue to improve the effectiveness of stroke care and our value to our local population, EMS providers, internal stakeholders and the Joint Commission. Purpose: The purpose of this project at our 433-bed community hospital was to shift the focus from micro-management of outdated metrics to a macro-view of our program and demonstrate an effective method for internal evaluation. Methods: We followed the CDC guidelines for public health program evaluation. We reviewed the evidence for all aspects of our program, and developed a program logic model (Figure 1) and theory-based evaluation questions. We used a mixed-methods approach to analyze data for each question. We engaged our leaders in focus groups to review the findings. Results: Table 1 shows examples of our findings. Eleven program leaders, including the hospital medical director, the ED medical director, and nursing directors, identified four priorities: expanding our community outreach, improving ED stroke processes, increasing the use of stroke order sets, and improving post-discharge follow-up recommendations. Conclusions: Structured program evaluation is a means for primary stroke centers to continue to improve outcomes for stroke patients and justify their valuable role in the continuum of stroke care.

Hinckley Freed, But Judge Sets Numerous Restrictions

Hinckley Freed, But Judge Sets Numerous Restrictions

Perception of low-titer group A plasma and potential barriers to using this product: A blood center's experience serving community and academic hospitals

BackgroundTo alleviate the shortage of AB plasma, an alternative plasma product, low-titer group A plasma (LTGAP), is now available. The product is indicated for emergency transfusions when the patient's blood group has not been identified. The product's defining anti-B titers vary across institutions, and at our blood center we define <1:100 as low-titer. MethodsWe created two surveys and emailed them to hospital blood bank managers, supervisors, and medical directors who currently use LTGAP and those that have not ordered it. We calculated the amount of LTGAP that met our <1:100 cutoff. We searched our inventory database to obtain sales of LTGAP, AB, and all other types of plasma in 2014. ResultsWe learned from the surveys that the product is safe and being used as indicated for only life or limb-threatening emergencies until patient's blood group is known and specific products can be provided. Most common reasons for not using LTGAP were lack of need in non-trauma hospitals and limiting capabilities in blood bank software. Although sales of LTGAP increased by ~5% by end of the first year since introduction, sales of AB plasma remained relatively steady. ConclusionLTGAP appears to be a safe alternative to group AB plasma for emergency indications. By reviewing our percentage of group A plasma units that meet our low-titer cutoff and the current interest for the product, we can reduce the amount of units we titer each day by ~30% and can readjust that amount if there is increased interest. Besides lack of familiarity and limitations in computer software to incorporate LTGAP, the steady demand for AB plasma can potentially be attributed to trauma centers ordering more AB plasma than needed and potentially wasting it in nonurgent cases to avoid outdating the product and lack of institutional guidelines on when to switch from AB to type-specific plasma resulting in excess AB plasma being transfused.

Epilepsy care in the southern Caribbean.

Very little has been reported about the health resources available for patients with epilepsy in the five English-speaking southern Caribbean countries of Trinidad and Tobago, Barbados, Grenada, Saint Vincent and the Grenadines, and Saint Lucia. There is no comprehensive resource describing their health systems, access to specialty care, antiepileptic drug (AED) use, and availability of brain imaging and EEG. The purpose of this study was to profile epilepsy care in these countries as an initial step toward improving the standard of care and identifying gaps in care to guide future policy changes. In each southern Caribbean country, we conducted study visits and interviewed health-care providers, government health ministers, pharmacy directors, hospital medical directors, pharmacists, clinic staff, radiologists, and radiology and EEG technicians. Health-care providers completed extensive epilepsy care surveys. The five countries all have integrated government health systems with clinics and hospitals that provide free or heavily subsidized care and AEDs for patients with epilepsy. Only Trinidad and Tobago and Barbados, however, have neurology specialists. The three smaller countries lack government imaging and EEG facilities. Trinidad had up to one-year waits for public MRI/EEG. Government formularies in Grenada, Saint Vincent and the Grenadines, and Saint Lucia are limited to first-generation AEDs. One or more second-line agents are formulary in Trinidad and Barbados. Nonformulary drugs may be obtained for individual patients in Barbados. Grenada, Saint Lucia, and Saint Vincent and the Grenadines participate in an Organization of Eastern Caribbean States formulary purchasing system, which added levetiracetam following the survey. Newer generic AED formulations with the lowest risks for pregnancy malformation were not in use. In conclusion, patients with epilepsy in the southern Caribbean have excellent access to government clinics and hospitals, but AED choices are limited. Local medical providers reported that the major limitations in care were lack of specialty care, lack of imaging and EEG services, financial barriers to care, long wait times for care, and limited access to additional AEDs.

Hospital leadership perspectives on the contributions of Ronald McDonald Houses. Results from an international survey.

The purpose of this paper is to describe an international survey of hospital executives and administrators' perspectives on the contributions of their affiliation with a Ronald McDonald House (RMH) as an example of accommodation in family-centered care to the hospital's mission, operations and patient experience. RMHs worldwide provided the names and e-mail addresses of the people holding key leadership positions in their main hospital partner, who in turn were invited to complete an internet-based survey (530 participants; response rate of 54.5 percent). Hospital leaders reported very positive opinions about the contributions of their RMHs affiliation to their ability to serve seriously ill children and their families. This included such important outcomes as increasing family integrity and family participation in care decisions; and decreasing psychosocial stress and hospital social work resource burdens associated with lodging, food, transportation and sibling support. Hospital chief executive offices (CEOs) and medical directors reported very strong and positive opinions regarding the value-added of their RMHs affiliation in many areas, including enhanced marketing of hospital specialty services and reduced length of stay. Survey response bias is a limitation, although the results are still useful in terms of identifying multiple ways in which RMHs are perceived as contributing to hospitals' operations and provision of family-centered care. Overall, the results suggest that, internationally, hospital leaders believe that RMHs play a key and valued role in their provision of family-centered care to seriously ill children and their families. Family accommodation is more than the simple provision of lodging and plays an integral role how hospitals approach family-centered care. This international study contributes to the general literature on the role of family accommodation in hospitals' provision of family-centered care and the specific and very sparse literature on RMHs in particular.

Funding Approved for Golden Gate Bridge Suicide Barriers

Back to table of contents Previous article Next article Professional NewsFull AccessFunding Approved for Golden Gate Bridge Suicide BarriersVabren WattsVabren WattsSearch for more papers by this authorPublished Online:25 Jul 2014https://doi.org/10.1176/appi.pn.2014.8a21On June 28, a sigh of relief was generated across northern California as the board of directors of the Golden Gate Bridge, Highway, and Transportation District approved funding to add suicide barriers to the Golden Gate Bridge. SandyS/Shutterstock“We did it!,” shouted Sue Story, just moments after the directors announced that they had unanimously approved the $76 million funding package. Her son, Jacob, died after jumping from the bridge in 2010. “It’s no longer the Bridge of Death,” Story shouted, with tears, in the lobby of the Golden Gate Bridge Administration Building.Since the opening of the iconic structure in 1937, more than 1,600 people have jumped to their deaths from the bridge, including 46 last year, according to the Bridge Rail Foundation, an organization dedicated to preventing suicides from bridges. The Golden Gate Bridge is reported to be the most-used suicide site in the United States, second in the world to Nanjing Yangtze River Bridge in China.In 2008, the Golden Gate Bridge, Highway, and Transportation District took the historic step of approving the permanent suicide deterrents that will be placed 20 feet below the bridge’s sidewalk, followed in 2011 by approvals for the design of the steel-net barriers; however, securing funding for the net was plagued by much opposition, according to Saint Francis Memorial Hospital Medical Director of Psychiatry Mel Blaustein, M.D., who organized and chairs the Task Force for the Golden Gate Bridge Suicide Barrier of the Psychiatric Foundation of Northern California.“There were several myths that we had to counter” that opponents offered as reasons not to fund the barrier, said Blaustein in an interview with Psychiatric News. He said that arguments by naysayers ranged from “barriers would ruin the aesthetics of the bridge” to “they’ll just go somewhere else to attempt suicide,” and finally, “it’s too expensive to fund.” To refute these opponents, Blaustein, who is a past president of the Psychiatric Foundation of Northern California, and the task force showcased the findings from a 1978 study showing that 95 percent of 515 individuals who were forcibly stopped from jumping off the Golden Gate Bridge by the California Highway Patrol were still alive 25 years later or died from natural causes. In addition, emphasized Blaustein, in 2013, President Obama authorized federal funding for bridges that are more prone to be sites for suicide—allowing the addition of deterrents for such structures. Installation of the multimillion-dollar suicide barriers is expected to be completed within the next three years. Caltrans and the region’s Metropolitan Transportation Commission will allocate $49 million in federal funds toward the barriers, $20 million will come from bridge tolls, and $7 million will come from state mental health funds.Blaustein told Psychiatric News that having funds secured for the construction of the barriers “sends a message of compassion and care” for individuals with mental illness. ■ ISSUES NewArchived

A Trip Through the Emergency Department: Cost-Conscious Care

OPEN ACCESSApril 24, 2014A Trip Through the Emergency Department: Cost-Conscious Care Emily McIsaac, DO, Jennifer Walthall, Adam Sharp Emily McIsaac, DO Indiana University Google Scholar More articles by this author , Jennifer Walthall Indiana University Google Scholar More articles by this author , Adam Sharp University of Michigan Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9784 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Evidence-based medicine is now the gold standard of care in the United States, and physicians will be challenged to incorporate new standards of care, including cost conscious care. Though medical research now has some focus on economics in medicine, further emergency medicine-specific scholarship is important to improve care in this unique setting. Recent literature has outlined the areas where emergency physicians should change practice patterns to improve cost efficiency and possibly improve patient outcomes, as physicians will have more fiscal responsibility in their clinical decision making to cut down costs on a larger scale This resource provides a discussion of health care economics that can be easily incorporated into daily practice to improve the efficiency of the overall health care system. Methods: This module contains an hour-long didactic session. It includes a brief introduction with a worksheet to spark the learners' curiosity and encourage discussion points. The presentation is 30 minutes in length. After the presentation, the learners are asked to revisit the worksheet and discussion points, and participate in a 20-minute discussion of cost-effective care challenges and implementation. Faculty leadership should be available to provide guidance and expertise. Results: The module was presented as an hour-long didactic session for medical students, residents, and faculty at an emergency medicine academic center. Feedback from the session was overall positive. There was some desire by the learners to include discussions on tort reform, patient satisfaction, and the current government health care model. Discussion: Physicians in general have a poor understanding of the economic ramifications of their clinical decision making on their patients, and both medical students and residents receive minimal training in this area anecdotally. This resource helps provide a portion of this understanding. It should be noted that due to the breadth of this topic, it was limited to focusing on how health care providers can be better advocates for their patients in reference to health care spending. The session benefited from having the hospital medical director and a faculty researcher in cost-effective care present. These faculty mentors provided unique points of view but were not essential to the discussion of this topic. Educational Objectives By the end of this session, learners will be able to: Articulate the current economic implications of the health care environment.Describe the difference between a cost and a charge.Acknowledge the lack of provider understanding of the costs of tests.Describe how health care spending awareness can impact individual patients and the system.Locate resources for patients to provide lower cost medication options.Explain the challenge of incorporating cost-effective research into practice.Communicate the impact of admissions on health care spending.Be aware of different patient advocacy groups working towards evidence-based and cost-effective care. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructors Guide.pdf Survey.docx Trip Through Emergency Department folder To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 McIsaac et al. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsCost ControlEmergency MedicineHealth Care Costs Disclosures None to report. Funding/Support None to report. Loading ...

Moderating Role of Interior Amenities on Hospital Medical Directors' Patient-Related Work Stresses

Considering hospital medical directors' work stress, this study aims to examine how interior amenities might moderate the effect of work stress on their health. Previous studies have revealed that hospital medical directors-senior physicians in the management positions with high-demand jobs in clinical practices and management-had a lower self-rated health. This was a cross-sectional survey study and 737 hospital medical directors in Taiwan were included. A developed and structured questionnaire covered the dimensions of patient-related work stress (i.e., physician-patient relationship stress and patient condition stress), hospital interior amenities (i.e., indoor plants, aquarium, music, art and exhibitions, and private or personalized spaces that are common or surround the workplace of healthcare professionals), and self-rated health status and health complaints. Hierarchical regressions were performed. Hospital medical directors' physician-patient relationship stresses were found to have more negative effects on their self-reported health status and complaints than do their patient condition stresses; however, only indoor plants were found to have moderating effects on their short-term health complaints (p < 0.05). On the other hand, the hospital medical directors' patient condition stresses were negatively related to their short-term health complaints; however, music, art and exhibitions, and private or personalized spaces in the workplaces had moderating effects (p < 0.05). Considering the unavoidable patient-related work stresses imposed on hospital medical directors, some proposed interior amenities can produce buffering effects on work stress to some extent. Future studies could focus on finding alternatives to relieve hospital medical directors' physician-patient relationship work stresses. Evidence-based design, physicians, privacy and security, satisfaction, work environmentPreferred Citation: Lin, B. Y.-J., Lin, Y.-K., Juan, C.W., Lee, S., Lin, C.-C. (2013). Moderating role of interior amenities on hospital medical directors' patient-related work stresses. Health Environments Research & Design Journal 6(2), pp 77-92.

A framework for assessing the value of laboratory diagnostics

Ministries of Health as well as hospital chief executive officers, department heads, and medical directors from a wide range of hospital types consistently rate quality care and value-for-money as key priorities. The role of the laboratory is changing across the healthcare continuum and new laboratory diagnostics are coming to market at an ever-increasing rate. There is a need to better define, measure, and evaluate the value of laboratory diagnostics. This paper provides perspectives on the current challenges associated with the evaluation of laboratory diagnostics, and provides a framework of key dimensions that should be included when assessing their value to hospitals and healthcare systems.

The use of sunitinib in metastatic thyroid carcinoma: case report of an off-label treatment

BackgroundThyroid cancer typically has a good outcome following standard treatments, which include surgery or radioactive iodine or systemic chemotherapy. During the last two years many randomised trials have demonstrated that...