Medium-sized Community Research Articles

Glacier Bancorp, Inc. (NEW)

Mergent's Dividend AchieversVolume 3, Issue 4 p. 126-126 U.S. Company Reports Glacier Bancorp, Inc. (NEW)† First published: 10 October 2006 https://doi.org/10.1002/div.4769 † Contact: : John S. MacMillan — Chmn. Address: : 49 Commons Loop, Kalispell, MT 59901-2679 Web Site: : www.glacierbancorp.com AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Other Depository Banking (MIC: 8.5 SIC: 6035 NAIC: 522120) Glacier Bancorp is a regional multi-bank holding company providing commercial banking services from 71 banking offices in Montana, Idaho, Wyoming, Utah and Washington. Co. offers a range of banking products and services, including transaction and savings deposits, commercial, consumer, and real estate loans, mortgage origination services, and retail brokerage services. Co. serves individuals, small to medium-sized businesses, community organizations and public entities. As of Dec 31 2005, Co. had total assets of $3.71 billion and total deposits of $2.53 billion. Volume3, Issue4Autumn (Fall) 2006Pages 126-126 RelatedInformation

In-Hospital Care Pathways for, Stroke

Section Editor: Graeme J. Hankey MD, FRCP Care pathways are structured care plans that are used by the different members of the multidisciplinary team and are usually implemented to manage more than one aspect of patient care (eg, diagnosis, investigation, acute stroke treatment). When used within a case management framework, care pathways can assist health care professionals with clinical decision-making, and they aim to promote organized and efficient patient care that is based on the best-available research evidence and clinical guidelines.1,2 A care pathway can take the form of a printed or electronic document, and it often replaces the patient’s case record for the duration of the hospital stay. Many hospitals have adopted this tool, often as one of the components of a continuous quality improvement scheme, with an aim to improve the quality of stroke care, reduce variation of standards, minimize resource utilization, and educate health care staff.3,4 But is there sufficient evidence to support the use of care pathways for the management of stroke patients? The first Cochrane review of in-hospital care pathways for stroke found some evidence that care pathways may increase the use of certain investigations and reduce the likelihood of urinary tract infections and readmission to hospital.5 However, this benefit …

Improving the visual quality of commercial development at the rural–urban fringe

Rapid growth at the rural–urban fringe has resulted in increased commercial development along arterial roads connecting cities and the countryside. These developments, often termed “commercial strips” or “linear commercial complexes”, are characterized by a mix of many different types of businesses that often lack any separation from the road, spatial definition, or natural features such as trees. The result is too often an open, barren, confusing setting with little aesthetic appeal. Could a change in the design of the commercial setting or the addition of natural features improve the visual quality of the roadway at the rural–urban fringe? This study examines the extent to which local citizens prefer various development patterns for a roadway corridor at the fringe of a medium-sized community. Participants responded to a photo-questionnaire that included images of alternative design treatments for the roadside and written items dealing with visual quality. The results revealed moderate preference for the existing condition that showed a typical Midwestern US agricultural setting. The addition of various types of commercial development to the settings caused preference ratings to plummet. However, the addition of trees to the commercial development scenes increased preference ratings substantially. In fact, this low cost alteration in the design not only caused preference ratings to rebound, but actually exceed the ratings for the existing condition. Ratings were higher still for scenes in which trees were added to the existing condition. The findings suggest that nature plays an important role in the aesthetics of developed settings at the rural–urban fringe, and that trees in particular can be used to improve visual quality. This study has implications for the design of roadways and commercial developments at the fringe.

"Nobody ever asked me before": understanding life experiences of African American elders.

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg's phenomenological Method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.

The association between emergency department crowding and time to antibiotic administration

Study objectives: There is concern that crowding in our nation's emergency departments (EDs) leads to lower quality of care, but there is little evidence that this is the case. Time to antibiotic administration (TTAA) for patients with community acquired pneumonia (CAP) is a national hospital quality measure used by the Centers for Medicare and Medicaid and the Joint Commission on Accreditation of Healthcare Organizations where performance is critical. Our objective was to determine the relationship between crowding and TTAA for CAP patients. Methods: We conducted a retrospective observational cohort study using the encounter database from a medium-sized community hospital in Connecticut to identify patients admitted with CAP from December 2001 through December 2002. Crowding was defined in 2 ways: (1) when the CAP patient arrived exceeded bed capacity; and (2) length of stay for patients in the when the CAP patient arrived exceeded national (4 hours). Our outcome measure was based on national performance measures of TTAA for CAP (240 minutes). We reviewed medical records to determine TTAA for CAP patients. CAP cases were included in TTAA determination if age was older than 18 years, admitting diagnosis was CAP, hospital discharge diagnosis was CAP, and admission was from home or a nursing home. CAP cases were excluded from TTAA determination if antibiotic therapy was given before presentation, the patient was in the hospital during the previous 10 days, or if immunodeficiency, Pneumocystis carinii pneumonia, or tuberculosis was suspected. We sought a sample size (N=310) to detect a 1-way difference of 12 minutes in TTAA with α=0.05 and β=0.80. Bivariate analyses were completed using simple linear regression and t test. Secondary analyses were also completed stratifying for pneumonia severity index (PSI) and the shift the CAP patient registered. Results: We identified 438 CAP patients, of whom 302 met criteria for inclusion in the national quality measure. Patients' age was 71.8±16.8 years; 133 (44%) were women; 88 (29%) had a PSI of 90 or less (stable for outpatient treatment); and 264 (87%) were treated between 7 am and 11 pm. The correlation coefficient for versus TTAA was R =0.05 ( P =.37) and for length of stay versus TTAA was R =0.02 ( P =.69). Using census greater than or equal to capacity definition of crowded, the difference between TTAA during crowded and uncrowded periods was 2.4 minutes ( P =.91). Using ED length of stay greater than or equal to national mean definition of crowded, this difference was 8.8 minutes ( P =.75). Data stratified by PSI of 90 or less versus greater than 90 and by arrival between 7 am and 11 pm versus 11 pm to 7 am revealed no statistically significant associations. Post hoc analyses, although statistically not significant, show that TTAA was shorter at lower ( Conclusion: crowding, by or length of stay criteria, does not have a statistically significant association with TTAA for patients admitted with CAP. These results demonstrate that crowding is a complex problem, and more research is needed to understand its effect on patient care.

Splitting the Difference--Patient Preference versus Conservation of Resources

Case Dr. Dan Troy is a well-respected, well-liked family physician in a medium-sized urban community. He has been practicing family medicine for more than 20 years in a multispecialty group practice in a small city and enjoys his work very much.

African American and White perceptions of police services: Within- and between-group variation

Existing research on attitudes toward the police identified demographic variables predicting citizen satisfaction with police services and performance. Common themes in this literature were the disparate rates of satisfaction reported by African American and Caucasian citizens. While it is generally understood that African American citizens express lower levels of satisfaction, the degree to which this reduced satisfaction is consistent among African Americans and the factors causing such variation are unclear. In addition, variation in levels of citizen satisfaction across diverse measures of police services has yet to be considered by race. This study used data from a medium-sized Midwestern community to contrast samples of White and African American citizens to better understand how demographic, experiential, and neighborhood contextual factors shape perceptions of global, traditional, and community police services. Results from this study indicate that there is significant variation in the importance of certain exogenous factors in predicting satisfaction with police services. The differences between perceptions and race are most prominent in the community policing services model.

Dynamic Trip Generation for a Medium-Sized Urban Community

Traditional transportation modeling activities in medium-sized urban communities follow the four-step planning process: trip generation, trip distribution, mode split, and traffic assignment. These models forecast daily traffic volumes on major roadways of the communities to support infrastructure investment decisions. Recently, researchers have focused on dynamic traffic-assignment models, which provide time as a measure in the trip-modeling process, to support incident management and intelligent transportation system–based decisions. As a methodology to support the dynamic traffic-assignment models, development of a dynamic trip-generation model for a medium-sized urban community is considered. An overview of the need for dynamic trip-generation data is presented, and a methodology and a data-collection effort to develop a dynamic trip-generation model are discussed. Results are included of a validation study performed on the model. It is concluded that the models developed in the effort can provide dynamic trip-generation data and represent a first step toward making the dynamic transportation model a viable resource.

Interactivity in Television: Use and Impact of an Interactive Program Guide

This study is designed to examine the uses and impact of interactive program guides (IPGs), a television technology that enables viewer inter- activity. Data were obtained from a television survey of 365 IPG users in a medium-sized Midwestern community. Results showed that age, premium channel subscribership, perceived IPG utility, and IPG complexity were significant predictors for IPG use. Further, the study found evidence that the IPG has influenced users' viewing behaviors. IPG use was related to watching more television, viewing enriched program types, and having a larger digital cable channel repertoire.

When Wolves Recolonize: Indirect Effects on the Small and Medium-Sized Mammal Community

The abundance and diversity of mammals will be greatly affected by a number of factors, including plant productivity, climate, natural disturbance, and disease. Of particular interest to conservation strategies, there is little known about the ecological role that carnivores play in maintaining ecosystem structure. Large carnivores were essentially eliminated from much of their range during the last century. Yet, a growing body of experimental evidence indicates that top carnivores are keystone species, and they play important roles in maintaining the health of Nature. The predatory activities of large carnivores produce effects that ripple through the trophic levels of an ecosystem and affect organisms that seem distantly removed, ecologically and taxonomically. But, few studies have examined the indirect impacts of predation across those trophic levels. Such studies have been deemed a high priority in the Greater Yellowstone Ecosystem. Presently, we are assessing the abundance of selected species of mammals at sites representing five major vegetation types found in the Grand Teton National Park. The five vegetation sites are sampled in areas with and without wolves. The size range of these mammals extends from voles/mice to coyotes. Small rodents are being assessed through standard capture/recapture techniques using Sherman traps. Carnivores are being estimated by genetic identification of scat. That method is non-invasive, and by walking transects two times, we can essentially estimate populations sizes using the Lincoln-Peterson statistical technique. Mammals that can not be easily trapped or identified through scat will be followed over time using indices of abundance.

An investigation of cultural cohesion in a community bank

This study examines the culture of a medium-sized community bank based in the Western United States. The study aims to identify the organization's culture and then measure the level of cultural cohesion that exists three years after a major cultural campaign was launched. The cultural characteristics the organization valued most highly were integrity, willingness to serve the customer and teamwork - all components of the official bank document on culture. Interestingly, the analysis uncovered some significant value differences among different employee groups and also employees and management; differences which can affect firm performance levels. The analysis also revealed that changing the culture in an organization does not necessarily lead to cultural cohesion.

Youth recreation centre participation and criminal offending: A 20-year longitudinal study of Swedish boys

This study assessed whether participation in Swedish youth recreation centres (Fritidsgardar) is related to long-term criminality assessed from late childhood to mid adulthood. A prospective, longitudinal investigation of a representative cohort of 498 boys from a medium-sized Swedish community was employed. A pattern-analysis identi” ed ” ve configurations of boys who showed different profiles of social and academic competence at the age of 10. The configurations were compared with respect to juvenile and adult criminality for boys who did, and who did not, make the decision to participate in a youth recreation centre at age 13. Results showed that participation in youth centres was nonrandom. Boys with a multiple problem profile of both social and academic problems in school at age 10 showed more frequent participation in recreation centres at age 13. The frequency of criminal offending increased for all configurations of boys who became involved in a recreation centre. Frequent participation in youth centres was linked to high rates of juvenile offending and persistent offending (i.e., registered for one or several offences both as a juvenile and as an adult). These ” ndings held after controlling for individual, family, and economic factors prior to involvement in the youth centre. The limitations of the ” ndings and their implications for social policy are discussed.

A retrospective study of the effect of postoperative indomethacin rectal suppositories on the need for narcotic analgesia in patients who had a cesarean delivery while they were under regional anesthesia

Objective: This study was undertaken to assess the efficacy of rectal indomethacin as an analgesic after cesarean delivery, comparing narcotic usage in patients receiving indomethacin with patients who received only standard narcotic analgesics. Study Design: A retrospective study of patient records consisting of 297 women who underwent cesarean delivery while they were under regional anesthesia in a medium-sized community hospital from February 1996 through December 1999. Narcotic usage was determined as morphine equivalents whereby 10 mg morphine sulfate equals 30 mg oxycodone equals 50 mg hydrocodone equals 75 mg meperidine. Indomethacin was administered as 50-mg rectal suppositories. Statistical analysis was done by Pearson correlation and independent Student t test analysis. Results: Narcotic usage was reduced by an average of 16 morphine equivalents (28%) in the indomethacin group. Pearson correlation revealed correlation at the .01 level; independent Student t test analysis revealed a P value of .001. Thus the mean amount of narcotic analgesic administered was significantly less in patients treated with indomethacin rectal suppositories. Conclusion: In this uncontrolled trial the use of indomethacin rectal suppositories resulted in a significant reduction in narcotic use in the postcesarean hospital recovery period as measured in morphine equivalents. (Am J Obstet Gynecol 2001;184:1544-8.)

Transparent Research

Transparent research is a strategy in which the subjects of ethnographic research are fully involved in designing the research project, collecting the data, and analyzing results. Transparent research is a variety of action research in that inquiry is designed to serve the needs of the people studied. However, it is also scholarly research intended to serve disciplinary goals. An advantage of this approach is that theoretical and practical knowledge gained by practitioners that would not otherwise be known by academic scholars is incorporated into research results. This article develops the idea of transparent research by presenting two case studies. One concerns the emergency medicine department of a medium-sized community hospital. The other concerns a congregational development project, developed in partnership with an Episcopal diocese, and focused on a single congregation.

Laparoscopic hysterectomy

Study Objective. To determine the soundness of laparoscopic hysterectomy compared with vaginal and abdominal hysterectomy Design. Nonrandomized, uncontrolled, retrospective study (Canadian Task Force classification III). Setting. Medium-size community hospitals. Patients. One thousand six hundred forty-eight women undergoing laparoscopic hysterectomy, including those with uterine size 17 weeks' gestation or less. Intervention. Laparoscopic hysterectomy staged as level 4, which includes laparoscopic dissection of the uterine artery. Measurements and Main Results. The median duration of surgery was 36 minutes (range 24–104 min), compared with the usual 115 minutes for laparoscopic-assisted vaginal hysterectomy. Complication rate was 0.66%. No complications occurred in the last 3 years when the procedures included transillumination of the ureters. Although the costs associated with disposable equipment are high, the technique is cost effective. Conclusion. With proper training and ureteral transillumination, laparoscopic hysterectomy is safe and effective, and with stents, ureteral injury is avoided.

Evaluation and implementation of the gel test for indirect antiglobulin testing in a community hospital laboratory.

The gel test, developed by Lapierre in 1984, was designed to standardize antiglobulin testing while improving sensitivity and specificity of the method. Anti-human serum immunoglobulin G (IgG) mixed with Sephadex G100 (gel phase) in a microtube traps red cell-IgG agglutination complexes during migration through the gel in a centrifugation step. Agglutination complexes are visibly detectable at various levels in the microtube as an inverse function of antibody coated on red cells. Unsensitized red cells form a cell pellet at the base of the microtube. To determine if indirect anti-human globulin testing could be standardized and simplified by replacing the tube test with the gel test without compromising quality or increasing costs. A medium-sized community hospital. In a blinded retrospective study, we used patient sera (n = 40), which included 10 positive specimens containing 18 known antibodies. Sixteen antibodies were detected and identified with the tube method (1 anti-D and 1 anti-C not detected). By the gel test, 18 antibodies were detected and identified. All negative samples showed 100% concordance. Favorable results were obtained in a nonblinded prospective correlation study (n = 121). Our technologists found the gel test easier to read and more reproducible and reliable than the tube method; they also found increased sensitivity for detecting weakly reacting antibodies. We successfully introduced the gel test into our laboratory as the standard method for indirect antiglobulin testing. Following implementation, improved personnel management was achieved. The gel test is a reliable and advantageous method and is appropriate for routine use for detection and identification of alloantibodies in a community hospital transfusion service laboratory.

Response of Consultants to the Emergency Department: A Preliminary Report

Study objective: To determine the timeliness of response of consultants called to evaluate patients in the emergency department of a community hospital. Methods: Consultation requests from an ED located in a medium-sized community hospital were studied for a 1-month period. Data collected included name and specialty of the consultant, urgency of patients’ conditions, times of pages, and times of consultants’ responses and arrival in the ED. Results: Two hundred forty-one consultations were requested and 199 data forms relating to 21 staff physicians were analyzed. Mean number of pages required to reach a consultant was 1.5±.4. Mean time from the first page to telephone response was 8±6 minutes and from first page to ED arrival was 42±23 minutes. Mean time from the first page to the consultant’s arrival in the ED was significantly shorter for emergency (17±10 minutes) than for urgent or nonurgent patients (50±41 and 41±23 minutes, respectively). There were wide variations in individual patterns of response; the 7 fastest consultants had a mean first page to arrival time of 25±10 minutes, and for the slowest 5 consultants the time was 56±24 minutes. Conclusion: Response times of consultants to the ED vary depending on the urgency of the patient’s condition and individual behavior patterns. [Vosk A: Response of consultants to the emergency department: A preliminary report. Ann Emerg Med November 1998;32:574-577.]

Establishing a Pain Management Program in a Community Hospital

Despite growing consensus in the pain management community that pain can be treated more effectively, and ought to be, commitment to pain management is too frequently lacking. Herein we describe an ongoing effort to develop a pain management program in a medium-sized community hospital, the kind of inpatient setting in which most patients with pain are treated. We intend that our experience will be useful to others undertaking similar projects. Evaluation of these efforts has included staff and patient assessments of current pain management practices using chart audits, staff surveys, and patient interviews. The results were used to design education programs for the nursing and medical staff. Follow-up audits and surveys to determine effectiveness and to shape future work are described in detail.

Complaints Against the Police: A Focus Group Study of Citizen Perceptions, Goals, and Expectations

This article explores citizen perceptions, goals, and expectations in filing complaints against the police. It is based on 10 focus groups representing a cross-section of a medium-sized midwestern community. Its findings confirm earlier research indicating a poor "fit" between complainant goals and complaint procedures. Although most existing complaint procedures are designed to investigate complaints of officer misconduct and to punish guilty officers, relatively few of the focus group participants indicated punishment as their goal. The majority wanted either an explanation for the incident, an apology, a face-to-face encounter with the officer, or documentation of the incident on the officer's record.

A Case Study of Combined Sewer Overflow Pollution: Assessment of Sources and Receiving Water Effects

Abstract Combined sewer overflow (CSO) pollution was assessed in a medium size community (the Town of Malacky) in western Slovakia by means of field monitoring and computer modelling. CSO samples were analyzed for suspended solids, total chemical oxygen demand, 5-day biochemical oxygen demand, total organic carbon, heavy metals (Cu, Zn, Ni, Cd, Pb), and biological and microbiological constituents. Study results identified CSOs as a major source of biodegradable organic pollution impacting on dissolved oxygen in the receiving streams. Cumulative effects of CSO discharges were also observed in the receiving streams, in the form of high organic content of benthic sediments, which indicated the deposition of wastewater-derived sediments flushed out from the sewer system during storm events. These findings have also been confirmed by analyses of biological constituents in the sediment samples collected from the receiving waters. A comparative analysis of various pollution sources indicated that pollution problems in the receiving waters were caused not only by the municipal effluents from the Town of Malacky, but also by diffuse agricultural pollution and release of heavy metals, especially Zn, from the native soils in the surrounding area.