Medium-sized Hospital Research Articles

Trends and Disparities in the Utilization of Thymectomy for Myasthenia Gravis in the United States.

In 2016, a randomized controlled trial demonstrated the clinical efficacy of trans-sternal thymectomy for patients with non-thymomatous myasthenia gravis (MG). Whether large-scale changes occurred in clinical practice after this trial is unknown. We performed a retrospective longitudinal cross-sectional analysis using National Inpatient Sample (NIS) data from 2012 to 2019. Our study included hospitalized adults at least 18 years of age diagnosed with MG without an associated thymoma. We used joinpoint regression to analyze annual trends in thymectomy volume and surgical approach (minimally invasive vs trans-sternal) from 2012 to 2019. Using logistic regression models, we examined patient and hospital-level factors that may have influenced whether thymectomy was performed, such as age, sex, race, insurance payor, hospital size and teaching status, and Elixhauser Comorbidity Index. Sampling weights were applied to account for the complex survey design of NIS. The total number of thymectomy procedures increased by 69.8% per year (95% CI 40.1-105.8) between 2012 and 2019. Trans-sternal thymectomies increased by 62.8% per year (95% CI 35.8-95.2) and minimally invasive thymectomies by 83.7% per year (95% CI 38.1-144.3). Thymectomies were significantly more likely to occur in 2017-2019 compared with 2012-2016 (OR 1.93, 95% CI 1.62-2.31). In a multivariable regression model, several factors decreased the odds of patients with MG having a thymectomy: older age, Black race (OR 0.62, 95% CI 0.49-0.77), female (OR 0.73, 95% CI 0.63-0.86), and higher Elixhauser Comorbidity Index. Patients in medium (OR 1.82, 95% CI 1.30-2.55) or large (OR 2.81, 95% CI 2.07-3.82) size and urban teaching hospitals (OR 6.09, 95% CI 2.65-13.97) were more likely to undergo thymectomy. Thymectomy is being performed more frequently for non-thymomatous MG, especially after 2016 after publication of a positive phase III clinical trial. There are several disparities in thymectomy utilization that warrant further attention.

Knowledge, Attitude, and Practice of Medical Waste Management in Medium-sized Hospital among Health Care Workers

Knowledge, Attitude, and Practice of Medical Waste Management in Medium-sized Hospital among Health Care Workers

Unraveling the impact of subjective and objective workload on patient experience: Mediation and moderation by missed nursing care assessments in a nested multisource diary design

BackgroundPatient reporting of their care experience is crucial for evaluating healthcare quality. Negative patient reports are often associated with missed nursing care, with previous research primarily attributing this to objective workload, neglecting the role of subjective workload. Furthermore, there is a gap in understanding the combined impact of patient and nurse assessments of missed nursing care on the overall patient experience. ObjectiveThis study aims to explore how the interaction of objective and subjective workload influences nurse-reported missed nursing care. Additionally, it investigates how the interaction of missed nursing care, as assessed by both patients and nurses, influences the patient's overall experience. DesignA quantitative daily diary design, employing a nested (shifts within nurses) and multi-sourced (nurses, patients, and objective data) approach, was implemented. SettingThe study was conducted in two medium-sized public hospitals, encompassing internal medicine and surgical wards. ParticipantsA total of 141 registered nurses providing direct patient care and 627 patients treated by these nurses participated in the study. MethodsParticipating nurses completed questionnaires during five morning shifts, detailing their experiences with specific patients. Concurrently, the same patients provided feedback through questionnaires. A dual moderated mediation model was analyzed using mixed-model regression analyses, suitable for the nested design. ResultsThe study supported the dual moderated mediation model. Subjective workload emerged as a statistically significant moderator, influencing the impact of objective workload on nurse-reported missed nursing care (β = −0.476, p = .009). Particularly, under high subjective workload, missed nursing care was higher during low compared to high objective workload. Moreover, patient-reported missed nursing care moderated the relationship between nurse-reported missed nursing care and patient experience (β = −0.411, p < .001). In instances of high patient-reported missed nursing care, positive patient experiences were observed with low compared to high nurse-reported missed nursing care. ConclusionsThis research emphasizes the need to recognize and address subjective aspects of nursing workload. Effectively managing these perceptions is vital for upholding high care standards and enhancing patient experiences. The study advocates for targeted strategies to manage workload effectively and improve patient–nurse communication, especially in high-workload healthcare settings.Tweetable abstract: Exploring the link between nursing workload and patient experience: revealing the impact of patient and nurse assessments on missed nursing care. #HealthcareQuality #NursingResearch.

Determination of hepatitis B virus (HBV) DNA in serum by nucleic acid screening

The determination of serum hepatitis B Virus (HBV) DNA is of paramount significance in the comprehensive management of HBV infection. It aids in diagnosis, disease staging, and treatment monitoring, ultimately improving patient outcomes and reducing the burden of HBV-related morbidity and mortality. In this work, serum HBV DNA detection was performed using a novel nucleic acid screening system. The sensitivity, selectivity, repeatability, cross reactivity, and HBV DNA stability were evaluated and compared with published data. The detection limit of 95% was 29.12 IU/mL and the 95% confidence interval was from 23.71 to 34.55 IU/mL. Blood samples that contain free hemoglobin (1 g/L, 2 g/L, 4 g/L) and triglycerides (3 mmol/L, 6 mmol/L and 9 mmol/L) were also analyzed. The results demonstrated that the system can also be used in the presence of free hemoglobin and triglycerides. The mean of the cycle threshold (Ct) in 5-day replicates was 35.71 ± 0.35 with a coefficient of variation (CV) of 0.97%. The results of negative samples in the anti-cross contamination experiment showed no response. The coincidence rate for 3001 samples over 20 days of real-time stability measurements and external quality assessment samples was 100%. The results demonstrate the effectiveness of the nucleic acid system for HBV-DNA, providing a theoretical basis for other small and medium-sized blood stations or hospitals to these devices.

Moderating Effects of Information Literacy Ability in The Relationship Between Resilience and Nursing Management Competency of Nurse Managers in Small and Medium-Sized Hospitals

This study aimed to explore ways to improve the nursing management competency of nurse managers in small and medium-sized hospitals and examine the relationship between variables based on information literacy ability in the structural model linking the resilience of nurse managers and nursing management competency. The data was collected from November 6, 2023, to December 6, 2023, using cluster sampling in four cities with similar urban settings, and surveys were conducted with the consent of nurse managers working in small to medium-sized hospitals with 100 to 300 beds. A total of 207 collected data points were analyzed using the moderating effect technique of structural equation modeling. The hypothesis testing results revealed that nurse managers in small and medium-sized hospitals partially affect on nursing management competency. Furthermore, it was observed that the impact of nurse managers' resilience on nursing management competency varies based on their level of information literacy ability. Therefore, it is recommended that combined training in interpersonal skills and information literacy is offered to develop a competency improvement program for nurse managers in small and medium-sized hospitals.

Impact of pharmacist-driven antimicrobial stewardship interventions in a secondary care facility in Japan: A pragmatic quasi-experimental study

BackgroundEfforts to promote antimicrobial stewardship aimed at reducing antimicrobial resistance are necessary regardless of hospital scale owing to delays in new antimicrobial development. We aimed to evaluate the effects of pharmacist-driven interventions on broad-spectrum antimicrobial usage and the prognosis of patients with bacteremia in a medium-sized hospital lacking infectious disease physicians and a microbiology laboratory. MethodsThis single-center, retrospective, pragmatic, quasi-experimental study was conducted to compare pre- and post-intervention effects at Saiseikai Futsukaichi Hospital. We analyzed the days of therapy (DOT) for carbapenems and days of antibiotic spectrum coverage (DASC) for antimicrobials using an interrupted time series analysis. Cox proportional hazards analysis was performed to assess 30-day mortality using propensity score and inverse probability of treatment weighting in patients with bacteremia. ResultsPharmacist-driven interventions significantly reduced the DOT (incidence rate ratio [IRR]: 0.53, 95 % confidence intervals [CI]: 0.33−0.81, p = 0.003) and DASC (IRR: 0.87, 95 % CI: 0.78−0.97, p = 0.016). The 30-day mortality due to bacteremia did not significantly differ between pre- and post-intervention in all patients (adjusted hazard ratio [HR]: 0.92, 95 % CI: 0.56−1.51, p = 0.74). Conversely, pharmacist-driven interventions significantly reduced the 30-day mortality owing to bacteremia with Pitt bacteremia score (PBS) ≥4 (adjusted HR: 0.52, 95 % CI: 0.28−0.99, p = 0.047). ConclusionsPharmacist-driven interventions may represent a valuable approach for optimizing antimicrobial treatment and improving prognosis, especially in patients with PBS ≥4, which will potentially benefit patients in similar healthcare environments facing challenges related to antimicrobial stewardship and patient prognosis.

Eight of ten patients return to daily activities, work, and sports after total knee arthroplasty.

Besides return to work (RTW) and return to sports (RTS), patients also prefer to return to daily activities (RTA) such as walking, sleeping, grocery shopping, and domestic work following total knee arthroplasty (TKA). However, evidence on the timelines and probability of patients' RTA is sparse. To assess the percentage of patients able to RTA, RTW, and RTS after TKA, as well as the timeframe and influencing factors of this return. A retrospective cohort study with prospectively collected data was conducted at a medium-sized Dutch orthopedic hospital. Assessments of RTA, RTW, and RTS were performed at 3 mo and/or 6 mo following TKA. Investigated factors encompassed patient characteristics, surgical characteristics, and preoperative patient-reported outcomes. TKA patients [n = 2063; 66 years old (interquartile range [IQR]: 7 years); 47% male; 28 kg/m2 (IQR: 4 kg/m2)] showed RTA ranging from 28% for kneeling to 94% for grocery shopping, with 20 d (IQR: 27 d) spent for putting on shoes to 74 d (IQR: 57 d) for kneeling. RTW rates varied from 62% for medium-impact work to 87% for low-impact work, taking 33 d (IQR: 29 d) to 78 d (IQR: 55 d). RTS ranged from 48% for medium-impact sports to 90% for low-impact sports, occurring within 43 d (IQR: 24 d) to 90 d (IQR: 60 d). One or more of the investigated factors influenced the return to each of the 14 activities examined, with R² values ranging from 0.013 to 0.127. Approximately 80% of patients can RTA, RTW, and RTS within 6 mo after TKA. Return is not consistently influenced by predictive factors. Results help set realistic pre- and postoperative expectations.

The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design.

To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. Nested diary study. Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. The study has adhered to STROBE guidelines. No patient or public contribution.

Disparities in the prevalence of febrile neutropenia in patients hospitalized with lung cancer: An observational study.

e24133 Background: Lung cancer is a leading cause of cancer-related deaths in the United States and globally.Febrile neutropenia is a well-known and often fatal condition that occurs in 10-40% of lung cancer patients undergoing chemotherapy but has not been widely studied so far in these patients. We conducted a retrospective analysis to understand better the prevalence and disparities of febrile neutropenia in patients with lung cancer. Methods: The National Inpatient Sample (NIS) for the years 2017-2020 was utilized to identify patients with a primary discharge diagnosis of lung cancer which included both regional and metastatic disease. The cohort was stratified based on the presence or absence of Febrile Neutropenia (FN). Basic demographic variables were analyzed in order to identify disparities in the prevalence of FN among patients with lung cancer. Multivariate regression analysis was employed to determine the association between FN and lung cancer. Results: Among 461,975 hospitalized lung cancer patients, 4,355(0.09%) had concurrent diagnoses of febrile neutropenia (FN). Patients who developed FN were younger than those who did not (65.42±11.69 vs 68.81±10.39, p &lt; 0.001). Older patients had a decreased likelihood of developing FN (36-45: OR = 0.36(0.16-0.79), p = 0.011; 46-64:OR = 0.26(0.13-0.51), p &lt; 0.001 ; &gt; 65: OR = 0.19(0.09-0.38), p &lt; 0.001 ). The FN group had a greater proportion of black (17.81% vs 12.81%) and Hispanic (7.37% vs 5.25%, p &lt; 0.001) populations, and these groups were more likely to develop FN than white patients (Black: OR = 1.39(1.14-1.69), p = 0.001; Hispanics: OR = 1.4(1.03-1.88), p = 0.027 ). Patients with a Charlson Comorbidity Index of 3 or higher had an increased likelihood of FN (OR = 1.39(1.09-1.76); p = 0.006). The FN group had a higher percentage of patients with Medicaid (15.46% vs. 9.81%) and private insurance (25.21% vs. 22.1%) and a lower percentage of patients with Medicare (56.96% vs. 65.9%), p &lt; 0.001. A greater percentage of patients with FN were discharged to home with home health services (37.35% vs. 31.92%), while a greater percentage of patients without FN were discharged to home (65.31% vs. 59.91%) and skilled nursing facilities (2.06% vs. 1.98%), p = 0.032. Patients in medium and large hospitals were less likely to have FN compared to smaller hospitals (OR = 0.64(0.5-0.82), p = 0.001 and OR = 0.69(0.55-0.86), p = 0.001, respectively). Patients with fluid and electrolyte disorders were more likely to have FN (OR = 1.61(1.37-1.88), p &lt; 0.001). Conclusions: Lung cancer patients who developed Febrile Neutropenia were younger and more likely to be Black and Hispanics. Patients hospitalized in the medium and large size hospitals were less likely to have Febrile Neutropenia in comparison to smaller hospitals. The statistics provide valuable insights for optimizing care and addressing disparities across different age and racial groups.

Hidden advertisements included in cancer information posts: Insights from social listening.

e21017 Background: Access to cancer information on the Internet has proliferated, yet ensuring the accuracy and reliability of such information remains a challenge. The abundance of online content necessitates a comprehensive understanding of the prevailing landscape of cancer information dissemination. Methods: Cancer-related information was retrieved from search engine results pages of NAVER and Google, the most frequently used websites for information search in South Korea, during September and October 2023. Promoted posts and overt advertisements were excluded from the dataset. Posts featuring more than 50% of advertising content were categorized as fully hidden advertisements (HA), while those with lesser proportions were classified as partially HA. In cases where there was no advertising content but the hospital name or contact information was indicated for promotional purposes, it was classified as a simple HA. Topic modeling techniques were employed to analyze the content of HA posts, identifying prevalent themes and keywords indicative of promotional intent. Results: Of the collected posts, 48.6% were classified as HA. The publisher of the HA was 26.8% of oriental medicine/care hospitals, followed by general hospitals (25.3%), non-professional (21.3%), and small and medium-sized private hospitals (17.4%). In HA, 40.3% were full advertisements, 36.75% were partial advertisements, and the remainder were simple displays. By cancer type, 65.3% of posts about breast cancer were advertising posts, 55.2% were about colon cancer, and 53.7% were about stomach cancer. In the topic modeling analysis of HA, despite containing basic and theoretical information about cancer, HA subtly directs users towards advertising content, featuring terms related to private insurance and complementary medicine. Conclusions: The study elucidates the prevalence and characteristics of HA within cancer-related information available online, highlighting the need for heightened awareness. While it may not be inherently wrong, HA can impact user perception and decision-making processes. Additional research is underway to determine whether information classified as HA can be trusted. Addressing issues such as HA within cancer information will likely require cooperation between search engine platforms and government agencies.

An Importance-Performance Analysis of patient safety activities for inpatients in small and medium-sized hospitals

An Importance-Performance Analysis of patient safety activities for inpatients in small and medium-sized hospitals

중소병원 간호사의 간호조직문화, 의사소통능력, 대인관계능력이 팀워크에 미치는 영향

중소병원 간호사의 간호조직문화, 의사소통능력, 대인관계능력이 팀워크에 미치는 영향

Care First-Fund Later (CareFFuL): an end-of-life home care quality improvement project

Previous work found referrals for end-of-life care are made late in the dying process and assessment processes for care funding, through continuing healthcare fast-track funding often inhibit people being able...

Is thyroid function testing necessary in all cases of new onset atrial fibrillation diagnosed in the emergency department? - a real-life study

Abstract Background Atrial fibrillation/flutter (AF) is the most frequent cardiac arrhythmia worldwide. It increases the risk for comorbidities and prompt management is thus important. One established risk factor for AF development is hyperthyroidism, and concomitant disease significantly impacts morbidity in these patients. Therefore, thyroid function testing is recommended in new-onset AF (NOAF) by the European Society of Cardiology. There are few studies examining the prevalence of previously undiagnosed hyperthyroidism in cases of NOAF, especially if diagnosed in the emergency department (ED). Furthermore, previous studies often relied upon thyroid stimulating hormone (TSH) levels to identify cases of hyperthyroidism, this approach is susceptible for diagnostic errors since TSH profiles can overlap in conditions like hyperthyroidism, non-thyroid illness, and central hypothyroidism (of which only the former is associated with AF). Because of this, it's essential to incorporate additional biomarkers for a more precise differentiation. Purpose We aim to evaluate the prevalence of previously undiagnosed hyperthyroidism in a real-life NOAF population admitted to and diagnosed in the ED with a 2.5-years follow-up. Furthermore, we aim to interpret thyroid dysfunctions in relation to TSH as well as free thyroid hormone levels and other relevant biomarkers. Methods This retrospective registry-based cohort study included all patients attending the ED at a medium-sized hospital in Sweden during 2018 and 2020. Inclusion criteria: main diagnosis of AF (ICD I48) and ≥18 years old. Exclusion criteria: multiple visits, previous AF, abnormal thyroid function within the previous 2 years, and current thyroid hormone substitution. Results Patients from a total of 1020 ED visits were screened for eligibility. After exclusion, 325 patients with NOAF were included in the analysis. Of those, 106 (33%) and 232 (71%) had undergone thyroid function testing in the ED and by the end of the 2.5-years follow-up, respectively. We found no cases of hyperthyroidism in the ED and only two cases (1% prevalence) during the 2.5-years follow-up. Conclusions In this real-life cohort we found modest thyroid testing rates in the ED, however, a majority of patients underwent testing during follow-up. Despite this, we found no cases of hyperthyroidism in the ED and only two cases during follow-up, this is considerably lower than previously reported and may raise a question whether all patients should undergo thyroid testing, or if thyroid testing should be directed towards those with a suspected thyroid disease.

Factors influencing peripheral intravenous catheter practice of nurses in small and medium sized hospitals: a cross-sectional study

BackgroundThe importance of the peripheral intravenous catheter (PIVC) practices on patient safety is increasing. Small and medium-sized hospitals play a central role in the provision of healthcare services in South Korea, but lack a system for quality improvement, leaving patient safety at risk. This study aimed to identify the extent to which the PIVC practice knowledge of nurses, the nursing working environment, and the patient safety-culture perception affect PIVC practices and thereby provide basic data for improving the PIVC practices in small and medium-sized hospitals.MethodsThis study had a cross-sectional descriptive design to identify the factors affecting PIVC nursing practices in small and medium-sized hospitals. Questionnaires returned by 149 nurses collected data on general characteristics, practical knowledge of PIVC nursing, nursing working environment, patient safety-culture perception, and PIVC practices. The questionnaire data were analysed using descriptive statistics, the independent t-test, one-way ANOVA, Scheffé’s test, Pearson correlation, and hierarchical regression analysis.ResultsThe mean score of PIVC practices was 4.60 out of 5. Length of clinical experience, practical knowledge of PIVC nursing and patient safety-culture perception were significant factors affecting the PIVC nursing practices, with these variables explaining 26.2% of the variance therein.ConclusionsThe PIVC practices of nurses in small and medium-sized hospitals can be improved by providing education and training based on the latest standard or guideline to facilitate the acquisition of knowledge and skills. And campaigns and programs to strengthen patient safety culture perception specific to small and medium-sized hospital should be implemented. to ensure the safety of PIVC practice.

The impact of nurse’s sense of calling, organizational commitment, job stress, and nursing work environment on patient safety management activities in comprehensive nursing care service units during the covid-19 pandemic

BackgroundAs the number of COVID-19 patients rises, there has been a notable increase in the workload for nurses. However, medium-sized hospitals lacked standardized protocols or consistent approaches to address the specific working conditions of nurses. Furthermore, concerns about patient care have heightened as the issue of nursing shortages coincides with the expansion of the comprehensive nursing care services project.PurposeThis study aimed to investigate the factors that influence patient safety management activities, such as calling, organizational commitment, job stress, and nursing work environment, among comprehensive nursing care service unit nurses during the COVID-19 pandemic.MethodsA conceptual framework based on the Job Demand-Resource model and literature review of patient safety management activities was used to develop structured questionnaires that were distributed to 206 participants working in 7 comprehensive nursing care service units of small and medium-sized hospitals with at least 300 beds in the S and K provinces. Data analysis was conducted using descriptive statistics, chi-squared tests, t-tests, ANOVA, and hierarchical regression with the SPSS/WIN 23.0 program.ResultsThe results showed that calling (β =.383, p<.001) and job stress (β= -.187, p=.029) significantly influenced patient safety nursing activities in comprehensive care service ward nurses. The explanatory power of the model was 26.0% (F= 6.098, p<.001).ConclusionsOur findings suggest that comprehensive care service ward nurses' career, income, COVID-19 patient nursing anxiety, calling, and job stress were important factors that influence patient safety nursing activities. Therefore, it was essential to develop calling education programs and improve the nursing work system and establish a fair compensation system during the pandemic situation.

The impact of hospitalization on inappropriate prescribing and polypharmacy in older patients: A descriptive cross-sectional study.

Polypharmacy and the use of potentially inappropriate medications (PIMs) in older individuals are widespread phenomena that are associated with an increase in morbidity and mortality. The Beers Criteria is a tool that helps to identify patients that are prescribed with PIMs, thereby reducing the risk of associated harm. Amongst other populations, the criteria identify drugs that should not be used by the majority of older patients. Determining the proportion of older inpatients who were discharged from hospitalization with polypharmacy (a prescription for more than seven drugs), or with a PIM as defined by the Beers Criteria. A descriptive cross-sectional study based on patients aged 65 and over who were hospitalized in the years 2019-2021 in the internal medicine, orthopedic and surgical wards at a medium-size hospital. Demographic information and details about drug treatment were collected from the electronic patient records system. Patients who died during hospitalization were excluded from the study group. The proportion of inpatients with polypharmacy or a PIM as part of their regular prescription, at the time of admission and at discharge. 49 564 patients were included in the study cohort. At discharge, 19% of the patients were given a prescription for a PIM, with a small but significant decrease compared with the rate admission (22.1%). At discharge, 42.8% of patients had polypharmacy, representing a small but significant increase compared with the rate on admission (40.6%). The study demonstrated high baseline rates of PIM prescription and polypharmacy. Hospitalization was associated with a decrease in PIM prescription and an increase in polypharmacy. This highlights the importance of medication review during admission to reduce the potential risk to older adults from polypharmacy and PIM prescription.

The effect of institutional pressures and dynamic managerial capability on strategic renewal: The case of strategic agility and digital readiness as mediators in healthcare industry

This research investigates the role of institutional pressures, dynamic managerial capabilities, strategic agility and digital readiness as mediating factors in the gap of the healthcare sector's post-pandemic digital transformation. This study employed strategic and managerial questionnaires involving 308 medium-sized private hospitals in Indonesia and LISREL 6.0 was used for the analysis. Findings indicated that strategic agility did not mediate dynamic managerial capability for strategic renewal. Moreover, the private healthcare sector was found to be influenced by pressures to imitate other hospitals and competitors, and digital readiness had a stronger mediating effect than strategic agility. The study enriches organization theory by investigating institutional pressures driving strategic renewal. It also enhances the literature on strategic management by exploring the mediating role of strategic agility and digital readiness in strategic change. Lastly, it highlights the association between digital readiness and managerial and organizational aspects resulting from strategic change and further emphasizes the need for integrated teams and digital health services in hospitals to achieve strategic renewal.

The effect of institutional pressures and dynamic managerial capability on strategic renewal: The case of strategic agility and digital readiness as mediators in healthcare industry

This research investigates the role of institutional pressures, dynamic managerial capabilities, strategic agility and digital readiness as mediating factors in the gap of the healthcare sector's post-pandemic digital transformation. This study employed strategic and managerial questionnaires involving 308 medium-sized private hospitals in Indonesia and LISREL 6.0 was used for the analysis. Findings indicated that strategic agility did not mediate dynamic managerial capability for strategic renewal. Moreover, the private healthcare sector was found to be influenced by pressures to imitate other hospitals and competitors, and digital readiness had a stronger mediating effect than strategic agility. The study enriches organization theory by investigating institutional pressures driving strategic renewal. It also enhances the literature on strategic management by exploring the mediating role of strategic agility and digital readiness in strategic change. Lastly, it highlights the association between digital readiness and managerial and organizational aspects resulting from strategic change and further emphasizes the need for integrated teams and digital health services in hospitals to achieve strategic renewal.

Effects of individual and environmental factors on COVID-19 infection control practices in small to medium-sized hospitals

This study analyzed the influence of individual and environmental factors on infection control practices among nurses in small to medium-sized hospitals of South Korea during the pandemic. We enrolled 171 nurses from 5 infectious disease-specialized hospitals with 200 to 299 beds located in metropolitan areas of South Korea. Individual factors, including general characteristics, coronavirus disease 2019 (COVID-19) knowledge, attitude, and risk perception, and environmental factors including COVID-19 safety climate, were collected using self-report questionnaires. Individual and environmental factors were analyzed using multiple logistic regression. COVID-19-related safety climate (β=0.423) had the greatest association with infection control practices, followed by COVID-19-related attitude (β=0.174). Higher safety climate and attitude scores were associated with higher scores in infection control practices. The explanatory power of these variables was 30.6%. This study indicated that safety climate and COVID-19-related attitudes significantly influence infection control practices in small to medium-sized hospitals. This provides a basis to establish policies for responses to emerging infectious diseases in small to medium-sized hospitals and contributes to consistent guidelines.