School Hospital Research Articles

The heterogeneous associations between gestational weight gain and adverse pregnancy outcomes in gestational diabetes mellitus according to abnormal glucose metabolism

ObjectivesThe gestational weight gain (GWG) and hyperglycemia are two key factors affecting adverse pregnancy outcomes among women with gestational diabetes mellitus (GDM). We aimed to investigate the combinatorial effect of abnormal glucose metabolism and GWG on adverse outcomes in GDM.MethodsThis retrospective cohort study included 2611 pregnant women with GDM in Women’s Hospital School of Medicine Zhejiang University. Bases on the OGTT glucose levels, we categorized the GDM cohort into three subgroups: impaired fasting glucose (IFG) group, impaired glucose tolerance (IGT) group, and combined impaired glucose (IFG&IGT) group.ResultsAmong pregnant women with IGT, insufficient GWG (IGWG) was an independent protective factor for pregnancy-induced hypertension syndrome (PIH) (aOR 0.55, 95% CI 0.32-0.95), macrosomia (0.38, 0.19-0.74) and large for gestational age (0.45, 0.32-0.62), as well as an independent risk factor for low birth weight infants (2.29, 1.24-4.22) and small for gestational age (1.94, 1.17-3.19); and excessive GWG (EGWG) was related to increased risks of PIH (1.68, 1.12-2.52), preterm delivery (1.82, 1.28-2.58), postpartum hemorrhage (1.85, 1.05–3.28), cesarean delivery (1.84, 1.38-2.46) and low body weight infants (2.36, 1.33-4.20). Moreover, EGWG was positively associated with PIH (3.27, 1.09–9.80) in the IFG group. But there were no significant associations between either IGWG or EGWG and any pregnancy outcomes in women with combined IFG&IGT.ConclusionsThe relationships between GWG and adverse outcomes were modified by abnormal glucose metabolism in women with GDM. Our results suggest that more specific GWG recommendations according to their metabolic state are needed for GDM.

Spinal Instability as a Prognostic Factor in Patients With Spinal Metastasis of Castration-resistant Prostate Cancer.

To evaluate the Spinal Instability Neoplastic Score (SINS) for prediction of survival in patients with spinal column metastasis of castration-resistant prostate cancer (CRPC). A retrospective study of spinal instability was performed in patients with CRPC using SINS. Overall survival was evaluated starting from the time of SINS evaluation. The subjects were 42 patients with CRPC among 261 cases diagnosed with metastatic spinal tumors by radiologists, among 42,152 cases that underwent a body computed tomography scan at Kawasaki Medical School Hospital within 32 months from December 2013 to July 2016. The median age was 78 (range=55-91 years), the median prostate-specific antigen (PSA) level at SINS evaluation was 42.1 (0.1-3,121.6) ng/ml, and 11 patients had visceral metastasis. The median periods from diagnosis of bone metastasis and development of CRPC to SINS evaluation were 17 (0-158) and 20 (0-149) months, respectively. The spine was stable in 32 cases (group S) and potentially unstable or unstable in 10 (24%) (group U). The median observation period was 17.5 (0-83) months and 36 patients died. The median survival period after SINS evaluation was longer in group S than that in group U (20 vs. 10 months, p=0.0221). In multivariate analysis, PSA level, visceral metastasis, and spinal instability were significant prognostic factors. The hazard ratio for patients in group U was 2.60 (95%CI=1.07-5.93, p=0.0345). Spinal stability evaluated using SINS is a new prognostic factor for survival of patients with spinal metastasis of CRPC.

Using patient feedback to develop patient information tools in dentistry.

Journal of Dental EducationAccepted Articles ADVANCING THROUGH INNOVATION Using patient feedback to develop patient information tools in dentistry Kirsty Ailie Carney Bachelor of Dental Surgery, Corresponding Author Kirsty Ailie Carney Bachelor of Dental Surgery [email protected] orcid.org/0000-0003-2260-5142 Dental Core Trainee in Restorative Dentistry and Quality Improvement, Department of Restorative Dentistry, Dundee Dental Hospital and Research School, Dundee, UK Correspondence Kirsty Carney, Dundee Dental Education Centre, Smalls Wynd, Dundee, DD1 4HN. Email: [email protected]Search for more papers by this authorJulie Kilgariff Consultant in Endodontics, Julie Kilgariff Consultant in Endodontics Consultant in Endodontics, Department of Restorative Dentistry, Dundee Dental Hospital and Research School, Dundee, UKSearch for more papers by this authorThomas Lamont Consultant in Restorative Dentistry, Thomas Lamont Consultant in Restorative Dentistry Consultant in Restorative Dentistry, Department of Restorative Dentistry, Dundee Dental Hospital and Research School, Dundee, UKSearch for more papers by this author Kirsty Ailie Carney Bachelor of Dental Surgery, Corresponding Author Kirsty Ailie Carney Bachelor of Dental Surgery [email protected] orcid.org/0000-0003-2260-5142 Dental Core Trainee in Restorative Dentistry and Quality Improvement, Department of Restorative Dentistry, Dundee Dental Hospital and Research School, Dundee, UK Correspondence Kirsty Carney, Dundee Dental Education Centre, Smalls Wynd, Dundee, DD1 4HN. Email: [email protected]Search for more papers by this authorJulie Kilgariff Consultant in Endodontics, Julie Kilgariff Consultant in Endodontics Consultant in Endodontics, Department of Restorative Dentistry, Dundee Dental Hospital and Research School, Dundee, UKSearch for more papers by this authorThomas Lamont Consultant in Restorative Dentistry, Thomas Lamont Consultant in Restorative Dentistry Consultant in Restorative Dentistry, Department of Restorative Dentistry, Dundee Dental Hospital and Research School, Dundee, UKSearch for more papers by this author First published: 15 June 2023 https://doi.org/10.1002/jdd.13300 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as https://doi.org/10.1002/jdd.13300 AboutPDF ToolsExport 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 Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

The Impact of Potassium Binders on Mortality in Patients with Hyperkalemia: A Single-Center Study

Hyperkalemia is associated with an increased risk of mortality and is a common complication in patients with chronic kidney disease (CKD). Despite the prevalence of hyperkalemia, current real-world data suggest that serum potassium levels are not effectively managed in clinical practice. The potential benefit of potassium binders in reducing the risk of death has not been thoroughly investigated. Therefore, this retrospective cohort study aimed to investigate the potential impact of potassium binders on mortality risk in patients with CKD by analyzing electronic medical records. The study included 1689 patients with CKD and hyperkalemia (serum potassium level > 5.0 mEq/L), who visited Kawasaki Medical School Hospital between January 2014 and December 2018. The patients were divided into two groups: those without CPS (calcium polystyrene sulphonate) treatment (CPS_OFF) and those with CPS treatment (CPS_ON). The results showed that the incidence of death was significantly higher in the CPS_OFF group than in the CPS_ON group (22.3% vs. 19.6%, p < 0.001). After propensity score matching, the CPS_ON group had a higher survival rate than the CPS_OFF group (log-rank test, p = 0.020). These results suggest that potassium binders may reduce the risk of death in patients with CKD and hyperkalemia. We hope that the results of this cohort study will be confirmed in future RCTs.

Childhood and Adolescent Sleep Awareness in Caregivers and Health Care Providers: A Community- and Hospital-Based Survey

BackgroundSleep disorders are common in childhood and adolescence with mental and physical consequences needing appropriate intervention by caregivers and health care providers (HCPs). The objective of the study, conducted at a tertiary teaching hospital and public school in north India, was to develop validated questionnaires to evaluate childhood and adolescent sleep awareness in caregivers and HCPs. MethodsThe study participants (caregivers represented by parents of 2-18 year olds attending a public school and of those attending outpatient services at the study hospital and HCPs represented by medical interns and nursing graduates within 1 year of graduation) were enrolled after appropriate screening. ResultsTwo separate questionnaires in English for caregivers (also translated in Hindi) and HCPs were applied on 313 caregivers and 175 HCPs (110 medical interns and 65 nursing graduates) and developed and validated with a Cronbach α of 0.73 and 0.74, respectively. The questionnaires covered three domains: sleep hygiene, sleep related health problems, and miscellaneous. Both group of respondents had >50% correct responses in sleep hygiene. The ĸ agreement between knowledge and practice of sleep hygiene in caregivers was 0.2. Poor response (<50% correct responses) was seen in sleep-related health problems in both groups of respondents implying knowledge deficit in various sleep disorders. The HCPs performed poorly on basic theoretical questions in miscellaneous domain. For consultation of sleep problems, most caregivers (48%) chose pediatricians. ConclusionThere is a need to strengthen undergraduate medical and nursing curriculum in sleep. Caregivers should be made aware of implications of unhealthy sleep.

Posterior Inferior Cerebellar Artery Excision and End-to-End Reanastomosis for Treatment of a Giant, Partially Thrombosed Aneurysm: 2-Dimensional Operative Video.

Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA Correspondence: Amir R. Dehdashti, MD, Department of Neurosurgery, North Shore University Hospital, 300 Community Drive, Manhasset, NY11030, USA. Email: [email protected]

Comparison of Peak Bulk Flow Rate of Programmable Intermittent Epidural Bolus and Manual Epidural Bolus Using a Closed-End Multiorifice Catheter.

Shanghai First Maternity and Infant Hospital School of Medicine Tongji University, Shanghai, China, [email protected]

The "oldest and the newest of nurses": Nursing and the Professionalization of Obstetrics and Gynecology.

When in the late nineteenth century American physicians increasingly replaced midwives in the care of obstetrical and gynecological patients, they could do so only because they were aided by another emerging group of healthcare professionals: nurses. Nurses were instrumental in assisting physicians in the care of patients in labor and during recovery. They were also necessary for male physicians because the vast majority of nurses were women and their presence during gynecological and obstetrical treatments made it more socially acceptable for men to examine female patients. In hospital schools in the northeast and through long-distance nursing programs, physicians taught students about obstetrical nursing and instructed them to protect the modesty of female patients. They also tried to instill strict professional hierarchies between nurses and physicians, emphasizing that nurses should never attempt to deliver a patient without a physician. But as nursing emerged into a unique professional practice separate from that of physicians, nurses were able to negotiate better education in the care of laboring patients. In order to take over women's sexual and reproductive health care from traditional providers, physicians conceded to nurses' demands for more authority in patient care.

Mechanical Thrombectomy Treatment More than 16 h after Last Known Well for Patients with Large Vessel Occlusion

Introduction: Mechanical thrombectomy (MT) has been reported to be effective within 24 h after last known well (LKW) by the DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) trial and within 16 h after LKW by the DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) trial. However, there have been few reports of MT more than 16 h after LKW, and the efficacy and safety of MT more than 24 h after LKW have not yet been demonstrated. We evaluated the efficacy and safety of MT more than 16 h after LKW. Methods: Using data from the Nippon Medical School Hospital MT registry from April 2011 to August 2022, consecutive patients with anterior circulation large vessel occlusion (LVO) and prehospital modified Rankin scale (mRS) scores of 0–3 were enrolled. Patients were classified into the following three groups: early group (LKW <6 h), middle group (LKW 6–16 h), and late group (LKW >16 h). The clinical characteristics and outcomes were compared among these three groups. Results: Among 778 patients in the MT registry, 624 were enrolled. The early group included 432 patients, the middle group included 123 patients, and the late group included 69 patients. The patients had a median age of 77 years (interquartile range, 68–83), and 359 were male (57.5%). The median prehospital mRS score was 1 (interquartile range, 1–1), median National Institutes of Health Stroke Scale score on admission was 17 (interquartile range, 10–23), and median Alberta Stroke Program Early CT Score was 10 (interquartile range, 8–10). Regarding safety and efficacy, the proportions of cases with successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2b–3; 85.4% vs. 92.7% vs. 88.7%; p = 0.47), symptomatic intracranial haemorrhage (6.4% vs. 5.7% vs. 7.2%; p = 0.99), mRS score ≤3 at 90 days (52.0% vs. 60.2% vs. 44.9%; p = 0.11), and mRS score of 6 at 90 days (11.3% vs. 10.6 vs. 8.7%; p = 0.37) were not significantly different between the three groups. Conclusion: Patients who received MT more than 16 h after LKW experienced the same safety and efficacy as those who received MT at 0–16 h after LKW. MT more than 16 h after LKW may be safe and effective for stroke patients with LVO.

Effect of positive emotion intervention during late pregnancy on improving colostrum secretion: a randomised control trial protocol

IntroductionThough evidence has revealed the beneficial effects of cognitive improvement interventions on breastfeeding, the effect of psychological interventions has rarely been studied. This study aims to test whether promoting a...

Learning as the best medicine: Proposal for SMART schooling for hospitalized children

This research paper explores learning alternatives for chronically ill students, considering the challenges they encounter in their learning processes due to prolonged or intermittent absences from school. International practices and recent research findings on this topic will be reviewed in the contexts of hospital schools, SMART hospitals, and SMART learning technologies to highlight their primary characteristics. The current situation of hospitalized students, particularly those in Dubai, will be discussed to propose an alternative education program to aid them: the Edu-Med Care Model. This model is built on SMART education and healthcare approaches to support the goal of helping students overcome barriers that prevent them from accessing conventional learning spaces. The strengths and limitations of the Edu-Med Care Model will be evaluated.

Entrepreneurship education application and effectiveness in Egyptian hospitality schools: A comparative study using European Framework for Entrepreneurial Competences (EntreComp)

Entrepreneurship education application and effectiveness in Egyptian hospitality schools: A comparative study using European Framework for Entrepreneurial Competences (EntreComp)

Evaluation of recurrence, mortality and treatment complications of oral squamous cell carcinoma in public health centers in Shiraz during 2010 to 2020

IntroductionOral Squamous cell Carcinoma (OSCC) is the most common oral cancer and is treated with surgery, radiotherapy and chemotherapy. Various complications of treatment include xerostomia, mucositis, and trismus, which affect patients’ quality of life. The aim of this study is to evaluate the mortality, recurrence rate and prevalence of oral complications in treated patients.Method and materialsThis cross-sectional study reviewed 326 cases of patients with OSCC who were referred to public health centers in Shiraz (Khalili Hospital and Dental School) from 2010 to 2020. All patients were contacted, and the survivors were called and examined by an oral physician. A medical record was created for them, including demographic information, location of the lesion, type of treatment, history of recurrence, metastasis and oral complications.Results53.5% of patients were male and 46.5% were female. The mean age of patients was 58.68 years. Mortality and recurrence rate was respectively 49.8% and 17.8%. The most common location of the lesion was tongue (64%). Surgery was done for all patients. 97.4% of patients complained of xerostomia, 46.2% of mucositis and 44.3% of trismus.ConclusionThe most common complications of treatment are xerostomia, mucositis, and trismus, respectively. Frequent and regular follow-ups and supportive therapies reduce these complications and improve patients’ quality of life.

A USER-FRIENDLY TOOL TO COMPUTE INFECTION PROBABILITY OF SARS-COV-2 INDOOR: THE USER GUIDE AND ITS APPLICATION IN MEDICAL PRACTICE

After some initial hesitancy at the beginning of the COVID-19 pandemic, the academic community agreed that the infection process is mostly airborne and generally associated with closed environments. Therefore, assessing the indoor infection probability is mandatory to contain the spread of the disease, especially in those environments, like school classrooms, hospital wards or public transportation, with higher risk of overcrowding. For this reason, we developed a software tool in Python to compute infection probability and determine those mechanisms that contribute to reduce its diffusion in closed settings. In this paper, we will briefly illustrate the model we used and focus our attention on the description of the main features of the software and give some examples of how it can be used in clinical practice to predict the spread of the disease in the rooms of a generic ward, optimize room occupancy or drive healthcare workers activity schedule. Finally, some limitations and further implementations of our work will be reported.

(043) Assessing Confidence in Caring for LGBTQ+ in Medicine and Teaching Acclimate Survey

Abstract Introduction Discrimination against LGBTQ+ individuals in West Virginia (WV) may compound the already poor health outcomes faced by all West Virginians. Medical students across the United States (US) report positive attitudes towards LGTBQ+ patients but do not feel adequately trained to provide proper care. Medical schools and residency programs in WV have begun to incorporate LGTBQ+ training in their curricula, but the effect on confidence is not known. We report preliminary survey results from WV resident physicians and medical students on their confidence caring for LGTBQ+ patients. Objective Use survey data to evaluate the quantity and quality of LGBTQ+ medical education of residents and medical students in WV and assess its impact on confidence and comfort in treating LGBTQ+ patients. Methods An anonymous survey was distributed via REDCap from February to June 2022 to residents and medical students at a major WV medical school and teaching hospital. The survey collected demographic information and exposure to LGTBQ+ undergraduate medical training, and assessed with a Likert Scale attitudes, comfort, and confidence in providing informed care; many questions were adapted from a validated survey. Data were analyzed with Fisher’s exact and Mann-Whitney tests. Significance was set at p&amp;lt;0.05. Results Thirty-five students and 23 residents completed the survey. Students identified as male (37%), female (54%), non-binary (6%), and other (3%); residents identified as male (52%) or female (48%). Most students (77%) and residents (83%) were heterosexual; other sexual orientations included gay (6% of students, 4% of residents), lesbian (6% of students), bisexual (9% of students, 13% of residents). One student (3%) identified as “other.” Most students (67%) were from WV and most residents (57%) attended medical school in WV. Residents were from nine specialties; Internal Medicine (22%) and Surgery (22%) were most represented. Residents attended US (61%), International (35%), and Caribbean (4%) schools. Most residents did not have LGBTQ+ lectures (57%) or standardized patients (57%) in medical school (57%), but have had lectures in residency (55%). Students reported LGTBQ+ curriculum (67%) but not standardized patients (69%). Students felt more competent than residents with LGTBQ+ language (z=3.04, p&amp;lt;0.00), and that physicians should ask patients their pronouns, gender identity (z=2.8, p=0.01). Among all respondents, those without LGTBQ+ curriculum in medical school felt less comfortable asking about gender identity (z=–2.24, p=0.03), sexual orientation (z=–2.207, p=0.03), sexual preferences (z=–2.705, p=0.01), and reported anxiety about their knowledge of LGTBQ+ healthcare (z=3.354, p&amp;lt;0.00). Those without standardized patient experiences felt less competent (z=–4.127, p&amp;lt;0.00) and more anxious (z=3.040, p&amp;lt;0.00) performing a physical exam on a transgender patient. Most subjects reported appropriate awareness of disparities (64%), but not in linking patients to resources (52%); most would attend training (89%) and support mandatory LGTBQ+ education (93%). Conclusions Though preliminary results, medical learners want training in LGTBQ+ healthcare and do not feel adequately prepared to care for the unique needs of these patients. Disclosure No

A Retrospective Study Comparing Olaparib and Bevacizumab as a Maintenance Therapy for Platinum-Sensitive Recurrent Ovarian Cancer: Impact on Recurrence-Free Survival in Japanese and Asian Populations.

The use of angiogenesis inhibitors and poly ADP-ribose polymerase inhibitors following multi-agent chemotherapy, including platinum-based agents, has become the standard treatment for platinum-sensitive recurrent ovarian cancer (PSROC). However, the optimal maintenance therapy and selection criteria for these patients remain unclear. Thus, this study aimed to optimize the treatment options and selection criteria for patients with PSROC. The clinical data of 51 patients with PSROC admitted to Nippon Medical School Chiba Hokusoh Hospital and Nippon Medical School Hospital were retrospectively collected. The log-rank test was used for the survival analysis, and Cox proportional hazard regression analysis was used for the multivariate survival analysis. Of the 51 patients, 17 received maintenance therapy with bevacizumab (Bev), and 34 received olaparib (Ola). Recurrence-free survival (RFS) was significantly prolonged in the Ola group (27 months; 95% confidence interval (CI), 19-NA months) compared with that in the Bev group (9 months; 95% CI, 5-22 months; p = 0.000103). The efficacy of Ola was independent of background factors, including response to previous chemotherapy, homologous recombination status, histological type, or laboratory data. Ola is superior to Bev as PSROC maintenance therapy, especially in Japanese and Asian populations.

Clinical clerkship at an oncology hospital based on the curriculum of a clinical pharmacy program from a university belonging to low-middle-income country: Insights from a pharmacy program experience.

Nepal, a low-middle-income country, is relatively new to clinical pharmacy. Although the program started in 2000 with several universities running it as of today, the effectiveness of this program has been under discussion since its inception regarding its syllabus, practical issues, clinical postings, and importance in hospital settings. In this commentary, we share our 14 days of experience of a clinical clerkship period carried out under a curriculum of a university constituent school in an oncology-based hospital with a clinical pharmacy department providing clinical pharmacy services.

Lower optimal dose of amrubicin for relapsed small-cell lung cancer: a retrospective study.

Amrubicin (AMR) is one of the most active agents for small-cell lung cancer (SCLC). However, hematologic toxicity and infection at a commonly used dose (40mg/m2) is problematic; the optimal dose remains undetermined. To evaluate the optimal dose of AMR in terms of efficacy and safety, we reviewed consecutive data on patients with relapsed SCLC who received AMR at doses of 40, 35, and 30mg/m2 (on days 1-3) at Nippon Medical School Hospital between October 2010 and November 2021. We reviewed the data of 86 patients (20, 45, 27 who received AMR doses of 40, 35, 30mg/m2, respectively) according to our study criteria. For patients ≥ 75years, the proportion who received second-line treatment tended to be higher in the 30-35mg/m2 group. Objective response rates were 37/46/35%, median progression-free survival (PFS) were 3.0/4.7/3.2months, and median overall survival (OS) were 7.8/16.3/8.0months, respectively. Grade 4 neutropenia occurred in 58/39/31% of patients, which was higher for the 40mg/m2 group. The incidence of febrile neutropenia did not differ between groups. Multivariate analysis identified the AMR dose was not associated with longer PFS and OS. Treatment with AMR between 30 and 35mg/m2 showed relatively mild hematologic toxicity compared with AMR at 40mg/m2, without any significant difference in efficacy. Lower dose of AMR for relapsed SCLC could be a promising treatment option.

Analysis of the education and training of haute cuisine chefs: is there a common pattern?

This study examines the haute cuisine chefs’ education and training in order to identify a common pattern of training. Specifically, this study investigates the education and training received during the careers of a sample of 60 Michelin-starred chefs in Catalonia, a Spanish region recognized for its gastronomy. To conduct the study, a qualitative methodology was adopted and a semi-structured questionnaire was used to interview the professionals. The results show that the studies in hospitality schools are important to cement the basis of knowledge, but internships and work experience are also relevant ways to acquire explicit and tacit knowledge to succeed in this sector. These findings have allowed the identification of three different clusters of haute cuisine chefs also considering age and experience. This paper contributes to the research by analyzing the education of a group of professionals and identifying a common pattern of training in a growing sector that contributes significantly to national economies.

Climbing the Ladder, Chasing the Dream: The History of Homer G. Phillips Hospital By Candace O’Connor

Reviewed by: Climbing the Ladder, Chasing the Dream: The History of Homer G. Phillips Hospital By Candace O’Connor Linda T. Wynn Climbing the Ladder, Chasing the Dream: The History of Homer G. Phillips Hospital. By Candace O’Connor. (Columbia: University of Missouri Press, 2021. Pp. xvi, 314. $40.00, ISBN 978-0-8262-2247-3.) Candace O’Connor’s Climbing the Ladder, Chasing the Dream: The History of Homer G. Phillips Hospital is one of several books written about African American hospitals that came into existence because of de facto or de jure practices that decreed the separation of African Americans and whites in spaces that delivered health care and social services. When St. Louis’s Homer G. Phillips Hospital opened in 1937, it joined the ranks of other hospitals for African Americans founded in the late nineteenth and early twentieth centuries such as Chicago’s Provident Hospital and Training School, established in 1891; Philadelphia’s Frederick Douglass Memorial Hospital and Training School, established in 1895; Baltimore’s Provident Hospital and Free Dispensary, established in 1894; and Nashville’s Millie E. Hale Hospital, established in 1916. The number of these institutions peaked in the 1920s and 1930s, during a period when ambitious stratagems were developed for creating segregated medical training and practice facilities. These hospitals delivered a higher standard of medical care to African American patients and provided education and training for African American physicians and nurses. Like many African American medical institutions, Homer G. Phillips held a special place within its community’s collective memory. O’Connor’s book was prompted by an association of retired nurses who trained at Homer G. Phillips Hospital over the course of its four-decade existence. Through interviews [End Page 380] excavating the memories of those who studied and worked at “Homer G.,” O’Connor brings the narrative of a successful hospital and its attendant auxiliaries to life (p. xiii). However, Climbing the Ladder, Chasing the Dream is more than a history of Homer G. It also provides significant perspectives on numerous themes including the Great Migration, the causes of systemic racism, the aftereffects of racial desegregation, and the overall spectrum of race relations in America from the late 1930s to the late 1970s. O’Connor has drawn on her extensive previous research into St. Louis’s medical institutions to explore the history of Homer G. Phillips Hospital. To bring its story to the printed page, she combed through “more than 40 years of stories from Black and white newspapers,” researched “stacks of scholarly books and articles,” and held “dozens of interviews” with former staff members and others associated directly or indirectly with the institution (p. xiii). To cover Homer G.’s impact on the community and beyond, O’Connor has divided the tome into chapters that chronicle the hospital’s forty-two-year history, tracing its events and vicissitudes through decades of operation. Yet Climbing the Ladder, Chasing the Dream is also thematic and broaches wide-ranging topics such as the “Ville,” the thriving African American community that was home to “more than a third of the city’s Black leadership” (p. 5). Like many African American communities, the population of the Ville included “school-teachers and janitors; doctors and meat packers; lawyers and railroad men; hospital staff and domestics” (p. 5). Other major themes include hospital units and nursing life. Consisting of thirteen chapters, Climbing the Ladder, Chasing the Dream begins with “The Mysterious Life and Death of Homer G. Phillips, 1878–1931” and ends with an account of the hospital’s closure on August 17, 1979. The chapter on the hospital’s namesake is one of the book’s more intriguing contributions. Homer G. Phillips was an influential Black attorney with a law degree from Howard University. During the 1920s, he passionately supported the establishment of a hospital for St. Louis’s African American community. But Phillips was murdered in 1931, six years before his dream came to fruition. O’Connor’s historical chronicle develops into a true-crime account as the author investigates Phillips’s mystifying murder in a tome already brimming with captivating local history and personal stories. For more than forty years, one of the country...