<p> Personal health record (PHR) is considered a crucial part in improving patient outcomes by ensuring important aspects in treatment such as continuity of care (COC), evidence- based treatment (EBT) and most importantly prevent medical errors (PME). Recently there has been more focus on preventive care or monitoring and control of patients symptoms than treatment itself. Nowadays, there are many mobile health applications and sensors such as blood pressure sensors, electrocardiogram sensors, blood glucose measuring devices, and others that are used by the patients who monitor and control their health. These apps and sensors produce personal health data that can be used for treatment purposes. If managed and handled properly, it can be considered patient-generated data. There are other types of personal health data that are available from various sources such as hospitals, doctors offices, clinics, radiology centers or any other caregivers. </p><p> Aforementioned health documents are deemed as a PHR. However, personal health data is difficult to collect and manage due to the fact that they are distributed over multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and each may describe patient problems in their own way. Such inconsistencies could lead to medical mistakes when it comes to the treatment of the patient. In case of emergency, this situation makes timely retrieval of necessary personal clinical data difficult. In addition, since the amount and types of personal clinical data continue to grow, finding relevant clinical data when needed is getting more difficult if no actions are taken to resolve such issue. Having complete and accurate patient medical history available at the time of need can improve patient outcomes by ensuring important aspects such as COC, EBT, and PME. Despite the importance of PHR, the adoption rate by the general public in the U.S. still remains low. In this study we attempt to use Personal Health Record System (PHRS) as a central point to aggregate health records of a patient from multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and to standardize personal health records (e.g. use of International Classification of Diseases (ICD- 10) and Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)) through our proof-of-concept model: Health Decision Support System (HDSS). </p><p> We started out by exploring the barriers in adopting PHRs and proposed a few approaches that can promote the adoption of PHRS by the general public so it is possible to implement continuity of care in community settings, evidence-based care, and also prevent potential medical errors. To uncover the barriers in adopting PHR, we have surveyed articles related to PHRS from 2008 to 2017 and categorized them into 6 different categories: motivation, usability, ownerships, interoperability, privacy, and security and portability. </p><p> We incorporated the survey results into our proposed PHRS, so it can help overcome some of the barriers and motivate people to adopt PHRS. In Our proposed PHRS, we aimed to manage personal health data by utilizing metadata for organizing and retrieval of clinical data. Cloud storage was chosen for easy access and sharing of health data with relevant caregivers to implement the continuity of care and evidence-based treatment. In our study, we have used Dropbox as storage for testing purposes. However, for practical use, secure cloud storage services that are Health Insurance Portability and Accountability Act (HIPAA) complaint can be used for privacy and security purposes, such as Dropbox (Business), Box, Google Drive,Microsoft OneDrive, and Carbonite. In case of emergency, we make critical medical information such as current medication and allergies available to relevant caregivers with valid license numbers only. In addition, to standardize PHR and improve health knowledge, we provide semantic guidance for using SNOMED CT to describe patient problems and for mapping SNOMED CT codes to ICD-10-CM to uncover potential diseases. As a proof of concept, we have developed two systems (prototypes): first, my clinical record system (MCRS) for organizing, managing, storing, sharing and retrieving personal health records in a timely manner; second, a health decision support system (HDSS) that can help users to use SNOMED CT codes and potential disease(s) as a diagnosis result.</p><p>

<p> The purpose of this marketing plan is to identify the need for ASC&rsquo;s in the field of cosmetic and plastic surgery. Outlining an assessment of the market will provide a detailed overview of the industry and a roadmap to building a sustainable business. Each section in the analysis will present information that pertains to the industry, customer, and competitors. The marketing plan will help organize all of the data and research about the business and is useful tool for business owners or potential investors. Beverly Drive Surgery Center intends on offering patients seeking cosmetic or plastic surgery with the optimal surgical environment and exceptional care.</p><p>

<p> The purpose of this action research study was to examine the effects of the stigma of mental illness towards individuals with mental illness on services provided by medical professionals, specifically, registered nurses who work in an emergency department (ED). There have been numerous studies on how attitudes towards mental illness can be present in health care professionals; however, none that focused specifically on the attitudes of ED nurses. Nurses working in the ED are often the first health care professional a patient with mental illness sees and their attitude can influence the rest of the ED visit. The Opening Minds Scale for Health Care Workers (Modgill, Patten, Knaak, Kassam, &amp; Szeto, 2014. &ldquo;Opening Minds Stigma Scale for Health Care Providers (OMS-HC): Examination of Psychometric Properties and Responsiveness&rdquo;) and the Caring Nurse Patient Interaction Short Form (Cossette, Cote, Pepin, Ricard, &amp; D&rsquo;Aoust, 2006. &ldquo;A Dimensional Structure of Nurse-Patient Interactions from a Caring Perspective: Refinement of the Caring Nurse-Patient Interaction Scale (CNPI-Short Scale)&rdquo;) were used to measure attitude towards stigma and the perception of the care a nurse gives a patient. Thirty-four nurses from two emergency departments participated in the research with the expectation of there being high levels of stigma which would in turn affect the care given to the patients with mental illness. Descriptive statistics, multiple regression and ANOVA were used to find low to moderate levels of stigma of mental illness, and these nurses had a perception of providing excellent care to their patients. This is in contrast to other studies finding moderate to high levels of stigma in general among health care professionals. This information can be useful in exploring and then using any policies and procedures present in the research sites for the benefit of other emergency departments. Additional research is planned to further review these sites and other emergency departments within the hospital network to ascertain if these results hold true, and if so, identify the dynamics involved.</p><p>

<p> AAdvocacy Group LLC is a for profit healthcare consulting firm, specializing in improving overall patient experience through its professional consulting services for healthcare organizations and private patient advocacy services to the Los Angeles Community. AAdvocacy Group LLC does not provide legal or clinical advice, and also does not accept any health coverages for patient advocacy services. AAdvocacy Group LLC is a firm believer, and also supported by research, there is a strong correlation between patient experience and patient health outcomes. Through the two distinct services, patient experience consulting services and private patient advocacy services, AAdvocacy Group LLC holds an impact on both a macro (organizational base) and micro (patient) level. In addition, this allows the organization to be abreast with leading industry practices.</p><p>

<p> Acute care hospitals and senior healthcare leaders are facing increasing governmental regulations enacted by the Affordable Care Act (ACA), Value-Based Programing, and a constantly changing political agenda. Senior healthcare leaders are expected to solve these new challenges and lead their employees and organizations during these challenging times. However, the ever-changing healthcare environment, which may be attributing to the high turnover rates and low rates of job satisfaction for senior healthcare leaders, is preventing lasting solutions to the current challenges the healthcare industry is facing (Fiabane, Giorgi, Sguazzin, &amp; Argentero, 2013; Keyko, Cummings, Yonge, &amp; Wong, 2016). Research supports that intrinsic variables of job satisfaction are the key to increasing motivation and job satisfaction for healthcare employees (Janssen, De Jonge, &amp; Bakker, 1999; Lee &amp; Cummings, 2008; Lundh, 1999; Nolan, Nolan, &amp; Grant, 1995; Speedling, 1990). Research also indicated that value congruence is positively related to job satisfaction (Edwards &amp; Cable, 2009; Kristof, 1996; Kristof-Brown, Zimmerman, &amp; Johnson, 2005; Ren &amp; Hamann, 2015) and has a stronger relationship between intrinsic variables of job satisfaction than extrinsic variables of job satisfaction (Caudron, 1997; Fisher, 2010). The purpose of this research study was to explore the relationship between the rates of extrinsic and intrinsic job satisfaction and the degree of person-job value congruence for senior healthcare leaders. Surprisingly, this study&rsquo;s findings indicated that there is no statistically significant relationship between person-job value congruence and extrinsic or intrinsic job satisfaction. Also, contrary to previous literature, extrinsic job satisfaction was highlighted as more important than intrinsic job satisfaction for increasing job satisfaction for senior healthcare leaders. The study&rsquo;s findings also note that female senior healthcare leaders have less extrinsic job satisfaction and feel that they need to achieve more (be more successful, capable, and ambitious) in their roles than male senior healthcare leaders. This study&rsquo;s findings offer acute care hospitals evidence that supports employee engagement strategies that differ from the common practice to focus on intrinsic variables and personal values. Instead, this study&rsquo;s findings suggest acute care hospitals focus on the more explicit extrinsic variables of job satisfaction and explore potential gender differences between senior healthcare leaders.</p><p>

<p> The purpose of this exploratory qualitative study was to identify experiences or barriers that arise during the first year as Certified Registered Nurse Anesthetists (CRNAs) transition into management and; if these shared experiences can prepare future CRNA managers by providing insight into what knowledge, skills, and abilities are necessary to ensure a smooth and successful career transition. </p><p> A representative sample by email and Facebook (FB) elicited 18 phone interviews of current and past Certified Registered Nurse Anesthetist (CRNA) managers. One interviewer asked 16 questions: seven demographic and nine open-ended. Survey information was (1) transcribed, (2) reviewed and de-identified, and (3) coded for content and classical analysis by two experienced independent coders. A coding tree was developed by coders after independent and random assessment of codes with an IRR (0.93). NVivo 11 software was used to assist with analysis of codes. </p><p> CRNA participants (66%) had less than five years of CRNA management experience, and 61% had no previous management experience or education before accepting their first role as a CRNA manager. An incidental finding, 83% of participants were reluctant managers and 76% of CRNA managers devoted greater than 50% of their time to performing clinical duties over managerial duties. Two resources that CRNA participants agreed were helpful resources during transition included: mentors (83%) and previous education or experiences (44%), especially in business, finance, or management. The skills CRNA participants believed were important during transition included people skills (56%), financial knowledge (33%), and communication (28%). </p><p> CRNA managers are more likely to be reluctant managers that may be relatively new in the role, and with no previous management experience or education. Recommendations for new CRNA managers during transition included; mastering &ldquo;people skills,&rdquo; either through relationship management or communication skills. Derailment may be avoided if new managers consider the results of this investigation.</p><p>

<p> Dramatic shifts in the way healthcare and related healthcare services are delivered and managed in the United States are unfolding at an unrelenting pace. Concurrent with ongoing changes in United States&rsquo; delivery of medicine, some argue that traditional notions of power are undergoing an equally transformative shift (Mintzberg, 2015; Na&iacute;m, 2013). The confluence of the emerging reconsideration of the role of power in our society and organizations along with the dramatic changes in the American healthcare system provides a fertile backdrop and context for this study of power. </p><p> At the center of this transformation, the physician maintains a unique and &ldquo;very special position&rdquo; in the hospital setting (Freidson, 1970). This grounded research study investigates the ways in which 24 physicians in modern hospital healthcare setting (MedHealth) conceptualize their exercise of power, autonomy, and control in their day-to-day interactions in the practice of medicine. </p><p> I find physicians at MedHealth chose to conceptualize their exercise of their power, autonomy and control unitarily. Physicians in all three participant groups at MedHealth (surgeons, pediatricians and others) conceptualized a significant loss of power, autonomy, and control, in the practice of medicine. Additionally, physician conceptualizations of their exercise of power, autonomy, and control in the practice of medicine are shaped and fashioned by micro, meso, and macro level interactions. </p><p> I present a theoretical model in an effort to gain a richer appreciation of how physicians at MedHealth conceptualize their power, autonomy, and control (PAC). I argue a reconceptualization of their PAC is necessary given the transformative changes to the US healthcare model. Last, I offer numerous implications for theory and practice, and recommendations for areas for future research that emerged from this research project.</p><p>

<p> Escalating health care costs in the military health system are not sustainable long term. Regular physical activity has been shown to improve health and reduce health care costs. Military members serving in the United States Air Force (USAF) are encouraged to maintain physical fitness year-round and undergo mandatory physical fitness assessments (PFAs) annually. The purpose of this quantitative correlational study was to determine the nature of the relationship between the timing of the PFA and health care utilization (HU) by active duty service members assigned to the United Kingdom's USAF military treatment facility. Donabedian's framework and the logic process model were used to design the study. Archived fitness and health care utilization data were obtained on 361 military members. Findings indicated a strong, positive correlation between the timing of the PFA and HU, which was strongest during the PFA month. Monthly HU 6 months prior to PFA was compared using a 1-way repeated measures ANOVA. Findings indicated a significant difference between T-1 (PFA month), T-2 (1 month prior to PFA), and T-5 (5 months prior to PFA). Paired-samples t tests demonstrated a statistically significant increase in HU from T-5 to T-2. Although findings are not generalizable, they signal a need for further study to evaluate HU variability between populations, to identify at-risk groups, and to inform health and fitness policies that affect the readiness and retention of military members. The DNP project may promote interdisciplinary collaboration between health care providers and senior military leadership, innovation in health care delivery, and evidence-based and cost-conscious policies.</p><p>

Context. There has been increasing attention concerning the use of DNA-based genetic tests in health care. Many have argued that the use of genetic technologies should be subject to public debate and scrutiny. However, few in the general population can offer views informed by actual experience with genetic services. Prenatal and newborn screening programs are examples of genetic services that are routinely offered to the general population. Objectives. To determine if conjoint analysis is a useful tool for eliciting user preferences for newborn screening services. Methods. Discrete choice conjoint analysis (CA). Results. Counterintuitive results identified issues concerning the validity of the CA instrument that was developed. As a result limitations to the usefulness of aggregate logit regression for the analysis of CA data were identified. Other analytical approaches, such as latent class analysis, merit further examination to determine their validity and the value of the information they may provide.

<p> As the aging population continues to increase, the move to assisted living facilities (ALFs) is becoming a popular choice as an alternative to remaining at home. The majority of older adults entering assisted living facilities have one of more chronic conditions that prevent them from performing their activities of daily living, thereby requiring assistance from direct care workers (DCWs). These DCWs are unregulated, and their training varies from state to state and from ALF&rsquo;s. Hence, there could be an apparent shortfall in the care provided to residents in ALFs by DCWs. Stake&rsquo;s case study methodology was used to answer the research question about the issues that family members experience with the care provided by DCWs for a relative in assisted living facilities. A gap was identified in the literature that signals the need to have the input of the family members on how care is given in ALFs. Open-ended interview questions were used to capture the issues family members saw with the care their loved ones receive. Data analysis took the form of direct interpretation, categorical aggregation, finding patterns, identifying themes within case, and establishing linkages between cases. The final phase of the data analysis was the interpretive phase where conclusion was drawn. Five main themes emerged after analysis of the data. They were: training for DCWs, satisfaction with care, cultural competencies, expectation of care, and need for improvement. The findings suggest that there are several issues family members have with the care provided in ALFs. These finding could then be used to devise training for the DCWs that are geared to provide adequate care to the residents in ALFs. The implications from the study suggest that more training should be implemented and based on humanistic theory resulting in individualized care with the person focus approach. Well trained direct care workers in assisted living facilities will enhance the quality of life for older adults and preserve the integrity of the assisted living industry. </p><p>