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Study Design. Retrospective study. Objective. To compare the true cost between posterior cervical laminectomy and fusion and cervical laminoplasty using time driven activity-based costing methodology. Summary of Background Data. Cervical laminoplasty (LP) and posterior cervical laminectomy with fusion (LF) are effective procedures for treating cervical myelopathy. A comprehensive accounting of cost differences between LP versus LF is not available. Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs in patients with cervical myelopathy undergoing LP versus LF. Materials and Methods. We conducted a retrospective analysis of 277 LP and 229 LF performed between 2019 and 2023. Total facility costs, which included personnel and supply costs, were assessed using TDABC. Separate analyses including and excluding implant costs were performed. Multiple regression analysis was utilized to assess the independent effect of LP compared with LF on facility costs, with all costs standardized using cost units (CUs). Results. Patients undergoing LP had lower total supply costs [672.5 vs. 765.0 CUs (0.88x), P < 0.001] and lower total personnel costs [330.0 vs. 830.0 CUs (0.40x), P < 0.001], resulting in a lower total facility cost both including [1003.8 vs. 1600.0 CUs (0.63x), P < 0.001] and excluding implant costs [770.0 vs. 875.0 CUs (0.88x), P < 0.001] (Table 1). After controlling for demographics and comorbidities, LF was associated with increased total facility costs, including (588.5 CUs, 95% CI: 517.1-659.9 CUs, P < 0.001) and excluding implant costs (104.3 CUs, 95% CI: 57.6-151.0 CUs, P < 0.001). Conclusions. Using time-driven activity-based costing, we found that total facility costs were lower in patients treated with laminoplasty. These findings suggest that laminoplasty may of fer a less costly and more efficient surgical option for treating cervical myelopathy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Same-day mastectomy (SDM) protocols have been shown to be safe, and their use increased up to 4-fold compared with prepandemic rates. We sought to identify factors that predict overnight patient admission and evaluate the associated cost of care. STUDY DESIGN: Patients undergoing mastectomy from March 2020 to April 2022 were analyzed. Patient demographics, tumor characteristics, operative details, perioperative factors, 30-day complication, fixed and variable cost, and contribution margin were compared between those who underwent SDM vs those who required overnight admission after mastectomy (OAM). RESULTS: Of a total of 183 patients with planned SDM, 104 (57%) had SDM and 79 (43%) had OAM. Both groups had similar demographic, tumor, and operative characteristics. Patients who required OAM were more likely to be preoperative opioid users (p = 0.002), have higher American Society of Anesthesiology class (p = 0.028), and more likely to have procedure start time (PST) after 12:00 pm (49% vs 33%, p = 0.033). The rates of 30-day unplanned postoperative events were similar between SDM and OAM. Preoperative opioid user (odds ratio [OR] 3.62, 95% CI 1.56 to 8.40), postanesthesia care unit length of stay greater than 1 hour (OR 1.17, 95% CI 1.01 to 1.37), and PST after 12:00 pm (OR 2.56, 95% CI 1.19 to 5.51) were independent predictors of OAM on multivariate analysis. Both fixed ($5,545 vs $4,909, p = 0.03) and variable costs ($6,426 vs $4,909, p = 0.03) were higher for OAM compared with SDM. Contribution margin was not significantly different between the 2 groups (-$431 SDM vs -$734 OAM, p = 0.46). CONCLUSIONS: Preoperative opioid use, American Society of Anesthesiology class, longer postanesthesia care unit length of stay, and PST after noon predict a higher likelihood of admission after planned SDM. OAM translated to higher cost but not to decreased profit for the hospital. [ABSTRACT FROM AUTHOR]

Objective: We estimated, for women and men (1) the associations between psychological distress and the prevalences of presenteeism and absenteeism, (2) average hours lost annually per person, and (3) costs from the employers' economic perspective. Methods: Participants were 1292 Canadian white-collar workers. Psychological distress, presenteeism, and absenteeism were assessed with validated questionnaires. The average annual hours of productivity loss and related costs were estimated using generalized linear models with a negative binomial distribution and a log link. Results: High psychological distress in women and men was associated with presenteeism costs ($6944 and $8432) and absenteeism costs ($2337 and $2796 per person). The association between psychological distress and annual hours lost to presenteeism was twice stronger for men than women. Conclusions: Productivity losses associated with psychological distress are high in women and men older workers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite its increasing prevalence, the economic impact of eosinophilic esophagitis (EoE) is understudied. METHODS: We estimated the societal economic burden of EoE by using real-world data from Swedish health registers. RESULTS: Patients with EoE had 45% higher societal cost ($6,290 vs $4,349) compared with the general population, primarily driven by increased healthcare costs ($2,414 vs $1,022), which accounted for 72% of the excess societal cost in EoE. DISCUSSION: EoE is associated with a considerable economic burden to society. With the prevalence of EoE still rising, the economic burden of EoE is expected to continue to grow. [ABSTRACT FROM AUTHOR]

Nurses are uniquely positioned to significantly impact organizational and system improvement through improving quality and reducing costs. Using an evidenced based tool to identify costs and the financial benefit involved iii any quality improvement project is invaluable in developing and evaluating proposals and allocation of resources to support the organization's financial health and viability. The return on investment analysis is an essential accounting tool that will provide nurse leaders with critical information quantifying costs and benefits of both financial and nonfinancial metrics to identify the feasibility, efficacy, risk or efficiency of a proposed project. [ABSTRACT FROM AUTHOR]

Background: Despite growing interest in delivering high-value orthopaedic care, the costs associated with hip arthroscopy remain poorly understood. By employing time-driven activity-based costing (TDABC), we aimed to characterize the cost composition of hip arthroscopy for labral pathological conditions and to identify factors that drive variation in cost. Methods: Using TDABC, we measured the costs of 890 outpatient hip arthroscopy procedures for labral pathological conditions across 5 surgeons at 4 surgery centers from 2015 to 2022. All patients were ≥18 years old and were treated by surgeons who each performed ≥20 surgeries during the study period. Costs were normalized to protect the confidentiality of internal hospital cost data. Descriptive analyses and multivariable linear regression were performed to identify factors underlying cost variation. Results: The study sample consisted of 515 women (57.9%) and 375 men (42.1%), with a mean age (and standard deviation) of 37.1 ± 12.7 years. Most of the procedures were performed in patients who were White (90.6%) or not Hispanic (93.4%). The normalized total cost of hip arthroscopy per procedure ranged from 43.4 to 203.7 (mean, 100 ± 24.2). Of the 3 phases of the care cycle, the intraoperative phase was identified as the largest generator of cost (>90%). On average, supply costs accounted for 48.8% of total costs, whereas labor costs accounted for 51.2%. A 2.5-fold variation between the 10th and 90th percentiles for total cost was attributed to supplies, which was greater than the 1.8-fold variation attributed to labor. Variation in total costs was most effectively explained by the labral management method (partial R² = 0.332), operating surgeon (partial R² = 0.326), osteoplasty type (partial R² = 0.087), and surgery center (partial R² = 0.086). Male gender (p < 0.001) and younger age (p = 0.032) were also associated with significantly increased costs. Finally, data trends revealed a shift toward labral preservation techniques over debridement during the study period (with the rate of such techniques increasing from 77.8% to 93.2%; Ptrend = 0.0039) and a strong correlation between later operative year and increased supply costs, labor costs, and operative time (p < 0.001 for each). Conclusions: By applying TDABC to outpatient hip arthroscopy, we identified wide patient-to-patient cost variation that was most effectively explained by the method of labral management, the operating surgeon, the osteoplasty type, and the surgery center. Given current procedural coding trends, declining reimbursements, and rising health-care costs, these insights may enable stakeholders to design bundled payment structures that better align reimbursements with costs. [ABSTRACT FROM AUTHOR]

Despite neweffective medications, patients with spinal muscular atrophy types 1-3 can continue to have inadequate cough flows to prevent episodes of acute respiratory failure. Ventilator unweanable intubated patients are thought to require tracheostomy tubes. As a result, potentially beneficial medications may be discontinued and patients die despite receiving these medications. Three cases are presented of medically treated, physically strengthening children, with spinal muscular atrophy type 1. All three subsequently died or underwent tracheotomy. However, there is no evidence of extubation attempts to noninvasive ventilatory support settings or optimal mechanical insufflation-exsufflation despite this option being described to be over 98% successful for extubating unweanable medically untreated children with spinal muscular atrophy 1. [ABSTRACT FROM AUTHOR]

Objective. To compare the cost-effectiveness of lumbar decompression alone (DA) with lumbar decompression with fusion (DF) for the management of adults undergoing surgery for lumbar stenosis with associated degenerative spondylolisthesis. Summary of Background Data. Rates of lumbar fusion have increased for all indications in the United States over the last 20 years. Recent randomized controlled trial data, however, have suggested comparable functional outcomes and lower reoperation rates for lumbar decompression and fusion as compared with DA in the treatment of lumbar stenosis with degenerative spondylolisthesis. Materials and Methods. A multistate Markov model was constructed from the US payer perspective of a hypothetical cohort of patients with lumbar stenosis with associated spondylolisthesis requiring surgery. Data regarding clinical improvement, costs, and reoperation were generated from contemporary randomized trial evidence, meta-analyses of recent prospective studies, and large retrospective cohorts. Base case, one-way sensitivity analysis, and probabilistic sensitivity analyses were conducted, and the results were compared with a WTP threshold of $100,000 (in 2022 USD) over a two-year time horizon. A discount rate of 3% was utilized. Results. The incremental cost and utility of DF relative to DA were $12,778 and 0.00529 aggregated quality adjusted life years. The corresponding incremental cost-effectiveness ratio of $2,416,281 far exceeded the willingness to pay threshold of $100,000. In sensitivity analysis, the results varied the most with respect to rate of improvement after DA, rate of improvement after lumbar decompression and fusion, and odds ratio of reoperation between the two groups. Zero percent of one-way and probabilistic sensitivity analyses achieved cost-effectiveness at the willingness- to-pay threshold. Conclusions. Within the context of contemporary surgical data, DF is not cost-effective compared with DA in the surgical management of lumbar stenosis with associated spondylolisthesis over a two-year time horizon. [ABSTRACT FROM AUTHOR]

As an outreach recruitment endeavor, a hospital system and an affiliated college of nursing collaborated to host an immersive nursing learning experience for diverse high school participants. The program included hospital tours, speakers, educational games, and wellness activities to promote pursual of nursing as a future career path. The authors describe details of the development of the program, lessons learned, program outcomes, and implications for future programs and applicability in different settings. [ABSTRACT FROM AUTHOR]

Background Conversion THA, which we defined for this study as THA with concomitant removal of preexisting orthopaedic hardware, has been associated with increased hospital costs and perioperative complications compared with primary THA. Yet, conversion THA is classified as a primary procedure under the Medicare Severity Diagnosis-Related Group coding scheme, and hospitals are reimbursed based on the resource use expected for a routine primary surgery. Prior authors have argued for conversion THA to be reclassified as a revision procedure. Although prior research has focused on comparisons between conversion THAs and primary arthroplasties, little is known about the resource use of conversion THA compared with that of revision THA. Questions/purposes (1) Do inpatient hospital costs, estimated using cost-to-charge ratios, differ between conversion THAand revision THA? (2)Do themedian length of stay, intensive care unit use, and likelihood of discharge to home differ between conversion and revision THA? Methods This was a retrospective study of the Medicare Provider Analysis and Review Limited Data Set for 2019. A total of 713,535 primary and 74,791 revision THAs and TKAs were identified initially. Exclusion criteria then were applied; these included non--fee-for-service hospitalizations, nonelective admissions, and patients with missing data. Approximately 37% (263,545 of 713,535) of primary and 34% (25,530 of 74,791) of revision arthroplasties were excluded as non--fee-for-service hospitalizations. Two percent (13,159 of 713,535) of primaries and 11% (8159 of 74,791) of revisions were excluded because they were nonelective procedures. Among the remaining 436,831 primary and 41,102 revision procedures, 31% (136,748 of 436,831) were primary THAs and 36% (14,774 of 41,102) were revision THAs. Two percent (2761 of 136,748) of primary THAs involved intraoperative removal of hardware and were classified as conversion THAs. After claims with missing data were excluded, there were 2759 conversion THAs and 14,764 revision THAs available for analysis. Propensity scores were generated using a multivariate logistic regression model using the following variables as covariates: gender, age, race, van Walraven index, hospital setting, geography, hospital size, resident-to-bed ratio, and wage index. After matching, 2734 conversion THAs and 5294 revision THAs were available for analysis. The van Walraven index, which is a weighted score of patient preoperative comorbidities, was used to measure patient health status. Hospital costs were estimated by multiplying cost-to-charge ratios obtained from the 2019 Impact File by total hospital charges. This methodology enabled the use of a large national database to mitigate the random effects of individual hospitals' unique practices and patient populations. Multivariable regression was performed after matching to determine the independent effects of surgery type (that is, conversion versus revision THA) on hospital cost, length of stay greater than 2 days, intensive care unit use, and discharge to home. Results There was no difference in the estimated hospital cost between conversion THA and revision THA (β = 0.96 [95% confidence interval 0.90 to 1.01]; p = 0.13). Patients undergoing conversion THA had increased odds of staying in the hospital for more than 2 days (odds ratio 1.12 [95% CI 1.03 to 1.23]; p = 0.01), increased odds of using the intensive care unit (OR 1.24 [95% CI 1.03 to 1.48]; p = 0.02), and decreased odds of being discharged to home (OR 0.74 [95% CI 0.67 to 0.80]; p < 0.001). Conclusion The inpatient hospital cost of conversion THA is no different from that of revision THA, although patients undergoing conversion surgery have modestly increased odds of prolonged length of stay, intensive care unit use, and discharge to a nonhome location. These findings support the conclusion that reclassification of conversion THA is warranted. Orthopaedic surgeons must advocate for the reclassification of conversion THA using data-backed evidence or run the risk that orthopaedic procedures will be given decreased reimbursement. Level of Evidence Level III, economic and decision analysis. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin. Methods: This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales. Results: The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001). Conclusions: Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background and Objectives: Data are lacking on the estimated costs of pharmacist prescription reviews (PPRs) for hospitalized internal medicine patients. This study investigates the estimated costs of drug-related problems (DRPs) prevented by PPRs among hospitalized internal medicine patients. Methods: We reviewed all medication orders for patients at an academic teaching hospital in China for 2 years. DRPs were categorized using the Pharmaceutical Care Network Europe classification. The severity of the potential harm of DRPs was assessed by the Harm Associated with Medication Error Classification (HAMEC) tool. The estimated cost of PPRs was calculated. Results: A total of 162426 medication orders for 4314 patients were reviewed, and 1338 DRPs were identified by pharmacists who spent 2230 hours performing PPRs. Among the 1080 DRPs that were prospectively intervened upon, 703 were resolved. The HAMEC tool showed that 47.1% of DRPs were assessed as level 2, 30.4% as level 3, 20.6% as level 1, and 0.6% carried a life-threatening risk. Pharmacist interventions contributed to the prevention of DRP errors and a reduction of $339 139.44. This resulted in a mean cost saving of $482.42 per patient at an input cost of $21 495.06 over the 2 years. The benefit-cost ratio was 15.8. Conclusion: PPRs are beneficial for detecting potential DRPs and creating potential cost savings among hospitalized internal medicine patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Variability in operating room supply cost is a modifiable cause of suboptimal resource use and low value of care (outcomes vs cost). This study describes implementation of a quality improvement intervention to decrease operating room supply costs. STUDY DESIGN: An automated electronic health record data pipeline harmonized operating room supply cost data with patient and case characteristics and outcomes. For inpatient procedures, predicted mortality and length of stay were used to calculate observed-to-expected ratios and value of care using validated equations. For commonly performed (1 or more per week) procedures, the pipeline generated figures illustrating individual surgeon performance vs peers, costs for each surgeon performing each case type, and control charts identifying out-of-control cases and surgeons with more than 90th percentile costs, which were shared with surgeons and division chiefs alongside guidance for modifying case-specific supply instructions to operating room nurses and technicians. RESULTS: Preintervention control (1,064 cases for 7 months) and postintervention (307 cases for 2 months) cohorts had similar baseline characteristics across all 16 commonly performed procedures. Median costs per case were lower in the intervention cohort ($811 [$525 to $1,367] vs controls: $1,080 [$603 to $1,574], p < 0.001), as was the incidence of out-of-control cases (19 (6.2%) vs 110 (10.3%), p = 0.03). Duration of surgery, length of stay, discharge disposition, and 30-day mortality and readmission rates were similar between cohorts. Value of care was higher in the intervention cohort (1.1 [0.1 to 1.5] vs 1.0 [0.2 to 1.4], p = 0.04). Pipeline runtime was 16:07. CONCLUSIONS: An automated, sustainable quality improvement intervention was associated with decreased operating room supply costs and increased value of care. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to describe cost and frequency of work-related musculoskeletal disorders in Kansas. Methods: Data were provided by the Kansas Department of Labor and included all closed workers' compensation claims entailing indemnity and medical costs from 2014 to 2022. Results: Work-related musculoskeletal disorder claims entailed a median total cost of $20,097. Medical comprised 48.4% of costs, indemnity 46.4%, and legal 5.2%. The most frequently injured and costliest body part was the shoulder. Manufacturing comprised 28.4% of claims, followed by health care and office. Lifting was the most common cause, generating 32.0% of claims. Education, transportation, and mining were among industries with above average claim rates. Conclusions: Very few studies use workers' compensation data to assess work-related musculoskeletal disorder costs. This study introduces a state not yet analyzed and presents more recent years of data than available in the literature. [ABSTRACT FROM AUTHOR]

Restrictive nurse practitioner (NP) practice regulation at the state level continues to obstruct patient access to quality affordable care because primary care provider shortages heighten across the nation. Evidence-based research supports NPs as cost-effective providers without conceding quality of care. A patchwork of highly variable state policies subjectively determines the degree of collaborative oversight required for NPs to practice in each state. An objective review of policies influencing NP capacity to deliver care promotes evidence-informed policy adaptation. A policy analysis was completed using Bardach and Patashnik's framework to evaluate policy options for NP practice regulation in Texas. Full practice authority (FPA) policy effect was quantitively evaluated through difference-indifferences regression models using selected measures of all 50 states and the District of Columbia. Health welfare outcomes were calculated using emergency department utilization, average household health expenditures, poor physical health days, and NP-specific adverse action reports (AAR). Overall, FPA policy did not have a statistically significant effect on state-clustered emergency department utilization, average household health expenditures, or poor physical health days. Full practice authority was associated with decreased NP AAR. The analysis supports FPA as a viable policy option for states such as Texas and counters claims FPA policy adoption results in detrimental sequalae in the health of the population. [ABSTRACT FROM AUTHOR]

Study Design. This was a retrospective study. Objective. To assess the impact of surgical costs on patient-reported outcomes in adult spinal deformity (ASD). Summary of Background Data. With increased focus on delivering cost-effective health care, interventions with highresource utilization, such as ASD surgery, have received greater scrutiny. Materials and Methods. ASD patients aged 18 years and older with BL and 2-year data were included. Surgical costs were calculated using the 2021 average Medicare reimbursement by Current Procedural Terminology code. Costs of complications and reoperations were intentionally excluded. Patients were ranked into tertiles by surgical cost: highest surgical costs (HC) and lowest surgical costs (LC). They were propensity score matched to account for differences in baseline age and deformity. Bivariate logistic regressions assessed odds of achieving outcomes. Results. Four hundred twenty-one patients met inclusion (60.7 yr, 81.8% female, Charlson Comorbidity Index: 1.6, 27.1 kg/m²), 139 LC and 127 HC patients. After propensity score matching, 102 patients remained in each cost group with an average reimbursement of LC: $12,494 versus HC: $29,248. Matched cohorts had similar demographics and baseline health-related quality of life. Matched groups had similar baseline sagittal vertical axis (HC: 59.0 vs. LC: 56.7 mm), pelvic incidence and lumbar lordosis (HC: 13.1 vs. LC: 13.4°), and pelvic tilt (HC: 25.3 vs. LC: 22.4°). Rates of complications were not significantly different between the cost groups. Compared with the LC group, by 2 years, HC patients had higher odds of reaching substantial clinical benefit in Oswestry Disability Index [odds ratio (OR): 2.356 (1.220, 4.551), P= 0.011], in Scoliosis Research Society-Total [OR: 2.988 (1.515, 5.895), P=0.002], and in Numerical Rating Scale Back [OR: 2.739 (1.105, 6.788), P=0.030]. Similar findings were appreciated for HC patients in the setting of Schwab deformity outcome criteria. Conclusions. Although added cost did not guarantee an ideal outcome, HC patients experienced superior patient-reported outcomes compared with LC patients. Although cost efficiency remains an important priority for health policy, isolating cost reduction may compromise outcomes and add to future costs of reintervention, particularly with more severe baseline deformity. [ABSTRACT FROM AUTHOR]

Introduction: Ankle-foot orthosis (AFO) and functional electrical stimulation (FES) are commonly used interventions for patients with foot drop caused by a central neurological origin. The aimof this systematic review is to analyze the available evidence on the improvement of gait endurance in people with foot drop caused by a central neurological origin when comparing effectiveness of AFO and FES. The secondary aim is to evaluate the available evidence for the difference between the use of FES and AFO on perception of walking function. Methods: A literature search was conducted using MEDLINE/PubMed, Cochrane, JBI, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, Scopus, and Web of Science. All articles published through July 2020 were included in this review. Randomized control trials or crossover trials addressing the comparison of AFO to FES in people with foot drop of central neurological origin on gait endurance and perception of improvement in walking function were assessed. PEDro scale was used to assess methodological quality. Two independent reviewers screened titles, abstracts, and full articles, and a third reviewer resolved any disagreements. Results: Twenty-five records were screened with 16 full-text articles assessed for eligibility using the PEDro score. Eleven final studies (PEDro scores range from 5 to 7) were included in qualitative analysis. Only two of the nine studies that evaluated gait endurance reported significant improvement in gait endurance in favor of FES. Seven of the eight studies evaluated the participant preference of device for various walking functions, which showed significance in favor of the use of FES. Conclusions: Our review reveals inconclusive evidence to support the use of FES compared with AFO for improving gait endurance. However, qualitative analysis of device preference for walking by participants reveals that FES was the preferred device in this population compared with AFO. Clinical Relevance: For patients with foot drop of central nervous system pathology, FES or AFO can be used to improve gait endurance. However, FES may be the preferred device by participants for their walking function. [ABSTRACT FROM AUTHOR]

Temporary work absenteeism costs of COVID-19 represent a significantly high economic burden for society. Expanded investment in the implementation of the strategies for controlling communicable disease attacks and protective policies in workplaces can reduce work absenteeism and economic costs through improving worker productivity. Objective: This study aimed to estimate the lost productivity cost of temporary work absenteeism due to COVID-19. Methods: This study conducted on all hospitalized patients with COVID-19 in northeastern Iran between February 2020 and March 2022 (10,406 cases). Data were collected from the Hospital Information System. Indirect costs were estimated using the human capital approach. Data were analyzed with the STATA version 17. Results: The total indirect cost of work absenteeism due to COVID-19 was estimated at $513,688. There was a statistically significant relationship between the mean lost productivity cost and COVID-19 peak, sex, insurance type, age, and hospitalization. Conclusions: Because the absenteeism costs of COVID-19 had increased in the second peak, which coincided with the summer holidays, the country's crisis management headquarters should pay more attention to formulating and implementing appropriate preventive programs in future epidemics. [ABSTRACT FROM AUTHOR]

We estimated incremental costs of a competency-based Problem Management Plus (PM+) training of trainers (ToT) and training of helpers (TOH), guided by the World Health Organization (WHO)/United Nations International Children's Emergency Fund (UNICEF) Ensuring Quality in Psychological Support (EQUIP) platform compared to a standard PM+ training. Activity-based cost analysis was conducted in Kathmandu, Nepal from July to October 2021. Organisational perspectives were assessed on resources required to implement one PM+ ToT, one EQUIP training for trainers and six PM+ ToH. For PM+ trainers, a standard PM+ ToT costs NPR 63,800.06 (US$510.40), with additional training on EQUIP competency-based approaches and digital platform costing an incremental NPR 45,111.15 (US$360.89). A standard PM+ helper training costs an average of NPR 207,906.35 (US$1,663.25) compared to an EQUIP-based PM+ ToH costing NPR 211,122.71 (US$1,688.98), for an incremental NPR 3,216 (US$25.73) per ToH. An EQUIP competencybased approach requires initial investment through training of PM+ trainers; thenceforth, differences in time and costs are negligible for training PM+ helpers when using an EQUIP approach compared to a standard approach. Given minimal cost differences and potential benefits for improving provider competency and client safety and outcomes, we recommend greater use of EQUIP. Stakeholders may use this study as a guide for costing competency-based approaches. [ABSTRACT FROM AUTHOR]

Background: Tobacco screening interventions have demonstrated effectiveness at improving population health, yet many people who want to quit using tobacco lack access to professional assistance. One way to address this gap is to train members of the clinical team as tobacco treatment specialists (TTSs). Purpose: The purpose of this study was to understand how TTSs have been used across a variety of health care organizations implementing health systems change for tobacco treatment and examine the sustainability of TTSs as a health systems change innovation for tobacco cessation. Methodology: This study used qualitative interviews (n = 25) to identify themes related to implementing TTSs as a health systems change innovation and examined these themes within the constructs of the theory of innovation implementation. Results: Insights about implementing TTSs as an innovation primarily aligned with four theoretical constructs: implementation policies and practices, implementation climate, innovation-values fit, and implementation effectiveness. Specific themes were perceived to facilitate the sustainability of TTSs including team-based TTS efforts, widespread awareness of TTS roles, leadership buy-in, and recognized value of TTS services. Barriers to sustainability included inadequate resources (e.g., time and staff ), lack of tracking outcomes, inappropriate referrals, and lack of reimbursement. Practice Implications: Health care organizations planning to implement health systems change for tobacco cessation can encourage committed use of TTSs as an innovation by considering the insights provided in this study. These primarily related to five overarching implementation considerations: staff selection and training, tracking and dissemination of impacts, adequate resources, referrals and workflow, and billing and reimbursement. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is an increasing usage of noninvasive screening modalities for colorectal cancer (CRC), primarily the fecal immunochemical test (FIT) and multi-target stool DNA test (Cologuard [CG]). The aim of this study was to determine the comprehensive, long-term cost implications of these noninvasive screening modalities. STUDY DESIGN: Using a national insurer-based administrative dataset, patients screened for CRC from January 1, 2019 to December 31, 2019 were analyzed. A hierarchical logic system was used to determine the primary screening modality for each patient. The total annual costs in US dollars ($) were extrapolated using number of patients screened, costs per test, screening intervals, and costs incurred from false results. Patients within our tumor registry diagnosed with CRC were matched to their claims data, and cancer stage distribution was compared. RESULTS: Of 119,334 members who underwent noninvasive screening, 38.1% underwent screening with FIT and 40.0% with CG. The combined annual cost for these 2 screening modalities was $13.7 million. By transitioning to FIT alone for all noninvasive screening, the total annual cost would decrease to $7.9 million, resulting in a savings of approximately $5.8 million per year. Additionally, by combining data from the network cancer registry and insurer-based claims dataset, we were able to match 533 individuals who underwent screening and were later diagnosed with CRC. The rate of early-stage (stage 0 to II) disease was found to be similar between those screened with FIT and CG (59.5% FIT vs 63.2% CG; p = 0.77). CONCLUSIONS: The adoption of FIT as the primary noninvasive CRC screening method has the potential to generate significant cost savings, and therefore, carries significant value implications for a large population health system. [ABSTRACT FROM AUTHOR]

Our current economy necessitates attention to nursing professional development programs that positively impact the fiscal budget. This project evaluated the cost-effectiveness of the patient care internship program designed to attract and retain nursing talent in a Midwest hospital system. Nurse leaders partnered with nursing faculty to recruit student nurses and prepare them to transition to the registered nurse role. The programhad cost savings to the organization greater than $200,000 over a 2-year period. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We estimate the economic impact of applying risk assessment tools to identify very low-risk patients with upper gastrointestinal bleeding who can be safely discharged from the emergency department using a cost minimization analysis. METHODS: We compare triage strategies (Glasgow-Blatchford score = 0/0-1 or validated machine learning model) with usual care using a Markov chain model from a US health care payer perspective. RESULTS: Over 5 years, the Glasgow-Blatchford score triage strategy produced national cumulative savings over usual care of more than $2.7 billion and the machine learning strategy of more than $3.4 billion. DISCUSSION: Implementing risk assessment models for upper gastrointestinal bleeding reduces costs, thereby increasing value. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the costs of caring for patients admitted with a coronavirus disease (COVID)–related illness with non-COVID patients at one academic center in North Carolina. The authors hypothesized that the daily average cost of hospitalization would be higher among COVID patients compared with non-COVID patients. Objectives: The coronavirus disease 2019 (COVID-19) pandemic has created a significant financial burden on the US healthcare system. The purpose of this study was to compare the costs of caring for patients admitted with COVID-related illness versus non-COVID patients. We hypothesized that the average daily costs of hospitalization would be higher among COVID patients compared with non-COVID patients. Methods: This was a retrospective cohort study. Data were downloaded for patients who were admitted at Atrium Wake Forest Baptist Hospital from January 1, 2020 through February 28, 2021. The study population was dichotomized by COVID and non-COVID patients, and the average daily hospital cost was calculated. Multivariate adjusted linear regression models were used to calculate additional "average daily cost" comparisons. Results: The COVID group was slightly older (mean age 61.0 vs 58.0 years), with longer mean length of stay (6.12 vs 4.95 days) and higher mean average daily direct cost ($1504.01 vs $1341.30) when compared with the non-COVID group, respectively (P < 0.001). After adjusting for various patient characteristics, the direct inpatient cost was $123.00 (95% confidence interval 74.4–171.5) higher per day in patients with COVID-19 (P < 0.0001). When indirect costs are considered, the combined indirect and direct cost may be four times greater. Conclusions: The average daily direct hospital cost is higher among patients with COVID compared with non-COVID-related illness. Many reasons contributed to this cost difference, including decreased nurse staffing ratios, lower physician censuses, and needed infrastructure changes. Studies with a larger sample size and more precise comparable study groups are warranted to validate our findings. [ABSTRACT FROM AUTHOR]

Healthcare professionals provide care to help patients; however, sometimes that care is of low value – at best ineffective and at worst harmful. To address this, recent frameworks provide guidance for developing and investigating de-implementation interventions; yet little attention has been devoted to identifying what strategies are most effective for de-implementation. In this paper, we discuss Behavior substitution, a strategy whereby an unwanted behavior is replaced with a wanted behavior, thereby making it hypothetically easier to reduce or stop the unwanted behavior. We discuss why Behavior substitution may be a useful de-implementation strategy, and why it may not be suitable for all circumstances. On the basis of the body of knowledge in behavioral science, we propose a list of principles to consider when selecting a substitute behavior for a de-implementation intervention. Applying these principles should increase the likelihood that this technique will be effective in reducing low-value care. [ABSTRACT FROM AUTHOR]

Health care is a highly competitive environment where managers must compete for finite resources. The Centers for Medicare & Medicaid Services–directed reimbursement models such as value-based purchasing and pay-for-performance heavily focused on quality improvement and nursing excellence are having a major impact on financial reimbursement for health care services in the United States. As such, nurse leaders must function in a business-focused environment where decisions regarding resource allocation are driven by quantifiable data, the potential return on investment, and the organization's ability to provide quality patient care in an efficient manner. It is imperative for nurse leaders to recognize the financial impact of potential additional revenue streams, as well as avoidable costs. Nurse leaders must also be skilled at translating the return on investment for nursing-centric programs and initiatives, often hidden in anecdotal terms and cost avoidance rather than revenue generation, to ensure appropriate resource allocation and budgetary assumptions. This article uses a case study framed within the business case to review a structured approach to operationalizing nursing-centric programs and highlights key strategies for success. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) after prior knee surgery, also known as conversion TKA (convTKA), has been associated with higher complications, resource utilization, time, and effort. The increased surgical complexity of convTKA may not be reflected by the relative value units (RVUs) assigned under the current U.S. coding guidelines. The purpose of this study was to compare the RVUs of primary TKA and convTKA and to calculate the RVU per minute to account for work effort. Methods: The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was analyzed for the years 2005 to 2020. Current Procedural Terminology (CPT) code 27447 alone was used to identify patients who underwent primary TKA, and 27447 plus 20680 were used to identify convTKA. After 1:1 propensity score matching, 1,600 cases were assigned to each cohort. The 2023 Medicare Physician Fee Schedule RVU-to-dollar conversion factor from the U.S. Centers for Medicare & Medicaid Services (CMS) was used to calculate RVU dollar valuations per operative time. Complication rates were compared using a multivariate logistic regression model controlling for baseline characteristics. Results: The mean operative time for TKA was 97.8 minutes, with a corresponding RVU per minute of 0.25, while the mean operative time for convTKA was 124.3 minutes, with an RVU per minute of 0.19 (p < 0.0001). Using the conversion factor of $33.06 per RVU, this equated to $8.11 per minute for TKA versus $6.39 per minute for convTKA. ConvTKA was associated with higher overall complication (10.9% versus 6.5%, p < 0.0001), blood transfusion (6.6% versus 3.7%, p < 0.01), reoperation (2.3% versus 0.94%, p < 0.0001), and readmission (3.7% versus 1.8%, p < 0.001) rates. Conclusions: The current billing guidelines lead to lower compensation for convTKA despite its increased complexity. The longer operative time, higher complication rate, and increased resource utilization may incentivize providers to avoid performing this operation. CPT code revaluation is warranted to reflect the time and effort associated with this procedure. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Study Design.: Multicenter retrospective study. Objective.: This study reports long-term clinical and radiographic outcomes in surgically treated patients with adult symptomatic lumbar deformity (ASLD). Summary of Background Data.: The short-term results of corrective spinal surgery for ASLD are often favorable despite a relatively high complication profile. However, long-term outcomes have not been completely characterized. Methods.: A total of 169 surgically treated consecutive ASLD patients (≥50 yr) who achieved minimum 5 year follow-up were included (average 7.5 yr observation window, average age 67±8 yr, 96% female). The subjects were stratified by current age (50s, 60s, and 70s) and compared. Kaplan-Meier analysis was used to estimate the cumulative incidence of unplanned reoperation stratified by age group. Initial and overall direct costs of surgery were also analyzed. Results.: The SRS-22 at final follow-up was similar among the three groups (50s, 60s, and 70s; 4.0±0.5 vs. 3.8±0.7 vs. 3.8±0.7, respectively). The overall major complication rate was 56%, and 12% experienced late complications. The cumulative reoperation rate was 23%, and 4% required late reoperation. Patients in their 70s had a significantly higher reoperation rate (33%) and overall complication rate (65%). However, the late complication rate was not significantly different between the three groups (9% vs. 12% vs. 13%). Sagittal alignment was improved at two years and maintained to the final follow-up, whereas reciprocal thoracic kyphosis developed in all age groups. The direct cost of initial surgery was $45K±9K and increased by 13% ($53K±13K) at final follow-up. Conclusions.: Long-term surgical outcomes for ASLDs were favorable, with a relatively low rate of late-stage complications and reoperations, as well as reasonable direct costs. Despite the higher reoperation and complication rate, ASLD patients of more advanced age achieved similar improvement to those in the younger age groups. [ABSTRACT FROM AUTHOR]

Clinical ladder programs were designed to support nurse retention and professional development. Hospital systems are vigorously working to recover from the critical staffing shortages exacerbated by the pandemic. The Centers for Disease Control and Prevention framework for program evaluation was utilized to assess a hospital professional nurse clinical ladder. These findings suggest favorable outcomes in commitment to stay and professional development. This evaluation can serve as a potential resource for organizations to evaluate and enhance programs to support nurse retention. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. A subanesthetic intravenous ketamine infusion is a safe and effective acute pain management modality for moderate to severely painful surgical procedures and may be useful in patients who are at increased risk for opioid-related adverse events. Despite its safety profile, intravenous ketamine is often restricted to the intensive care unit, which results in decreased patient access to this effective therapy. For clinicians who wish to implement an intravenous ketamine protocol in the medical-surgical setting, there are few resources available. In this brief report, we present our ketamine infusion protocol for acute pain and the clinical and financial outcomes 1 year after implementation. In our experience, ketamine infusions on the medical-surgical ward are safe and cost-effective when an established acute pain service protocol is followed. Nurse practitioners play an essential role in increasing patient access to intravenous ketamine infusions and leading change by collaborating with stakeholders to develop a protocol, training nurses and interdisciplinary team members, and providing ongoing support to nursing staff. [ABSTRACT FROM AUTHOR]

We assessed the implementation status of policies and environmental strategies for improving physical activity and healthy eating in small and medium-sized corporations. Policies and strategies that are costly were less feasible and acceptable, whereas those that can be implemented through employee participation and employer efforts were more feasible and acceptable. Objective: We assessed the implementation status of policies and environmental strategies for increasing physical activity (PA) and healthy eating (HE) in small and medium corporations to identify feasible and acceptable interventions. Methods: An anonymous self-administered questionnaire was administered to 655 small and medium corporations to determine whether they implemented PA (18 items) and HE (17 items) policies and environmental strategies and, if not, their intention to do so in the future. We compared differences in the implementation and intention to implement rate by corporation size. Results: The implementation and intention rates of costly items for PA and HE were low, regardless of corporation size, but were significantly lower in small corporations than in medium corporations. Conclusions: To overcome cost barriers, employee participation must be encouraged, and employee knowledge of PA and HE must be improved. [ABSTRACT FROM AUTHOR]

Goal: The COVID-19 pandemic has caused both short- and long-term impacts on every aspect of society. Hospitals are among the most critical frontliners and have had to continually navigate the challenges caused by the pandemic. In this study, we examined hospitals' financial performance following the onset of the pandemic. Methods: We used data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System. The study sample included all general acute care and critical access hospitals that receive Medicare payments. The primary outcomes included operating margins, net patient revenues, operating expenses, and uncompensated care costs. We tested for average changes from 2019 to 2020 in hospitals' financial outcomes. We also tested for changes in financial outcomes across samples stratified by hospital characteristics: ownership type (investor-owned, nonprofit, and public), Medicaid disproportionate share hospital status, rural status, county uninsured rate quartile, and Medicaid expansion status. Principal Findings: Our sample consisted of a balanced panel of 4,059 hospitals (8,118 observations) with data spanning 2019 and 2020. Across the full sample of hospitals, operating margins declined by an average of 5.3 percentage points between 2019 and 2020, equating to a 130% reduction from 2019 levels. Underlying these margin declines, net patient revenues declined by 3.2% on average, while operating expenses increased by 1.5%. We observed no changes in uncompensated care costs despite the large number of job losses that accompanied the pandemic. When stratifying the analysis by hospital characteristics, differences were observed across ownership types. Notably, investor-owned facilities were less affected financially than nonprofit and public hospitals. Although safety-net and rural hospitals generally fared no worse than their non-safety-net and nonrural counterparts, hospitals located in Medicaid expansion states experienced steeper declines in operating margins relative to hospitals located in nonexpansion states, driven by larger relative declines in patient revenues. Practical Applications: The operating margin declines we observed can be attributed to supply-chain issues, persistent labor shortages, and suspension of elective services. The Affordable Care Act reforms in health insurance markets likely helped to insulate hospitals from increases in uncompensated care costs. In the shifting context of the pandemic, it is important to understand hospitals' financial performance so that measures can be taken to address further financial distress that may eventually lead to increased consolidation, hospital closures, and lower quality of care. Our findings stress the need for targeted responses that are tailored to underlying hospital characteristics. Temporary and targeted increases in inpatient and outpatient service prices can help offset revenue losses from the deferment of nonurgent care. Other policies can address the ongoing workforce challenges and supply-chain issues. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the differences between road (ROAD) vs. trail (TRAIL) elite runners in terms of force-velocity profile (FVP), running biomechanics, lower-limb maximal isometric strength, cost of running (Cr), and training. Seventeen male elite athletes (10 TRAIL and 7 ROAD) participated in this study. Force-velocity profile was measured using a 2-sprint test on a cycle ergometer. Strength was assessed with a dynamometer measuring isometric maximum voluntary torque of the knee extensors and knee flexors. Biomechanics parameters (running kinematics and stiffness) were measured, and Cr was calculated at 10 and 14 km·h-1 at 0% slope and at 10 km·h-1 on a 10% slope on a treadmill. Athletes also reported their training duration during the previous year. Theoretical maximal torque (F0) and maximal power (Pmax) in the FVP were higher for TRAIL vs. ROAD (122 ± 13 vs. 99 ± 7 N·m, p = 0.001; and 726 ± 89 vs. 626 ± 44 W; p = 0.016). Cost of running was higher for TRAIL compared with ROAD on flat at 14 km·h-1 (4.32 ± 0.22 vs. 4.06 ± 0.29 J·kg-1·m-1; p = 0.047) but similar at 10 km·h-1 and uphill. No differences were found in maximal isometric strength or running biomechanics. ROAD spent 81% more time training than TRAIL (p = 0.0003). The specific training (i.e., "natural" resistance training) performed during graded running in trail runners and training on level surface at high speed may explain our results. Alternatively, it is possible that trail running selects stronger athletes because of the greater strength requirements of graded running. [ABSTRACT FROM AUTHOR]

Introduction: The use of data to inform lifelong learning has become increasingly important in continuing professional development (CPD) practice. Despite the potential benefits of data-driven learning, our understanding of how physicians engage in data-informed learning activities, particularly for CPD, remains unclear and warrants further study. The purpose of this study was to explore how physicians perceive cultural factors (individual, organizational, and systemic) that influence the use of clinical data to inform lifelong learning and self-initiated CPD activities. Methods: This qualitative study is part of an explanatory sequential mixed-methods study examining data-informed learning. Participants were psychiatrists and general surgeons from Canada and the United States. Recruitment occurred between April 2019 and November 2019, and the authors conducted semistructured telephone interviews between May 2019 and November 2019. The authors performed thematic analysis using an iterative, inductive method of constant comparative analysis. Results: The authors interviewed 28 physicians: 17 psychiatrists (61%) and 11 general surgeons (39%). Three major themes emerged from the continuous, iterative analysis of interview transcripts: (1) a strong relationship between data and trust, (2) a team-based approach to data-informed learning for practice improvement, and (3) a need for organizational support and advocacy to put data into practice. Conclusion: Building trust, taking a team-based approach, and engaging multiple stakeholders, such as data specialists and organizational leadership, may significantly improve the use of data-informed learning. The results are situated in the existing literature, and opportunities for future research are summarized. [ABSTRACT FROM AUTHOR]

Background: Research suggests that changes in nurse roles can compromise perceived organizational safety. However, over the past 15 years, many infusion tasks have been reallocated from specialty nurse infusion teams to individual generalist nurses—a process we call infusion task reallocation. These changes purportedly benefit employees by allowing care providers to practice at the "top of their license." However, job demands–resources theory suggests that changing core task arrangements can either enrich or merely enlarge jobs depending on their effects on demands and resources, with corresponding consequences for performance (e.g., safety). There is relatively little research directly exploring these effects and their mechanisms. Purpose: This study examines the relationship between infusion task reallocation and perceptions of organizational safety. We also explore the extent to which this relationship may be mediated by infusion-related resources and psychological safety. Methodology: Data were collected through a survey of 623 nurses from 580 U.S. hospitals. The relationship between infusion task reallocation and perceptions of organizational safety, as well as the potential mediating roles of infusion-related resources and psychological safety, was examined using structural equation modeling. Results: Infusion task reallocation was negatively associated with respondents' perceptions of organizational safety, with nurses working in organizations without an infusion team indicating lower perceptions of organizational safety than nurses working in organizations with an infusion team. This relationship was mediated by nurse perceptions of psychological safety within the organization, but not by infusion-related resources, suggesting that task reallocation is associated with lower perceived organizational safety because nurses feel less psychologically safe rather than because of perceived technical constraints. Practice Implications: The results indicate that, although infusion task reallocation may be a cost-reducing approach to managing clinical responsibilities, it enlarges rather than enriches the job through higher demands and fewer resources for nurses and, in turn, lower perceived organizational safety. [ABSTRACT FROM AUTHOR]

This study evaluated the early drug prescription patterns as predictors of final workers compensation claim costs and closure based on an updated analysis on a large cohort. The result would provide claim management with tools to estimate final claims outcomes in the first 3- or 6-months post-injury. Objective: The aim of the study is to determine the associations of workers' compensation claim costs and return to work with drugs prescribed for early symptom management. Methods: Claims filed from 1998 to 2007 were followed for 10 years from the injury date. Drugs analyzed included gabapentin, pregabalin, antipsychotics, antidepressants, sedatives, benzodiazepines, carisoprodol, and opioids, controlling for initial reserve, sex, age, physical therapy, attorney involvement, and surgery. Results: Gabapentin, antipsychotics, antidepressants, and sedatives used in the first 3 months after injury were significantly associated with higher claim cost (≥$100,000). All opioid morphine equivalent doses greater than or equal to 5 mg/d for the first 6 months was significantly associated with higher cost (≥$100,000) and not being released to work at end of third year after injury with dose-response relationships. Conclusions: Prescription patterns in the first 3 months or first 6 months of workers' compensation claim development may be used as predictors of claim outcomes. [ABSTRACT FROM AUTHOR]

Fatalities in electrical occupations are attributable to increased exposures to electrical hazards due to frequent work in the installation, maintenance and repair of electrical wiring and fixtures, as well as to direct or indirect contact with overhead power lines. Deviations from safety practices were cited as a main contributing factor. Objective: The aim of this study was to examine contributing factors to fatalities in electrical occupations due to contact with electricity. Methods: Proportionate mortality ratios were calculated along with the Mantel-Haenszel chi-square test of significance using Occupational Safety and Health Administration data. Cross-tabulation analyses were examined by the Pearson chi-square test of independence. Results: Electricians and electrical power installers/repairers experienced significantly higher proportions of fatalities due to contact with electric current of machine, tool, or light fixture and contact with overhead power lines, respectively. Factors such as accident date, location, union status, project type, cost, electrical event, human factor, part of body, source of injury, and fatality cause, exhibited significant associations with electrical trade fatalities. Conclusions: Fatalities in electrical occupations are attributable to increased exposures to electrical hazards during regular work activities. Strict adherence to safe work practices and procedures is critical to electrical fatality prevention. [ABSTRACT FROM AUTHOR]

Background: Diabetes-related complications contribute to a costly health burden in the United States. Telehealth (TH) is a tool that can increase access to care and offer ongoing support for chronic disease self-management. Local Problem: A primary care practice in Texas needed a method to manage an influx of patients with uncontrolled diabetes and improve type 2 diabetes outcomes using nurse practitioner (NP) TH appointments. Methods: Thirty patients meeting inclusion criteria participated in monthly TH check-ins and followed monthly for 3 months. Baseline and postintervention diabetes laboratory studies (hemoglobin A1c [HbA1c], estimated glomerular filtration rate, and microalbumin) were collected. Interventions: During each monthly TH visit, an NP-led diabetes TH QI protocol was implemented. The Telehealth Usability Questionnaire was administered to patients after the 3-month intervention. Results: The TH QI protocol resulted in an overall ;1% reduction in HbA1c. Over 73% of participants experienced various reductions of HbA1c, of which 2.3% achieved a postintervention HbA1c <7%, indicating controlled diabetes. Kidney function indicated by eGFR improved by 7 ml/min/1.73 m2 in 83% of participating patients. At the end of the 3-month intervention, 84% of participants expressed overall satisfaction with TH appointments. Conclusions: Interventions using TH to improve chronic disease may be useful in diabetes outcomes and selfmanagement. Monthly TH visits can improve patient outcomes, reduce complications, and enhance the patient-provider relationship. Preventive self-care activities and long-term use of TH visits for self-management are implications for future studies. [ABSTRACT FROM AUTHOR]

Continuous quality improvement using Lean methodology engages and values the expertise of the staff close to the patient and the everyday work of caring for them. The patients are not safe if the staff is not safe. Finding the appropriate methodology, where the problem is deeply investigated, respect is visible in the process, and evidence-based decision-making takes place to find safe patient handling solutions for moving lifting and transferring patients was a key objective in this Lean process improvement effort. This article describes the journey taken, the collaboration of 2-unit based councils, and the successful implementation of an air-assisted moving, lifting, and transferring system at a large level 1 quaternary tertiary intercity hospital. [ABSTRACT FROM AUTHOR]

Parents play a critical role in snack selection among younger children. Given the prevalence of childhood obesity and the critical role parents play was their children's eating behaviors, the purpose of this study was to explore parents' ranking of snack nutritional ingredients and snack factors. One hundred thirty-three parents of elementary school students from a predominately Asian and Hispanic population participated in the study. The results indicated that the "nutritional ingredient", protein, had the highest weighted average rank, followed by whole grain, calories, sugar, and salt. Among the snack factors, healthiness had the highest weighted average rank, followed by taste, convenience, price, and social influence. The findings from this study can enhance children's healthy eating behaviors at home by lending better understanding of the snack attributes related to parents' choices. In addition, these findings provide implications for health and nutrition professionals in the field. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to evaluate programmatic elements supporting BSN attainment by employed nurses holding associate degrees or diplomas, using a stakeholder involvement approach. BACKGROUND: Studies have associated higher percentages of baccalaureate-prepared nurses with improved clinical outcomes. Since 2013, the study organization supported an RN-to-BSN requirement with an academic progression benefit program and achieved an 80% BSN goal by 2021. METHODS: The Centers for Disease Control and Prevention's Framework for Program Evaluation was used. A mixed methods approach was orchestrated by a stakeholder team to explore use and importance of programmatic elements, and motivators and barriers for degree attainment, using an online survey and focus groups. RESULTS: Respondents revealed a significant association between BSN degree attainment and financial assistance and perceived importance of financial assistance and educational fairs. CONCLUSIONS: Validating organizational tactics is important for achieving increased numbers of baccalaureate-prepared nurses and supportive of the cost-effective use of resources. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed to determine the weekly costs of contact precaution (CP) use with medically stable patients infected/colonized with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate the annual financial and environmental costs of CP. BACKGROUND: The increasing use of disposables for infection control contributes to increasing hospital costs and amounts of solid waste at rates that are becoming unsustainable. METHODS: A cost analysis was conducted using data from time/motion observations and previous waste audit study, along with hospital finance department values and US Department of Labor salary rates. RESULTS: Weekly and annual costs were $521.67 and $557 463 (5% hospital multidrug-resistant organism [MDRO] rate assumed). Personal protective equipment accounted for 43% of the waste produced (approximately 1600 pounds annually). CONCLUSIONS: Implications for nurse administrators include reevaluating activities that require personal protective equipment (PPE) and partnering with materials and human factor engineers to develop more financially and environmentally sustainable infection control practices. [ABSTRACT FROM AUTHOR]

Pelvic stress fractures are rare, making up an estimated 1% to 7% of all stress fractures with the primary locations being the pubic rami, pubic symphysis, and sacrum. Two cases of stress fractures of the ischium have been previously described in the literature, with both occurring in the ischial body. In this case, a 17-year-old high school American football player presented with nonspecific pelvic pain and bilateral point tenderness on deep palpation of the ischial tuberosities. Advanced imaging identified bilateral ischial tuberosity stress fractures. This report outlines the diagnosis and management of the first reported case of bilateral ischial tuberosity stress fractures. We report how ischial tuberosity stress fractures present clinically, potential management strategies, and highlight the use of computed tomography imaging for pelvic stress fractures. Knowledge of unusual stress fracture locations may improve early diagnosis, limit complications, reduce healthcare costs, and promote an accelerated recovery time. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to assess the influence of 3 variables on unit-based nurse managers' self-perception of business and financial competence in patient care: 1) educational degree; 2) participation in leadership development continuing education; and 3) prior nursing management experience. BACKGROUND: Nurse managers must develop business acumen to support patient care and the nurses who provide care. Successful managers must become fluent in the language of finance and must understand how to use it. Their ability to promote continuous quality improvement (QI) in a cost-effective, resource-conscious manner is the foundation of economic viability. METHODS: A feasibility study was conducted using Facebook to recruit nurse managers nationally and to distribute an electronic survey designed to assess the unit-based managers' self-perceptions of business and financial competence in patient care. RESULTS: The strongest predictors of self-perceived business and financial competence were continuing education and MSN degree. Years of experience in a leadership role did not predict self-reported levels of business or financial competence in patient care. CONCLUSION: Findings suggest that nursing leadership competency in the area of finance is developed through continuing education. Healthcare organizations should implement comprehensive nursing leadership mentoring and orientation programs for nurse managers to improve their self-perceptions of business and financial competencies. [ABSTRACT FROM AUTHOR]

38.5% of the Spanish working population reports pain, 5.1% severe pain. Pain is associated with a high utilization of health services, but, more importantly, with a significant reduction in the ability to continue their work performance. Interventions to minimize the significant costs inflicted by pain should be implemented. Objective: The objective of this paper is to provide an overview of the epidemiology of pain in the Spanish working population and to investigate the incremental costs of the different levels of pain on medical costs and productivity losses. Methods: This is a cross-sectional study of costs of pain in the Spanish working population from a societal perspective using data from a national representative survey. Results: Data from the 9919 respondents were analyzed. The prevalence of reported pain was 38.5%: 21.9% mild or very mild; 11.5% moderate; 5.1% severe or extreme. Increased self-reported pain was independently associated with significant increases in direct and indirect costs. Those reporting severe or extreme pain showed excess annual costs of €5118.97 per case, being 85% indirect costs. Conclusions: Spain is paying a heavy price for the high prevalence of pain in its working population. [ABSTRACT FROM AUTHOR]

Objective: To quantify the burden of work-relevant persistent musculoskeletal (MSK) pain to a large UK employer. Methods: A retrospective, longitudinal, analytical cohort study using linked Rolls-Royce data systems. Cases were employees with a MSK-related referral to occupational health; controls were age-, sex-, and job role-matched employees without such a referral. Outcomes were compared during 12 months' follow-up. Results: Overall, 2382 matched case-control pairs were identified (mean age: 46 y; 82% male). Cases took 39,200 MSK-related sickness absence days in total (equating to [pounds]50 million in sickness absence costs). Cases took significantly more all-cause sickness absence days than controls (82,341 [[pounds]106 million] versus 19,628 [[pounds]26 million]; P < 0.0001). Conclusions: Despite access to extensive occupational health services, the burden of work-relevant persistent MSK pain remains high in Rolls-Royce. There is a clear need to better understand how to effectively reduce this burden. [ABSTRACT FROM AUTHOR]

Hogg, JA, Riehm, CD, Diekfuss, JA, Simon, JE, Acocello, SN, Liang, Y, Wu, D, Myer, GD, and Wilkerson, GB. An exemplar frontal plane visual kinematic stimulus elicits sex-specific learned behavior: An exploratory report. J Strength Cond Res 36(3): 857-861, 2022-The purpose of this exploratory study was to determine if a visually delivered kinematic stimulus designed to promote injury-resistant biomechanics would induce sex-specific motor learning effects. Six female subjects and 6 male subjects participated in 2 consecutive day sessions in which they mimicked an avatar performing 5 sets of 8 repetitions of exemplar frontal plane mechanics during single-leg squats. Acute (~10 minutes) and delayed (~24 hours) transfer testing under single-task (single-leg balance) and dual-task conditions (single-leg balance plus cognitive task) were referenced to baseline measurements. Center of pressure (CoP) mean velocity (Vel), SD , and detrended fluctuation analysis (DFA) in the anterior posterior (AP) and medial-lateral (ML) directions were quantified, with dual-task costs defined as the percentage difference from single-task to dual-task. Separate 2 x 3 repeated-measures analysis of variance was conducted for each dual-task cost variable. Main effects and interactions with large effect sizes considered as >= 0.14 were further explored with pairwise post hoc comparisons. Sex by time interactions were observed for medial-lateral standard deviation cost ( [ABSTRACT FROM AUTHOR]

Uterus transplantation (UTx) has evolved rapidly since technical success was first demonstrated, and is now practiced worldwide, using both living and deceased donors. As UTx transitions from an experimental to widely available standard clinical procedure, new challenges and questions are becoming more urgent. These include issues of cost and coverage, the establishment of guidelines and registries to ensure quality of care and monitor outcomes, regulatory oversight (including for the allocation organs from deceased donors), and the extent to which indications for UTx should be expanded. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the effect on engagement, relational connection, and burnout of an intervention involving clinical faculty meeting in interprofessional self-facilitated groups and to determine whether a written discussion guide is necessary to achieve benefit. Methods: This is a randomized controlled trial, conducted at a large US academic medical center from May to August 2018. Subjects included 25 clinical physicians, nurse practitioners, and certified nurse midwives. The intervention involved three monthly self-facilitated groups for faculty. Groups were randomized to have no discussion guide, or to receive a one-page guide. Outcomes of burnout, engagement, and empowerment in work, and stress from uncertainty were assessed using validated metrics. Results: Rates of emotional exhaustion and depersonalization decreased significantly over the course of the 3-month study (56%-36%; P <.001; and 20%-15%; P =.006) and overall burnout decreased from 56% to 41% of faculty (P =.002). The percentage of faculty who felt engaged in their work increased from 80% to 96% (P =.03). No statistically significant differences in empowerment at work or in reaction to uncertainty were seen. The groups without a discussion guide had equivalent outcomes and benefits. Cost per participant was under $100. Discussion: A three-month, low-cost, self-facilitated series of dinner meetings for interprofessional clinical faculty decreased burnout and improved engagement, sense of connection to colleagues, and sense of departmental commitment to well-being. Structured discussion guides were not necessary to achieve benefit. This study broadens the possibilities for cost-effective opportunities to transform institutional culture and effectively enhance faculty well-being. [ABSTRACT FROM AUTHOR]