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It has been repeatedly demonstrated across industries that the demographic profiles of executives are highly correlated with organizational performance outcomes. Using Upper Echelons theory as a guide, this study seeks to apply this paradigm specifically to senior hospital administration. Despite theoretical support from Upper Echelons theory, prior empirical studies have been unsuccessful at consistently demonstrating a performance difference between hospitals with medical doctors (MDs) as chief executive officers (CEOs) and hospitals with non-MDs as CEOs. These studies have only tested for a main effect between MD versus non-MD and hospital clinical quality and financial outcomes without regard for tenure. The proposed model asserts that the time a CEO has been in their role, tenure, is a critical variable and has a different effect on the relationship between MD versus non-MD CEOs and hospital performance. The results of this study indicate an interaction between tenure and MD versus non-MD CEO status on hospital return on assets (ROA). However, no interaction was found for any of the clinical quality outcome variables. These study findings support the idea that while MD CEOs may initially garner less favorable ROAs than their non-MD CEO peers, they eventually meet and surpass non-MD CEOs after seven years of tenure. As such, hiring MDs as CEOs may represent a favorable long-term financial investment strategy for hospitals.
In this quasi-experimental, mixed methods study, a curricular intervention was tested to determine whether adding labs and discussions focused on both psychosocial and math content skills to an online college algebra course could boost student achievement and retention. College algebra has notably low success rates in the United States. The labs and discussions were designed based on Keller's ARCS Model of Motivation, and the psychosocial factors examined were motivation, self-efficacy, self-regulation, attribution, and anxiety, all significant in prior community college research.
The study compared 29 students from an 8-week course with full treatment and 49 students from 16-week courses with partial treatment to results from students in previous years' business-as-usual courses at a community college. Results showed that the treatment improved achievement and retention when compared to prior sections taught by the researcher and those taught by other instructors. Students' attribution of their success or failure, as well as the other four PSFs, were also analyzed. While quantitative measures showed no significant change in psychosocial factors, student reflections suggested some improvement. Interestingly, adult learners were particularly affected by the interventions. A regression model based solely on psychosocial factors predicted student achievement without consideration of demographics or background. Future research aims to expand the sample size, involve more instructors, and refine the research tools to confirm these findings.
Background: Effective anesthetic management is essential for managing elective orthopedic spine surgeries. Dexmedetomidine (DEX), a highly selective alpha-2 adrenergic agonist, has emerged as a promising adjunct in anesthetic practice. Using DEX after surgery can provide benefits such as reduced opioid requirements, stable hemodynamics, and minimal respiratory depression (Hwang et al., 2015; Okello et al., 2018). However, its postoperative outcomes are not well studied. Purpose: This quality improvement project aimed to assess the effects of intraoperative DEX administration on hemodynamic stability, pain control, and respiratory outcomes in patients undergoing elective lumbosacral spine surgeries. Methods: Utilizing a descriptive correlational design and retrospective quantitative data analysis data from 50 patient charts, aged 35-75 undergoing 1-3 level lumbosacral spine surgeries at a tertiary community care hospital, were collected and analyzed to explore the postoperative effects of using DEX as compared to not using DEX. Results: No significant differences were found between the DEX and non-DEX groups in terms of hemodynamics stability, pain scores, or respiratory events. However, DEX was associated with a safe postoperative profile, with no increase in adverse effects like hypotension or bradycardia. Conclusion: DEX did not significantly improve outcomes, but it showed evidence of having a safe profile, making it a viable option in multimodal anesthesia. Further investigation is needed to explore its impact on opioid use and broader surgical outcomes.
Keywords: dexmedetomidine, lumbosacral spine surgery, hemodynamic stability, respiratory events, pain management, postoperative outcomes
Surgery causes the body to enter a catabolic state, which can lead to complications in the postoperative period. However, protocols have been created to overcome this state, starting preoperatively with surgical and anesthetic approaches. Therefore, we explored the implementation of the Enhanced Recovery After Surgery (ERAS) protocol compared to non-ERAS care at a rural hospital in South Charlotte for patients undergoing laparoscopic or robotic-assisted hysterectomies. Our overarching clinical question was: In 30- to 70-year-old female patients who underwent laparoscopic hysterectomies (with or without robotics), how did the use of an ERAS protocol compare to traditional care impact postoperative pain scores, postoperative nausea and vomiting, or length of stay at a community hospital in South Charlotte? Data were collected via a retrospective chart review of 50 charts per age group (30-50 years old and 51-70 years old), and information was analyzed using descriptive and correlational statistics. The retrospective chart review for this QI project found no significant difference in the medications provided in the preoperative, intraoperative, or postoperative setting, thus leading to no significant difference in postoperative pain, PONV, or length of stay between the ERAS and non-ERAS groups at this specific site. However, this is not a negative outcome. This showed that regardless of the surgeon’s particular order, most patients received multimodal anesthesia; therefore, if all patients received multimodal anesthesia, there should be an overall decrease in PONV, PACU pain, and LOS.
The purpose of this quality improvement (QI) project aims to assess current practice at a large level one trauma center and compare it to the most recent clinical guidelines. With this data, the project will determine if anesthesia practitioners are following evidence based guidelines. It is essential providers follow clinical guidelines to ensure patients are not underdosed or overdosed when given neuromuscular reversal agents.
In patients aged 18-44 undergoing laparoscopic abdominal surgeries requiring neuromuscular paralysis, how is sugammadex administered for neuromuscular blockade reversal at a large level one trauma center, compared to current evidence based guidelines? This includes train of four count, weight-based dosing, and timing of extubation.
The purpose of this quality improvement project aims to assess current practice at a large level one trauma center and compare it to the most recent clinical guidelines. With this data, the project will determine if anesthesia practitioners are following evidence based guidelines. It is essential providers follow clinical guidelines to ensure patients are not underdosed or overdosed when given neuromuscular reversal agents.
In patients aged 18 to 44 years undergoing laparoscopic abdominal surgeries requiring neuromuscular paralysis, how is neostigmine administered for neuromuscular blockade reversal at a large level one trauma center compared to current evidence based guidelines? This includes train of four count, weight-based dosing, and timing of extubation.
Background: Dexmedetomidine (DEX), a selective alpha-2 adrenergic agonist, has been shown to have a promising role in decreasing opioid consumption, normalized hemodynamics, and minimizing respiratory depression in spine surgeries. However, its postoperative outcomes are not well studied. Purpose: This quality improvement project aimed to assess the effects of intraoperative DEX on hemodynamic stability, pain control, and respiratory outcomes in patients undergoing elective lumbosacral spine surgeries. Methods: Using a retrospective, descriptive correlational design the data from 50 patients aged 35-75 undergoing 1-3 level lumbosacral spine surgeries at a Level 1 trauma center was analyzed. Postoperative outcomes between patients who received DEX and those who did not were compared. Results: No significant differences were found between the DEX and non-DEX groups in terms of hemodynamic stability, pain scores, or respiratory events. However, DEX was associated with a safe postoperative profile, with no increase in adverse effects like hypotension or bradycardia. Conclusion: DEX did not significantly improve outcomes, but it showed evidence of having a safe profile, making it a viable option in multimodal anesthesia. Further research is needed to explore its impact on opioid use and broader surgical outcomes.
Background: Dexmedetomidine (DEX), a selective alpha-2 adrenergic agonist, has been shown to have a promising role in decreasing opioid consumption, normalized hemodynamics, and minimizing respiratory depression in spine surgeries. However, its postoperative outcomes are not well studied. Purpose: This quality improvement project aimed to assess the effects of intraoperative DEX on hemodynamic stability, pain control, and respiratory outcomes in patients undergoing elective lumbosacral spine surgeries. Methods: Using a retrospective, descriptive correlational design the data from 50 patients aged 35-75 undergoing 1-3 level lumbosacral spine surgeries at a Level 1 trauma center was analyzed. Postoperative outcomes between patients who received DEX and those who did not were compared. Results: No significant differences were found between the DEX and non-DEX groups in terms of hemodynamic stability, pain scores, or respiratory events. However, DEX was associated with a safe postoperative profile, with no increase in adverse effects like hypotension or bradycardia. Conclusion: DEX did not significantly improve outcomes, but it showed evidence of having a safe profile, making it a viable option in multimodal anesthesia. Further research is needed to explore its impact on opioid use and broader surgical outcomes.
Preoperative anxiety is a common problem for patients undergoing general anesthesia and can create untoward hemodynamic effects for patients in the operating room. Dexmedetomidine is an Alpha-2 adrenergic agonist commonly used for sedation by continuous infusion. Dexmedetomidine is now used for preoperative anxiolysis, however, there are no clinical recommendations for dosing and appropriate patient selection. Due to the hemodynamics of the medication, administration can result in the adverse effects of hypotension and bradycardia.
The Quality Improvement project consisted of a retrospective chart review of 100 patients. 50 patients were aged 65-85 at a large urban trauma center and 50 patients were aged 45-64 at a smaller affiliate site. The dose of dexmedetomidine ranged from 4 to 20 micrograms.
At both sites, heart rate change was not significantly associated with age, ASA status, or dexmedetomidine dose. Blood pressure change was not significantly associated with age, ASA, or dexmedetomidine dose.
This project found that in patients aged 46-85 at both sites doses of 4-20mcg for anxiolysis did not commonly result in bradycardia or hypotension. This suggests that it is safe to administer small doses of dexmedetomidine up to 20 mcg without the need for vasopressor support to lessen preoperative anxiety.
Literacy is a civil right that every child should have access to. Despite decades of research on how children best learn to read, literacy rates continue to be diminished in the United States, leading children to lives of poverty, unemployment and even crime. Via policy and research, the focus in literacy has shifted to teacher learning as a means to improve student achievement in reading. However, teachers’ voices are largely omitted from discussions regarding how this learning should take place and how they are empowered to apply new knowledge in their classrooms. Through an examination of teachers’ experiences with state mandated reading professional development, it is possible to glean understandings of what professional development practices are most helpful to teachers, particularly in rural areas. The proposed study seeks to answer two essential questions: 1) What factors contribute to rural elementary teachers’ experiences with LETRS professional development? and 2) In what ways do these factors act as facilitators and barriers to teachers' professional development? This study will follow a case study design, collecting data through focus groups. The findings of this study will highlight the experiences of teachers in rural areas, who are often omitted from educational research. More specifically, it will provide valuable guidance around the considerations of context when designing and delivering professional development.
