College of Health Professions
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Item Immediate Increases in Neck Strength Using Customized Mouth Guard: Gender Differences(2024-04-11) Gobert, Denise V.Purpose: The purpose of our study is to investigate gender differences in immediate muscle response to realigning the jaw using a customized mouth guard. Background: Decreased neck strength is a predictor for sport-related concussions (SRC). Females are not only more susceptible for SRC, but they have less neck strength compared to males. However, there is mixed evidence about the efficacy of neck strengthening protocols in females. There is a current need to augment gender specific training programs or the addition of appliances that target neck strengthening in females. Realigning the jaw is theorized to increase cervical spine stability, which could positively affect optimal cervical muscle length-tension relationships, and therefore, cervical strength. Methods: A total of 31 adults (13 females, 18 males) participated in this preliminary study. Overall neck and trunk function were assessed using standardized questionnaires and outcome measures. Isometric cervical muscle strength, cervical muscle endurance, and grip strength were measured with and without the customized mouth guard. Descriptive statistics were performed using SPSS vs 26 (IBM, Inc). Additionally, a two-way repeated measures ANOVA was used to explore gender and condition (with/without mouth guard) differences. Alpha level was p = 0.05. Results: Female participants showed overall lower neck strength, endurance, and grip strength with and without the mouth guard compared to males. However, both genders increased their strength and endurance, with repeated measures indicating the mouth guard as the overall indicator for the improvements (p < 0.05). Conclusions: Preliminary findings strongly suggest that the use of a customized mouth guard is a beneficial tool to immediately increase neck strength and endurance in both genders. However, the addition of a customized mouth guard to neck strengthening protocols could be needed more with females to improve neck strength and therefore decrease the risk of sport-related concussions.Item Online Medical Information for Patients(Independently published (November 23, 2022), 2022) Lieneck, Cristian H.; Young, Nicholashttps://www.amazon.com/Guidebook-American-Healthcare-I/dp/B0BMT7LKC6?asin=B0BMT7LKC6&revisionId=&format=4&depth=1Item How do you encourage patient responsibility?(Medical Group Management Association, 2016-01) Lieneck, Cristian H.; Mileski, MichaelIt has become imperative for us to focus on patient outcomes and ask ourselves, as practice management professionals, how we can help patients assume more responsibility for their care. Innovation in this area has become a major focus as scrutiny to providers will continue to increase.Item Accounting with “LIFO” vs. “FIFO”: The devil is in the details(Medical Group Management Association, 2015-04) Lieneck, Cristian H.The ongoing collaboration between the International Financial Reporting Standards (IFRS) and Federal Accounting Standards Board (FASB) has tax-related implications for medical group practices. One of the goals of this collaboration — harmonization of accounting standards across countries — has been pursued since post-World War II economic integration. Generally accepted accounting principle (GAAP) negotiations involve increased global transparency and similarity of accounting standard.Item Breaking the bean-counter stereotype: Member research assesses personality traits for healthcare financial managers(Medical Group Management Association, 2015) Lieneck, Cristian H.No abstract prepared.Item Member Perspectives on the ACA Insurance Exchange Grace Period(Medical Group Management Association, 2014-05) Lieneck, Cristian H.No abstract prepared.Item Assessing the other “R” in RHIOs: Risk and Liability of Electronic Privacy Implications(Medical Group Management Association, 2013-09) Lieneck, Cristian H.Regional Health Information Organizations (RHIOs) have developed at a rapid pace ever since the genesis of the Office of the National Coordinator for Health Information Technology (ONC) in 2004 as well as the legislative mandate for EHR adoption and meaningful use of such technology by the Health Information Technology and Clinical Health (HITECH) Act of 2009. With the intent of improving the health status of the population, this enhanced availability and exchange of health information creates an unavoidable risk for medical group practices at various levels within regional health information exchanges (HIEs).Item Capital questions: Balance sheets and leasing changes(Medical Group Management Association, 2013-02) Lieneck, Cristian H.; Weaver, EricNo abstract prepared.Item Avoiding pitfalls: Integration survival techniques for the practice manager(Medical Group Management Association, 2012-08) Lieneck, Cristian H.No abstract prepared.Item Service scripts, pay for performance, and practice liability: Learn how to manage what will be measured(Medical Group Management Association, 2012-09) Lieneck, Cristian H.No abstract prepared.Item Pandemic pause: Cost variables for ambulatory ACOs amid COVID-19(Medical Group Management Association, 2022-01) Lieneck, Cristian H.; Weaver, Eric; Maryon, ThomasThe COVID-19 pandemic has impacted the U.S. healthcare industry dramatically. Since March 2020, treatment protocols and access to care have been affected, challenging the quality of care provided to patients of all acuity levels. This deferment of care exacerbated chronic illnesses and related symptoms, and a reduction of routine and preventative care continues to be a secondary concern behind COVID-19 virus surges and initiatives to increase physical distancing and other public health measures. To assist healthcare organizations in treating patients requiring immediate acute care related to the pandemic, the Centers for Medicare & Medicaid Services (CMS) has relaxed the Quality Payment Program (QPP) reporting requirements for accountable care organizations (ACOs). Further, recent provide practice pattern shifts from the pre-COVID-19 value-based quality metric reporting system for ACO-involved organizations offers an assessment opportunity to identify key cost-influencing variables within the ACO environment.Item Hospital Price Transparency Perceptions and Observations in the United States: A Rapid Review(International Journal of Academic and Applied Research (IJAAR), 2022-07) Lieneck, Cristian H.; Darty, Kaven; Huddleston, Caitlin; Kreczmer, Jason; Lambdin, Stacy; Young, DylanBackground and Objectives: The Centers for Medicare and Medicaid (CMS) began implementing the Hospital Price Transparency Rule in 2019, requiring all participating hospitals to publish their chargemasters online (gross charges) for all services provided. Policy implementation at the organization level has been questionable, with patients and health care consumers left interpreting detailed hospital financial information available online. The research objective was to investigate price transparency perceptions and observations since the introduction of shoppable services price transparency mandates in 2021. Materials and Methods: Reviewers conducted a rapid review and identified and analyzed 20 articles and identified common themes. Results and Conclusions: Four underlying constructs surrounding hospital price transparency were identified: compliance and non-compliance with the CMS (2019) price transparency rule, pricing disparities, and accessibility/usability of public pricing information. The results of this rapid review provide insight for improving health service price transparency for the health care consumer and the potential limiting of follow-on surprise billing practices, while also helping to adapt policy on future price transparency initiatives.Item Healthcare Financial Accounting: A Guide for Leaders(Cognella, 2022-07) Lieneck, Cristian H.Recognizing that healthcare administrators must be well-versed in financial accounting principles to ensure appropriate financial management decisions for the variety of organizations which they lead, Healthcare Financial Accounting: A Guide for Leaders provides readers with a vital knowledge base. Strategically organized, the text supports a learner’s pathway towards the competent creation of valid and reliable financial statements for healthcare organizations. Utilizing both hospital and outpatient organizations as examples, chapters and their related content are organized to support readers’ cognitive processes according to Bloom’s Taxonomy while infusing a multitude of healthcare operational activities mapped to the financial accounting cycle. This application and chapter sequencing further supports healthcare administration students by preparing them for enrollment in a follow-on healthcare financial management course. The ultimate objective is for the reader to understand the intricacies of the formulation and development of the main financial statements to support their follow-on financial management fiduciary duties. Designed to help future healthcare leaders ultimately engage in sound financial management decisions, Healthcare Financial Accounting is ideal for both undergraduate and graduate courses in healthcare administration.Item Does Valved Holding Chamber Improve Aerosol Lung Deposition with a Jet Nebulizer? A Randomized Crossover Study(Multidisciplinary Digital Publishing Institute, 2022-05) Alcoforado, Luciana; Paiva, Dulciane Nunes; Ari, Arzu; de Melo Barcelar, Jacqueline; Brandao, Simone Cristina Soares; Fink, James B.; Dornelas de Andrade, ArmeleUsing valved holding chambers (VHC) during aerosol therapy has been reported to improve the inhaled dose with various aerosol devices, including vibrating mesh nebulizers. The aim of this study was to quantify the pulmonary deposition of a jet nebulizer (JN) with and without a VHC, and a mesh nebulizer (MN) with a VHC in a randomized cross-over trial with seven healthy consenting adults. Our hypothesis was that the use of a VHC would improve deposition with the JN. Diethylnitriaminopentacetic acid with technetium (DTPA-Tc99m), with the activity of 1 mC with 0.9% saline solution was nebulized. The radiolabeled aerosol was detected by 2D planar scintigraphy after administration. The pulmonary deposition was greater with a JN with a VHC (4.5%) than a JN alone (3.2%; p = 0.005. However, an MN with a VHC (30.0%) was six-fold greater than a JN or JN with a VHC (p < 0.001). The extrapulmonary deposition was higher in the JN group without a VHC than in the other two modalities (p < 0.001). Deposition in the device was greater with a JN + VHC than an MN+/VHC (p < 0.001). Lower residual drug at the end of the dose was detected with an MN than either JN configuration. The exhaled dose was greater with a JN alone than either an MN or JN with VHC (p < 0.001). In conclusion, the addition of the VHC did not substantially improve the efficiency of aerosol lung deposition over a JN alone.Item Facilitators and Barriers of COVID-19 Vaccine Promotion on Social Media in the United States: A Systematic Review(Multidisciplinary Digital Publishing Institute, 2022-02) Lieneck, Cristian H.; Heinemann, Katharine; Patel, Janki; Huynh, Hung; Leafblad, Abigail; Moreno, Emmanuel; Wingfield, ClaireBackground and Objectives: Information regarding the COVID-19 pandemic has spread internationally through a variety of platforms, including social media. While efforts have been made to help reduce the spread of misinformation on social media, many platforms are still largely unregulated. The influence of social media use on vaccination promotion is not fully understood. This systematic review aims to identify facilitators and barriers associated with vaccine promotion through social media use. Materials and Methods: Reviewers analyzed 25 articles and identified common themes. Facilitators of vaccine promotion included an increase in the efforts of social media companies to reduce misinformation, the use of social media to spread information on public health and vaccine promotion, and the positive influence towards vaccinations of family and friends. Results and Conclusions: Identified barriers to vaccine promotion included the spread of misinformation, decreased vaccine acceptance among users of social media for COVID-19 related information due to polarization, and a lack of regulation on social media platforms. The results of this review provide insight for improving public health campaign promotion on social media and can help inform policy on social media regulation and misinformation prevention.Item Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?(Multidisciplinary Digital Publishing Institute, 2021-07) Brooks, Matthew; Beauvais, Bradley; Kruse, Clemens S.; Fulton, Lawrence V.; Mileski, Michael; Ramamonjiarivelo, Zo; Shanmugam, Ramalingam; Lieneck, Cristian H.The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.Item Quantifying Delivered Dose with Jet and Mesh Nebulizers during Spontaneous Breathing, Noninvasive Ventilation, and Mechanical Ventilation in a Simulated Pediatric Lung Model with Exhaled Humidity(Multidisciplinary Digital Publishing Institute, 2021-07) Ari, Arzu; Fink, James B.Acutely ill children may transition between spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV), and commonly receive the same drug dosage with each type of ventilatory support and interface. This study aims to determine the aerosol deposition with jet (JN) and mesh nebulizers (MN) during SB, NIV, and MV using a pediatric lung model. Drug delivery with JN (Mistymax10) and MN (Aerogen Solo) was compared during SB, NIV, and MV using three different lung models set to simulate the same breathing parameters (Vt 250 mL, RR 20 bpm, I:E ratio 1:3). A heated humidifier was placed between the filter and test lung to simulate exhaled humidity (35 ± 2 °C, 100% RH) with all lung models. Albuterol sulfate (2.5 mg/3 mL) was delivered, and the drug deposited on an absolute filter was eluted and analyzed with spectrophotometry. Aerosol delivery with JN was not significantly different during MV, NIV, and SB (p = 0.075), while inhaled dose obtained with MN during MV was greater than NIV and SB (p = 0.001). The delivery efficiency of MN was up to 3-fold more than JN during MV (p = 0.008), NIV (p = 0.005), and SB (p = 0.009). Delivered dose with JN was similar during MV, NIV, and SB, although the delivery efficiency of MN differs with different modes of ventilation.Item Deep Vision for Breast Cancer Classification and Segmentation(Multidisciplinary Digital Publishing Institute, 2021-10-27) Fulton, Lawrence V.; McLeod, Alexander; Dolezel, Diane; Bastian, Nathaniel; Fulton, Christopher P.(1) Background: Female breast cancer diagnoses odds have increased from 11:1 in 1975 to 8:1 today. Mammography false positive rates (FPR) are associated with overdiagnoses and overtreatment, while false negative rates (FNR) increase morbidity and mortality. (2) Methods: Deep vision supervised learning classifies 299 × 299 pixel de-noised mammography images as negative or non-negative using models built on 55,890 pre-processed training images and applied to 15,364 unseen test images. A small image representation from the fitted training model is returned to evaluate the portion of the loss function gradient with respect to the image that maximizes the classification probability. This gradient is then re-mapped back to the original images, highlighting the areas of the original image that are most influential for classification (perhaps masses or boundary areas). (3) Results: initial classification results were 97% accurate, 99% specific, and 83% sensitive. Gradient techniques for unsupervised region of interest mapping identified areas most associated with the classification results clearly on positive mammograms and might be used to support clinician analysis. (4) Conclusions: deep vision techniques hold promise for addressing the overdiagnoses and treatment, underdiagnoses, and automated region of interest identification on mammography.Item Examining Predictors of Myocardial Infarction(Multidisciplinary Digital Publishing Institute, 10/27/2021) Dolezel, Diane; McLeod, Alexander; Fulton, Lawrence V.Cardiovascular diseases are the leading cause of death in the United States. This study analyzed predictors of myocardial infarction (MI) for those aged 35 and older based on demographic, socioeconomic, geographic, behavioral, and risk factors, as well as access to healthcare variables using the Center for Disease (CDC) Control Behavioral Risk Factor Surveillance System (BRFSS) survey for the year 2019. Multiple quasibinomial models were generated on an 80% training set hierarchically and then used to forecast the 20% test set. The final training model proved somewhat capable of prediction with a weighted F1-Score = 0.898. A complete model based on statistically significant variables using the entirety of the dataset was compared to the same model built on the training set. Models demonstrated coefficient stability. Similar to previous studies, age, gender, marital status, veteran status, income, home ownership, employment status, and education level were important demographic and socioeconomic predictors. The only geographic variable that remained in the model was associated with the West North Central Census Division (in-creased risk). Statistically important behavioral and risk factors as well as comorbidities included health status, smoking, alcohol consumption frequency, cholesterol, blood pressure, diabetes, stroke, chronic obstructive pulmonary disorder (COPD), kidney disease, and arthritis. Three access to healthcare variables proved statistically significant: lack of a primary care provider (Odds Ratio, OR = 0.853, p < 0.001), cost considerations prevented some care (OR = 1.232, p < 0.001), and lack of an annual checkup (OR = 0.807, p < 0.001). The directionality of these odds ratios is congruent with a marginal effects model and implies that those without MI are more likely not to have a primary provider or annual checkup, but those with MI are more likely to have missed care due to the cost of that care. Cost of healthcare for MI patients is associated with not receiving care after accounting for all other variables.Item Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review(Multidisciplinary Digital Publishing Institute, 10/30/2021) Lieneck, Cristian H.; Ramamonjiarivelo, Zo; Cox, Jennifer; Dominguez, Jack; Gersbach, Kendal; Heredia, Edward; Khan, AfrozaBackground and objectives: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic. Materials and methods: This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020. Results: Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge. Conclusions: To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.