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Mayo Clinic Releases PathWays: New Online “Case Study” Tool for Pathologists and Medical Enthusiasts

Andy Tofilon

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Mayo Clinic fellows and residents publishing weekly practical case studies on the Mayo Medical Laboratories blog for medical professionals around the world.

ROCHESTER, Minn. — A dark purplish blob (a.k.a., a karyosome) floats randomly next to perfectly pink circles. Electric yellow spots stand out in a sea of stained dark blue cells, viewed at 40 times the original magnification. For a pathologist, this unique “artwork” provides vital information that will unlock needed medical diagnoses for sick patients. These scientific images — combined with brief patient descriptions — comprise Mayo Clinic PathWays — an online learning tool for pathologists and for those who enjoy learning about medicine. Mayo Medical Laboratories and Mayo Clinic’s Laboratory Medicine and Pathology Graduate Medical Education Office have developed this case-study tool that will offer weekly “challenges” posted to the Mayo Medical Laboratories website.

MEDIA CONTACT: Gina Chiri-Osmond, Public Affairs, 507-284-5005, [email protected]

“We have a wonderful opportunity here to bring practical case studies from our fellows and residents within the Mayo Clinic Department of Laboratory Medicine and Pathology to pathology professionals around the world in an intriguing, professional and engaging manner,” says Bobbi Pritt, M.D. , a pathologist and vice chair of Education, Mayo Clinic Department of Laboratory Medicine and Pathology .

To meet teaching requirements of accreditation bodies and the Mayo Clinic Laboratory Medicine and Pathology Graduate Medical Education Office, fellows, residents and consultants will craft the case studies (complete with images and patient vignettes) and have the case studies vetted by Mayo Clinic faculty consultants. The case studies will initially focus on both the anatomic and clinical pathology disciplines.

“Through this project, our laboratory medicine and pathology consultants and trainees will integrate education, clinical practice and research via weekly cases,” says Dr. Pritt. “The goal is peer-to-peer education, but we also want to disseminate what we’ve learned to a larger audience in a free online instructive environment.”

Each week, readers of the Mayo Medical Laboratories blog can assume the role of a pathologist by evaluating a selected case, assessing the medical information and committing to a diagnosis by voting from four possible choices. The tool will explain why an answer is correct or inaccurate.

In the future, case studies will also be provided by the Mayo Clinic Center for Individualized Medicine  and other scientific centers of excellence.

View this week's case study here .

About Laboratory Medicine and Pathology at Mayo Clinic The Mayo Clinic Department of Laboratory Medicine and Pathology and its reference laboratory, Mayo Medical Laboratories , provide advanced laboratory testing and pathology services to support 4,000 health care organizations around the world. Revenue from this testing is used to support medical education and research at Mayo Clinic, a nonprofit worldwide leader in medical care, research and education for people from all walks of life. Complemented by collaborations with diagnostic and biotechnology companies, the department maintains a robust diagnostic test-development program, launching more than 150 new tests annually.

About Mayo Clinic

Mayo Clinic is a nonprofit organization committed to medical research, education and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/ .

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National Academy of Medicine; The Learning Health System Series; Grossmann C, Chua PS, Ahmed M, et al., editors. Sharing Health Data: The Why, the Will, and the Way Forward. Washington (DC): National Academies Press (US); 2022.

Sharing Health Data: The Why, the Will, and the Way Forward.

• Hardcopy Version at National Academies Press

12 CASE STUDY: MAYO-GOOGLE PARTNERSHIP

Interviewees: John Halamka, MD, MS, President, Mayo Clinic Platform; and Jeff Anderson, PhD, MBA, Director of Accounts, Clinical Data Analytics Platform

Security and privacy are foundational to digital health care innovation. In September 2019, Mayo Clinic entered a 10-year partnership with Google to design a framework for the ethical secondary use of clinical data. This new infrastructure has two components: 1) the Mayo Clinic Cloud, which houses patient records, and 2) the Mayo Clinic Platform, a controlled enclave in which Mayo can share a subset of its clinical data, de-identified, and allow collaborators to link to it or supplement it with their own data for advanced analytics, including the development and training of artificial intelligence (AI) systems. This, unique approach called “data under glass” exemplifies a federated learning model. With algorithms permitted into the enclave and data never leaving the home institution, the Mayo-Google partnership illustrates an approach to how health systems and technology companies can partner to facilitate knowledge generation while addressing privacy and cybersecurity concerns. It also promotes data collaboration and knowledge generation by off-setting the costs of procuring, managing, and storing large amounts of data needed for algorithmic development.

Case Study at-a-Glance: Mayo-Google Partnership.

Mayo Clinic is an academic medical center and integrated health system comprised of three “shields”—patient care, education, and research. In September 2019, Mayo announced a 10-year partnership with Google. The partnership establishes a cloud-computing infrastructure, called Mayo Clinic Cloud, which is aimed at benefiting all three shields. The Cloud offers Mayo the ability to centrally store 1.2 million patient records ( Furst, 2021 ). Through this partnership, Mayo also gains access to Google’s AI toolsets, engineering talent, and security experience. Although Mayo considered all cloud providers, the health system chose Google because of the technology company’s combinational strengths in these areas. These factors were important given Mayo’s reliance on secondary use of data to support translational, clinical, and epidemiological research studies.

Overall, Mayo’s recognition of the increasing digitalization of health care prompted the health system to undertake this transformation. The Mayo Clinic Platform is Mayo’s strategic initiative to improve health care through insights and knowledge derived from data and partnerships. In 2020, it pursued three major initiatives:

• Clinical Data Analytics Platform – the process by which internal and external collaborators access the de-identified data in Mayo Clinic Cloud to discover new cures and treatments
• Home Hospital Platform – cloud-hosted components that enable serious and complex care at a distance
• Remote Diagnostic and Management Platform – ingestion of novel data from wearables and home-based devices that is combined with AI algorithms to deliver care recommendations to providers and patients.

Prior to engaging with Google, Mayo Clinic unified data from 70 diverse care sites into a longitudinal patient data store called the Universal Data Platform. This critical step made it easier for Mayo to migrate its structured and unstructured data to a private cloud container within the Google Cloud. The arrangement is analogous to renting a storage unit within a warehouse in which one puts their belongings and secures it with a lock. The warehouse owner cannot open the storage unit, and ownership of the belongings remains with the owner of the storage unit. Although Mayo Clinic built Mayo Clinic Cloud within the Google Cloud, Google is not able to access Mayo data independently since Mayo holds the key. Thus, Google is unable to combine Mayo patient data with data sourced from Google applications such as Search, Gmail, Google Maps, and YouTube.

For Mayo’s internal operations, a patient-identified copy of Mayo’s data is stored in the private cloud container under Mayo’s control and not accessed by third parties. Another copy of the data, which is de-identified, is stored in a private cloud container that can be accessed by authorized third parties with Mayo’s control for analytics. Third parties can develop novel algorithms, validate existing algorithms, and perform data analyses, but the data never leaves the Mayo container. Third parties can only take wisdom with them in the form of the finished algorithm or completed analysis. This is called “data behind glass.”

The mechanism in its entirety represents a federated learning model (see Figure 6 ). Unlike a centralized data-sharing model in which a singular database hosts all of a person’s accumulated health information and is the locus of aggregation and computing, the federated learning model allows Mayo to maintain physical and logical control of its data while selectively inviting investigators in and having the ability to audit what they do. The resulting learnings are distributed across private, academic, and federal research entities and are exchanged accordingly for further development ( McMahan and Ramage, 2017 ).

Diagram of a Federated Learning Model. SOURCE: Google AI Blog. 2021. Google Research: Looking Back at 2020, and Forward to 2021. Available at: https://ai.googleblog.com/2021/01/google-research-looking-back-at-2020.html (accessed December 6, 2021).

• DESCRIPTION

Underpinning this partnership is a well-defined governance structure that consists of several layers of oversight for Mayo Clinic Cloud and Mayo Clinic Platform. A multi-stakeholder task force called “One Table” reviews data access requests and reports to Mayo’s board of governors, who also weigh in on decision making. Nonetheless, executive leadership notes that the tradeoff with establishing a multi-level governance structure is speed and efficiency. However, investing in clear-cut decision-making processes is time well spent. In addition, the Health Data and Technology Advisory (DaTA) Board was created in 2021 and now has 11 members. Members are a diverse group of Mayo patients who live in the Rochester area, charged with providing perspectives and opinions on how potential AI and health technology applications, including the Google partnership and data sharing, will impact individual patients and the community as a whole.

Management of the partnership with Google is governed by a joint steering committee. Technical controls are complemented by policy controls. Due to privacy and ethical concerns that stem from third-party involvement, the steering committee is responsible for establishing a combination of policy and technical controls for regimenting data access and auditing. The technical controls block a third-party user’s access if they connect to the cloud in an unsanctioned way. Policy controls prohibit partners from combining Mayo patient data with other data that could increase the risk of re-identification.

De-identification comes with challenges. From January to April of 2020, Mayo de-identified its structured data, including problem lists, medications, allergies, laboratories, and demographics. While the Health Insurance Portability and Accountability Act (HIPAA) mandates the removal of 18 types of direct and indirect identifiers, such as the patient’s name, phone number, and, in some cases, ZIP code to render the data sufficiently de-identified, Mayo navigated instances where the identity of a patient could be deduced based on the combination of data available ( HHS, 2015 ). As a result, Mayo employed both computer- and human-mediated mechanisms to redact datasets and the concept of “bin size” to assess if the data is sufficiently de-identified. Studying domestic and international privacy law, Mayo came to the conclusion to use a bin size of 10, which means that a dataset was considered sufficiently de-identified if the data could be thought to be any one of 10 individuals in the database. Once Mayo performed de-identification, the health system sought certification from a third-party expert to verify that the data had a low likelihood of re-identification.

From April to August of 2020, Mayo de-identified the unstructured data, including clinical notes and reports, which program leaders admitted was a much more difficult task. The process required the removal of text that could enable easy re-identification. For example, if a note included the term “this senator” or specified “a star quarterback” from a named sports team, the note would be considered not sufficiently de-identified. Similarly, text may be typed into notes in a way that compromises privacy, such as the presence of phone numbers typed in a non-standard form (i.e., 5674328999). All such issues had to be addressed before the data could be certified as de-identified.

Operating amid growing skepticism and scrutiny of third-party collaborations, Mayo leadership has had to be conscientious about questions of feasibility and fostering stakeholder buy-in. In the interest of building trust and transparency, Mayo shares details of partnerships as soon as agreements are finalized with a number of leading publications and holds seminars with the broader health care community to gather feedback on its policies and procedures. In partnership with the Healthcare Information and Management Systems Society, it conducted a nationwide survey gauging consumers’ attitudes vis-à-vis data sharing. Mayo Clinic Platform also works with community advisory boards, comprised of both patients and non-patients, to advise on topics such as Mayo’s genomics data sharing policy. Equally important was ensuring the comfort of Mayo’s own research community. This required educating the internal research community about the research benefit of these tools and addressing their concerns. Mayo also espouses the guiding principle of partnering only with external groups whose values align with its internal research practices.

• FUTURE DIRECTIONS

The interviewees for this case study cite the use of a federated learning model as the key factor to affording Mayo Clinic the agility and functionality to meet not only its data analytics goals, but also its stewardship responsibilities to patients. For health systems looking to emulate the Mayo-Google model, the interviewees advise starting small, thinking big, and moving fast. All of Mayo’s data projects start as limited pilots, which are only expanded after lessons learned are thoroughly reviewed and risks mitigated. External partnerships and coalitions bring diverse experiences to innovation projects, so it is important for health care institutions to seek alliances with others.

• Cite this Page National Academy of Medicine; The Learning Health System Series; Grossmann C, Chua PS, Ahmed M, et al., editors. Sharing Health Data: The Why, the Will, and the Way Forward. Washington (DC): National Academies Press (US); 2022. 12, CASE STUDY: MAYO-GOOGLE PARTNERSHIP.
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Mayo Clinic Infectious Disease Case Review: With Board-Style Questions and Answers

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This textbook addresses many of the current-day illnesses seen by primary care clinicians and infectious diseases specialists. A case presentation format is used for all 54 chapters, and this framework serves as a wonderful educational tool that mirrors, in many respects, the objectives of a “case conference” format. The dozens of authors from different areas of our specialty have ensured that a robust clinical examination of specific infection syndromes has been included. In addition, the Question and Answer section solidifies the educational benefits for all levels and types of clinicians who seek an understanding of disease diagnosis, management, and prevention. A well-recognized characteristic of infectious diseases specialists is our focus on epidemiology, and this trait has served us well in developing successful clinical careers. Perhaps our compulsive investigation of a patient’s illness has been key in the desire of our colleagues from other specialties to “get infectious diseases involved.” This focus is evident in each chapter so that the reader will have a deeper understanding of the epidemiology of illness and its impact on early, pathogen-based diagnoses. Advances in the microbiology laboratory have clearly been influential in the diagnosis and management of infectious diseases. Automated systems have revolutionized laboratory activities, and even work areas in the laboratory have evolved. This textbook addresses many of these laboratory tools and how to interpret laboratory test results, which now are often available in almost warp speed. As a result, the duration of empiric (and possibly incorrect) therapy is shortened with the subsequent initiation of specific treatment, to the benefit of the individual patient.

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Mayo Clinic: The 2020 Initiative

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Mayo clinic: the 2020 initiative description.

Describes the challenges facing Dr. John Noseworthy, President and CEO, in implementing a long-term strategy for the growth of the Mayo Clinic-a leading academic medical center with a reputation for excellence in tertiary and quaternary health care. The case highlights the concurrent forces of regional and national competition and federal health care reform as factors complicating the plans of Mayo Clinic to grow through several channels. Students must ultimately decide whether Mayo Clinic should focus its future growth on its current areas of expertise (regional provision of integrated medical care and international provision of tertiary and quaternary care), new opportunities in a broader range of services and treatment channels (e.g., telemedicine, mobile health, enterprise learning and training for other health care systems), or some combination of these opportunities.

Case Description Mayo Clinic: The 2020 Initiative

Strategic managment tools used in case study analysis of mayo clinic: the 2020 initiative, step 1. problem identification in mayo clinic: the 2020 initiative case study, step 2. external environment analysis - pestel / pest / step analysis of mayo clinic: the 2020 initiative case study, step 3. industry specific / porter five forces analysis of mayo clinic: the 2020 initiative case study, step 4. evaluating alternatives / swot analysis of mayo clinic: the 2020 initiative case study, step 5. porter value chain analysis / vrio / vrin analysis mayo clinic: the 2020 initiative case study, step 6. recommendations mayo clinic: the 2020 initiative case study, step 7. basis of recommendations for mayo clinic: the 2020 initiative case study, quality & on time delivery.

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Case Analysis of Mayo Clinic: The 2020 Initiative

Mayo Clinic: The 2020 Initiative is a Harvard Business (HBR) Case Study on Leadership & Managing People , Texas Business School provides HBR case study assignment help for just $9. Texas Business School(TBS) case study solution is based on HBR Case Study Method framework, TBS expertise & global insights. Mayo Clinic: The 2020 Initiative is designed and drafted in a manner to allow the HBR case study reader to analyze a real-world problem by putting reader into the position of the decision maker. Mayo Clinic: The 2020 Initiative case study will help professionals, MBA, EMBA, and leaders to develop a broad and clear understanding of casecategory challenges. Mayo Clinic: The 2020 Initiative will also provide insight into areas such as – wordlist , strategy, leadership, sales and marketing, and negotiations.

Case Study Solutions Background Work

Mayo Clinic: The 2020 Initiative case study solution is focused on solving the strategic and operational challenges the protagonist of the case is facing. The challenges involve – evaluation of strategic options, key role of Leadership & Managing People, leadership qualities of the protagonist, and dynamics of the external environment. The challenge in front of the protagonist, of Mayo Clinic: The 2020 Initiative, is to not only build a competitive position of the organization but also to sustain it over a period of time.

Strategic Management Tools Used in Case Study Solution

The Mayo Clinic: The 2020 Initiative case study solution requires the MBA, EMBA, executive, professional to have a deep understanding of various strategic management tools such as SWOT Analysis, PESTEL Analysis / PEST Analysis / STEP Analysis, Porter Five Forces Analysis, Go To Market Strategy, BCG Matrix Analysis, Porter Value Chain Analysis, Ansoff Matrix Analysis, VRIO / VRIN and Marketing Mix Analysis.

Texas Business School Approach to Leadership & Managing People Solutions

In the Texas Business School, Mayo Clinic: The 2020 Initiative case study solution – following strategic tools are used - SWOT Analysis, PESTEL Analysis / PEST Analysis / STEP Analysis, Porter Five Forces Analysis, Go To Market Strategy, BCG Matrix Analysis, Porter Value Chain Analysis, Ansoff Matrix Analysis, VRIO / VRIN and Marketing Mix Analysis. We have additionally used the concept of supply chain management and leadership framework to build a comprehensive case study solution for the case – Mayo Clinic: The 2020 Initiative

Step 1 – Problem Identification of Mayo Clinic: The 2020 Initiative - Harvard Business School Case Study

The first step to solve HBR Mayo Clinic: The 2020 Initiative case study solution is to identify the problem present in the case. The problem statement of the case is provided in the beginning of the case where the protagonist is contemplating various options in the face of numerous challenges that Mayo Clinic is facing right now. Even though the problem statement is essentially – “Leadership & Managing People” challenge but it has impacted by others factors such as communication in the organization, uncertainty in the external environment, leadership in Mayo Clinic, style of leadership and organization structure, marketing and sales, organizational behavior, strategy, internal politics, stakeholders priorities and more.

Step 2 – External Environment Analysis

Texas Business School approach of case study analysis – Conclusion, Reasons, Evidences - provides a framework to analyze every HBR case study. It requires conducting robust external environmental analysis to decipher evidences for the reasons presented in the Mayo Clinic: The 2020 Initiative. The external environment analysis of Mayo Clinic: The 2020 Initiative will ensure that we are keeping a tab on the macro-environment factors that are directly and indirectly impacting the business of the firm.

What is PESTEL Analysis? Briefly Explained

PESTEL stands for political, economic, social, technological, environmental and legal factors that impact the external environment of firm in Mayo Clinic: The 2020 Initiative case study. PESTEL analysis of " Mayo Clinic: The 2020 Initiative" can help us understand why the organization is performing badly, what are the factors in the external environment that are impacting the performance of the organization, and how the organization can either manage or mitigate the impact of these external factors.

How to do PESTEL / PEST / STEP Analysis? What are the components of PESTEL Analysis?

As mentioned above PESTEL Analysis has six elements – political, economic, social, technological, environmental, and legal. All the six elements are explained in context with Mayo Clinic: The 2020 Initiative macro-environment and how it impacts the businesses of the firm.

How to do PESTEL Analysis for Mayo Clinic: The 2020 Initiative

To do comprehensive PESTEL analysis of case study – Mayo Clinic: The 2020 Initiative , we have researched numerous components under the six factors of PESTEL analysis.

Political Factors that Impact Mayo Clinic: The 2020 Initiative

Political factors impact seven key decision making areas – economic environment, socio-cultural environment, rate of innovation & investment in research & development, environmental laws, legal requirements, and acceptance of new technologies.

Government policies have significant impact on the business environment of any country. The firm in “ Mayo Clinic: The 2020 Initiative ” needs to navigate these policy decisions to create either an edge for itself or reduce the negative impact of the policy as far as possible.

Data safety laws – The countries in which Mayo Clinic is operating, firms are required to store customer data within the premises of the country. Mayo Clinic needs to restructure its IT policies to accommodate these changes. In the EU countries, firms are required to make special provision for privacy issues and other laws.

Competition Regulations – Numerous countries have strong competition laws both regarding the monopoly conditions and day to day fair business practices. Mayo Clinic: The 2020 Initiative has numerous instances where the competition regulations aspects can be scrutinized.

Import restrictions on products – Before entering the new market, Mayo Clinic in case study Mayo Clinic: The 2020 Initiative" should look into the import restrictions that may be present in the prospective market.

Export restrictions on products – Apart from direct product export restrictions in field of technology and agriculture, a number of countries also have capital controls. Mayo Clinic in case study “ Mayo Clinic: The 2020 Initiative ” should look into these export restrictions policies.

Foreign Direct Investment Policies – Government policies favors local companies over international policies, Mayo Clinic in case study “ Mayo Clinic: The 2020 Initiative ” should understand in minute details regarding the Foreign Direct Investment policies of the prospective market.

Corporate Taxes – The rate of taxes is often used by governments to lure foreign direct investments or increase domestic investment in a certain sector. Corporate taxation can be divided into two categories – taxes on profits and taxes on operations. Taxes on profits number is important for companies that already have a sustainable business model, while taxes on operations is far more significant for companies that are looking to set up new plants or operations.

Tariffs – Chekout how much tariffs the firm needs to pay in the “ Mayo Clinic: The 2020 Initiative ” case study. The level of tariffs will determine the viability of the business model that the firm is contemplating. If the tariffs are high then it will be extremely difficult to compete with the local competitors. But if the tariffs are between 5-10% then Mayo Clinic can compete against other competitors.

Research and Development Subsidies and Policies – Governments often provide tax breaks and other incentives for companies to innovate in various sectors of priority. Managers at Mayo Clinic: The 2020 Initiative case study have to assess whether their business can benefit from such government assistance and subsidies.

Consumer protection – Different countries have different consumer protection laws. Managers need to clarify not only the consumer protection laws in advance but also legal implications if the firm fails to meet any of them.

Political System and Its Implications – Different political systems have different approach to free market and entrepreneurship. Managers need to assess these factors even before entering the market.

Freedom of Press is critical for fair trade and transparency. Countries where freedom of press is not prevalent there are high chances of both political and commercial corruption.

Corruption level – Mayo Clinic needs to assess the level of corruptions both at the official level and at the market level, even before entering a new market. To tackle the menace of corruption – a firm should have a clear SOP that provides managers at each level what to do when they encounter instances of either systematic corruption or bureaucrats looking to take bribes from the firm.

Independence of judiciary – It is critical for fair business practices. If a country doesn’t have independent judiciary then there is no point entry into such a country for business.

Government attitude towards trade unions – Different political systems and government have different attitude towards trade unions and collective bargaining. The firm needs to assess – its comfort dealing with the unions and regulations regarding unions in a given market or industry. If both are on the same page then it makes sense to enter, otherwise it doesn’t.

Economic Factors that Impact Mayo Clinic: The 2020 Initiative

Social factors that impact mayo clinic: the 2020 initiative, technological factors that impact mayo clinic: the 2020 initiative, environmental factors that impact mayo clinic: the 2020 initiative, legal factors that impact mayo clinic: the 2020 initiative, step 3 – industry specific analysis, what is porter five forces analysis, step 4 – swot analysis / internal environment analysis, step 5 – porter value chain / vrio / vrin analysis, step 6 – evaluating alternatives & recommendations, step 7 – basis for recommendations, references :: mayo clinic: the 2020 initiative case study solution.

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STRATEGIC HRM AT THE MAYO CLINIC: A CASE STUDY

For many decades, Mayo Clinic has been ranked as one of the top medical institutions in the world. The entire health care industry has been experiencing immense challenges. Given the current and historic success of Mayo, what does Mayo need to do from an HR perspective to maintain this standard of excellence? This case identifies the strategies used by Mayo to achieve excellence in employee and patient satisfaction. The case describes how this complex service organization fosters a culture that exceeds customer expectations and earns deep loyalty from both customers and employees. The role of HR is analyzed to explain how strategic HRM enables the organization to achieve its strategic business objectives.

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Healthcare sector has been seeing the large scale change in demand pattern for the last two decades, and so are the demands on healthcare leaders. It is not so easy for healthcare providers to reduce costs, recruit and retain qualified healthcare staff and improve patient satisfaction and patient safety without proactive initiatives led by HR. Healthcare organizations are continually battling conflicting priorities. Patients, now a days are dictating the need to focus on delivering high quality patient care, preventing infections, maintaining hospital security, and ensuring patient safety – all with extremely stretched resources. This paper makes an attempt to reviews the priorities for healthcare sectors and conducted a preliminary investigation regarding the HR practices and process towards employee satisfaction in large scale hospitals operating in Ghaziabad region in India

Pauline Stanton

This paper reports on a large scale survey into people management practices in the Victorian public healthcare sector. We find that although Chief Executive Officers and Human Resource Directors are aware of strategic human management and believe that they are practicing SHRM, functional managers are less optimistic. Overall respondents reported the same barriers to the practice of SHRM including lack of funding and resources, and government support and lack of specialist HRM knowledge and skills. People First - Serving Our Stakeholders 8-11 December 2004, University of Otago, Dunedin, New Zealand

Dr Najib ERRAISS

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A 55-year-old man was admitted with symptoms of septic shock and started on broad spectrum antibiotics, which included piperacillin-tazobactam and vancomycin. A computerized tomography scan showed pneumoperitoneum, metastatic pancreatic adenocarcinoma, and a hepatic abscess that had eroded through the capsule. The abscess was treated by drain placement as the patient was deemed not a surgical candidate.

Blood cultures yielded the organism shown in the image below. The organism grew as β-hemolytic colonies on sheep blood agar. It did not grow on Thiosulfate-citrate-bile salts-sucrose (TCBS) agar. The organism tested oxidase- and indole-positive, and fermented glucose.

Which of the following is the most likely identity of the recovered organism?

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• Enterobacteriaceae  species 
• Vibrio  species
• Aeromonas  species

The correct answer is ...

The correct answer is: Aeromonas  species.

Unlike Vibrio species, Aeromonas species do not grow on TCBS agar, making this agar useful in distinguishing Aeromonas from Vibrio . Enterobacteriaceae species ferments glucose and are indole positive but oxidase negative, which distinguishes it from Aeromonas . Listeria species are gram positive.

• Aeromonas infections. (n.d.). Retrieved from  https://www.uptodate.com/contents/aeromonas-infections/print
• Aeromonas wound infections associated with outdoor activities -- California. (n.d.). Retrieved from  https://www.cdc.gov/mmwr/preview/mmwrhtml/00001628.htm
• 2 Fernández-Bravo, A., & Figueras, M. J. (2020). An update on the genus Aeromonas: Taxonomy, epidemiology, and pathogenicity. Microorganisms, 8(1), 129. doi:10.3390/microorganisms8010129
• Freeman, J., & Roberts, S. (n.d.). Approach to Gram stain and culture results in the microbiology laboratory. Retrieved from http://www.uptodate.com/contents/approach-to-gram-stain-and-culture-results-in-the-microbiology-laboratory
• 1 Janda, J. M., & Abbott, S. L. (2010). The genus Aeromonas: Taxonomy, pathogenicity, and infection. Clinical Microbiology Reviews, 23(1), 35-73. doi:10.1128/cmr.00039-09
• Morris, J. G., Jr. (n.d.). Minor Vibrio and Vibrio-like species associated with human disease. Retrieved from http://www.uptodate.com/contents/minor-vibrio-and-vibrio-like-species-associated-with-human-disease

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Resident, Anatomic and Clinical Pathology Mayo Clinic

Audrey Schuetz, M.D.

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