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Background: Transgender inclusive and gender affirmative healthcare includes asking patients about gender identity and sex assigned at birth through what is known as the "2-step" methodology. In May 2016, the sexually transmitted disease (STD) clinic in Seattle, WA switched from using a 1-step to a 2-step gender identity question. We aimed to determine if the updated questions increased ascertainment of transgender and gender nonconforming (TGNC) patients and used the improved gender identity data to describe the human immunodeficiency virus/STD risk profile of TGNC patients.Methods: We conducted a pre-post analysis comparing the proportion of patients that identified as TGNC during the year before and after implementation of the 2-step questions. Gender identity and medical history questions were ascertained using a computer-assisted self-interview. The 2-step question included 2 new gender response options: non-binary/genderqueer and write-in.Results: Institution of the 2-step question resulted in a 4.8-fold increase in patients who were identified as TGNC: 36 (0.5%) of 6635 to 172 (2.4%) of 7025 patients (P < 0.001). After implementation, 89 patients identified as non-binary/genderqueer (51.7% of TGNC patients). The proportion of patients identified as transgender men and women increased from 0.2% to 0.5% (P = 0.002) and 0.4% to 0.6% (P = 0.096), respectively. Non-binary patients' human immunodeficiency virus/sexually transmitted infection risk profile was distinct from that of transgender and cisgender men who have sex with men, suggesting that distinguishing subpopulations within the TGNC population is important for risk stratification.Conclusions: Using a 2-step gender identity question and including non-binary/genderqueer options increased our clinic's ascertainment of TGNC patients and more accurately captured gender identity among STD clinic patients. [ABSTRACT FROM AUTHOR]

Background: The use of high-performance work practices (HPWPs) related to career development (e.g., tuition remission, career ladders) is becoming more common in health care organizations, where skill shortages and concerns about quality of care have led to increasing investment in the frontline health care workforce. However, few studies have examined the effectiveness of these policies in shaping the career trajectories of health care workers. Purposes: The aim of this study is to examine how HPWPs that focus on career development are related to an individuals' perceived mobility with their current employer. We will also examine the relationships between perceived mobility, job satisfaction, and turnover intent. Methodology/Approach: We use confirmatory factor analysis and structural equation modeling to examine the relationships between HPWPs and perceived mobility in a sample of 947 frontline health care workers in 22 health care organizations across the United States. Findings: The findings suggest that tuition remission and educational release time positively predict perceived mobility. Measures of perceived organizational support in one's current position (e.g., financial rewards, workload, and autonomy) and perceived supervisor support for career development arc also significant predictors of perceived mobility. Finally, perceived mobility is a significant predictor of job satisfaction and intent to stay with current employer. Practice Implications: Our findings suggest that HPWPs related to career development may be effective tools in improving workers' assessments of their own career potential and improving overall job satisfaction of front line health care workers. Consequently, HPWPs related to career development may help employers both retain valuable workers and fill worker shortages. [ABSTRACT FROM AUTHOR]

BACKGROUND: : Middle manager resistance is often described as a major challenge for upper-level administrators seeking to implement complex innovations such as evidence-based protocols or new skills training. However, factors influencing middle manager support for innovation implementation are currently understudied in the U.S. health care literature. PURPOSE: : This article examined the factors that influence middle managers' support for and participation in the implementation of work-based learning, a complex innovation adopted by health care organizations to improve the jobs, educational pathways, skills, and/or credentials of their frontline workers. METHODS: : We conducted semistructured interviews and focus groups with 92 middle managers in 17 health care organizations. Questions focused on understanding middle managers' support for work-based learning as a complex innovation, facilitators and barriers to the implementation process, and the systems changes needed to support the implementation of this innovation. FINDINGS: : Factors that emerged as influential to middle manager support were similar to those found in broader models of innovation implementation within the health care literature. However, our findings extend previous research by developing an understanding about how middle managers perceived these constructs and by identifying specific strategies for how to influence middle manager support for the innovation implementation process. These findings were generally consistent across different types of health care organizations. PRACTICE IMPLICATIONS: : Study findings suggest that middle manager support was highest when managers felt the innovation fit their workplace needs and priorities and when they had more discretion and control over how it was implemented. Leaders seeking to implement innovations should consider the interplay between middle managers' control and discretion, their narrow focus on the performance of their own departments or units, and the dedication of staff and other resources for empowering their managers to implement these complex innovations. [ABSTRACT FROM AUTHOR]

Background: Because work satisfaction of nurses is related negatively to turnover and related positively to performance, it is essential that it be assessed accurately and meaningfully. The most commonly used scales for assessment of satisfaction were developed at least 30 years ago and are not consistent with the concerns of today's nurses. Objectives: The objectives of this study were to develop and test a new work satisfaction measure, the Satisfaction in Nursing Scale (SINS). Methods: On the basis of qualitative interviews with 20 nurses, 115 distinct items pertaining to work satisfaction as a nurse were identified. After assessment for content validity, 113 items remained. A total of 787 participants were used for the initial analyses of the SINS. Data from an additional 366 participants were used to confirm the factor structure and to assess the convergent validity of the SINS further. Results: Exploratory factor analysis yielded a scale with 59 items on four factors, accounting for 41 % of the variance in scores. Reliability estimates for the SINS factors range from .81 to .94. All four factors were confirmed using Structural Equation Modeling (SEM), with an additional 4 items removed. The SINS factors correlated moderately with a measure of organizational commitment (r = .40-.62). Moderate correlations were also found between the SINS and the counterpart factors of the Hinshaw and Atwood Work Satisfaction Scale. Discussion: The SINS is a sound work satisfaction instrument. Next steps include further construct validity assessment and exploration of the use of the SINS in other clinical settings. [ABSTRACT FROM AUTHOR]

Purpose of Review: The satellite cell is the principal muscle stem cell. Recent research, however, has highlighted new stem cell sources that, once activated in the muscle tissue, can participate in muscle regeneration. This article reviews the state of research on stem cell populations that have potential for treatment of muscular dystrophies., Recent Findings: Despite recent findings about the stem cell character of satellite cells and their in-vivo myogenic potential, limitations related to muscle precursor cell transfer therapy have encouraged the investigation of stem cell sources other than satellite cells. Current research is focused on identifying the best stem cell in the endothelial compartment, which is able to be systemically delivered to reach all the muscles and to contribute to widespread muscle regeneration within these muscles., Summary: Current results highlight many possible stem cell sources for stem cell therapy of muscle diseases, and work is ongoing to identify the most effective candidate that is able to robustly regenerate muscle tissue and to functionally repopulate the muscle stem cell compartment.

Purpose of Review: The aim of this review is to highlight advances in the field of skeletal muscle regeneration that have been made in the last year., Recent Findings: Studies have increased our understanding of the activation of satellite cells within their niche on the muscle fibre, the contribution of satellite cell-derived muscle precursor cells to skeletal muscle regeneration and the reduction of satellite cell function in old muscle. Although other stem cells, either bone marrow derived or present within skeletal muscle or other tissues, do contribute to muscle regeneration, recent studies have highlighted that this is at best minimal compared with the ability of satellite cells to regenerate skeletal muscle. The effect of the host muscle environment has been shown to have a profound effect on skeletal muscle regeneration. Age and denervation have a detrimental effect and certain types of muscle injury a positive effect. Work continues on the effect of growth factors on muscle cell lines in vitro and muscle regeneration in vivo., Summary: Recent work has focused on the contribution of satellite-cell derived muscle precursor cells and other stem cells to skeletal muscle regeneration. The muscle environment has a profound effect on the regenerative capacity of resident and implanted cells. Muscle regeneration may be optimized by using the best stem cell population and by modifying the host muscle environment.