A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

Mortality differences in Norway. Two biographical data analyses and one question about female mortality differentials

"The aim of this paper is, first, to give an overview of the local history approach developed in adult mortality differentials; secondly, to present its potentiality compared with a more usual approach.... Our methodology was applied to Norwegian data."     

《新西兰文化与认同感·序言》

《新西兰文化与认同感·序言》大卫·诺维茨比尔·威尔莫特著涂开益徐永安译编选本书的初衷,源出编者在讨论新西兰民族认同感与文化的基本命题时,对于人们所持方式的关注。我们俩人一致认为,当时的争论有两点失之偏颇：一是如何准确理解被称之为文化的这种奇特现象,二...     

Next-generation informatics. A new picture of quality medicine

It's up to the physician executive to make an informed choice when selecting a "next-generation" information system. Look for systems that truly integrate (not merely interface) managed care components, clinical capabilities, and other features in a model that mimics the workflow of an actual practice. Take the time to learn about the technology. Consider how a vendor's product will work at every point within your organization. Seven critical features that physician executives should consider in their decision-making are described.     

Physician glut. Physicians--the next victims of "downsizing?"

Should physicians really be polishing up their CVs or preparing to enter another line of work? In a word: No. What a recent survey makes clear is that, while managed care is driving physicians from some markets, jobs are still available in other markets traditionally underserved by physicians. This is not to suggest that the physician employment market has gone unchanged. Many physicians, particularly specialists, have taken income hits, and some specialists truly are in need of work. Primary care physicians, however, have seen their stars rise and are now in a position to work wherever they want. Physicians may no longer be able to practice within 50 miles of where they were raised or where they were trained, as has been their wont. Instead, they will have to do what other professionals have long done--go where job opportunities take them. In short, they will have to add a career strategy to their scientific mindset, and that means an aggressive job search, coupled with a strong consumer orientation.     

Euthanasia and persistent vegetative state individuals: the role and moral status of autonomy

This paper offers a philosophical consideration and evaluation of several different criteria of moral standing, and discusses their implications for persistent vegetative state (PVS) individuals who were once competent. It is argued that the only criterion PVS individuals meet is that of being human, which is not the best test of moral standing. Accordingly it is, in principle, morally acceptable to perform passive or active euthanasia on PVS individuals or to use their bodies for research or for organ harvest. Nevertheless, the autonomous choices made by the persons the PVS individuals used to be can still impose moral obligations. Indeed, it is argued that the capacity for autonomy is a particularly appealing criterion of moral standing, and that the implications of this standard for PVS individuals confirm that appeal.     

Matching anonymous pre-posttests using subject-generated information

Sensitive research issues call for anonymous questionnaires. This makes accurately matching pretests with posttests difficult or impossible. Various subject-generated coding schemes have been developed, but their accuracy has been unknown. This anonymous study, with 745 students, used subject-generated coding to match pretests with posttests. The matching was verified for accuracy with the use of a collateral, anonymous, sticker identification system. The coding system was able to accurately match 75.2% of all the pretest-posttest pairs. An additional 22.1% of the pairs were left unmatched and only 2.7% were matched incorrectly. Subject-generated coding systems can be very effective where confidentiality is important to protect.     

The implementation of the healthy cities project in developing countries: lessons from Chittagong

The Chittagong Healthy City Project was carried out in late 1994 in Chittagong, Bangladesh. This paper presents findings of an evaluation of the project based upon internationally generated process indicators related to the institutional aspects of the project. The following issues are discussed with regard to project implementation: the institutional organization of local authorities, institutions' conceptual understanding of the project, formal insertion of the project into public authorities' activities, institutional leadership of the project, central-local relations, the lack of interministerial coordination, the project's office, international projects, and community organization. Giving consideration to these issues may help program planners detect problems in forthcoming projects prior to their implementation.     

Changes in health, mortality, and disability and their impact on long-term care needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. Among those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes--such as the increasing educational level of the elderly population--is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.