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.     

Coming out

Self-knowledge is the beginning of integrity, of coming out of the closet, and is a prerequisite for dealing well with change. Integrity is not just about not lying. Integrity means as on the inside, so on the outside. The Latin roots of integrity refer to touch. To have integrity is to be untouched, undivided, whole, integrated, integral. There is a tight relationship between integrity and the ability to change, because integrity is about knowing yourself, about being transparent. Integrity allows you to move with tremendous speed when the time comes to move. An organization that wants to learn to dance with change must come to know itself and its environment thoroughly. To do this, it must make use of all the knowledge of every member--and all of their learning capability. It must be built into the culture that new information and different points of view are powerful, are welcomed.     

Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Where can we learn about change?

Presented here are some resources--books, consultants, and personal growth practices--that you might find useful in the struggle to become adept at dealing with change. Mastering change is a long process, but unlike building a cathedral or growing apples, as soon as you start you will have something that you can use--some insight, a different way of looking at what is confronting you, something to help jar you to a more creative strategy.     

Running toward the roar

How do you embrace paradox, changing and growing without losing your sense of who you are? We talked last time about the paradox of reaching for the new, without losing your ground in the old. Paradox is the place of insight. Accepting paradox, not as a momentary distraction but as a place to live, lies at the heart of dealing successfully with change. We can see this most clearly if we ask ourselves, "What business am I in? What am I about?" In health care, this did not used to be a meaningful question. Today, it is a critical one. But to really develop, we have to seek out the situations that are the most difficult for us, work them through, hang out with them long enough to begin to be at home in the paradoxical, ambiguous, and strange circumstance.     

Mixed estimation of old-age mortality

"Section 2 will first extend the method of mixed estimation to maximum likelihood estimation in general. Then, we will review generalized linear models with logistic and Poisson regressions as examples. In Section 3 we discuss different approaches for formulating the auxiliary information in practice. Section 4 first reviews the method of Coale and Kisker, provides empirical estimates for it, and then proceeds with the mixed estimation variant. In Section 5 we apply the methods to the estimation of mortality at ages 80+ in Finland in 1980-1993. We will first consider the evidence for mortality crossover between males and females....Then we will estimate life expectancies at age 100." (EXCERPT)     

Second generation decline? Children of immigrants,past and present--a reconsideration

"Is the contemporary second generation on the road to the upward mobility and assimilation that in retrospect characterized the second generation of earlier immigrations? Or are the American economic context and the racial origins of today's immigration likely to result in a much less favorable future for the contemporary second generation? While several recent papers have argued for the latter position, we suspect they are too pessimistic. We briefly review the second generation upward mobility in the past and then turn to the crucial comparisons between past and present."     

Ireland: an "emigrant nursery" in the world economy

"This paper focuses on historical and contemporary aspects of Irish emigration and argues that a world-systems, comparative approach avoids the pitfalls of behaviouralism and national exceptionalism in conventional accounts of Irish emigration. It suggests that causes and consequences vary with social class, ethnic group and regional context, compares 'traditional' with 'new wave' emigration and argues that it is premature to talk of the 'Europeanisation' of Irish emigration." (SUMMARY IN FRE AND SPA)     

Informed decision making: the new paradigm

Health care cannot survive in its present form. It is becoming unaffordable for a large share of the country's population. Its quality and effectiveness inexplicably vary between communities and across time. With all these problems, the process of health care can be understood. All that are needed are good, basic data; its access, management, and analysis; and then presentation of facts and observations. Together, these functions describe the translation of data into information--the field of medical informatics. Information about such management concerns as clinical efficiency (which largely is related to appropriateness and cost-effectiveness) and about the realities of day-to-day medical practice can be used to improve the value of health care. Informed decision making is based solely on confidence that, given the right information and understanding, we can all make the right decisions. The right decisions mean better patient acceptance and satisfaction, a sense of value enhancement by payers, and support of the Hippocratic tradition.