Keeping score. Scorecards, profiles and report cards rapidly expanding to track physician performance

Not all doctors like them, some even ignore them, but nevertheless the use of physician scorecards is growing and the scores may soon be widely available to the general public.     

Adolescents coping with mom's breast cancer: developing family intervention programs

The purpose of this pilot study was to gain a deeper understanding of how adolescents are affected by their mothers' breast cancer and to discover their opinions about how future intervention programs should be designed. Three focus groups were conducted with a total of 10 adolescents. Findings indicate that adolescents' lives had been complicated by their mothers' illness, as they often felt burdened with additional roles and responsibilities. Adolescents suggested that future intervention programs should have the following elements: Adolescent group comprised of boys and girls within 4 months of cancer diagnosis; psychoeducation; target coping skills sensitive to girls and boys of different ethnic and racial backgrounds; and after the adolescent groups, have multiple-family therapy groups that promote shared family understanding and open communication between parents and adolescents.     

Private lives,public accountability: A case study

Lend a Hand Children's Services is the most prominent provider of family services in rural south central Ohio. The agency is in the process of enlarging its fundraising goals and becoming even bigger in the community. Staff have brought to the attention of the vice president of the board that the board president and the executive director may be involved intimately as a couple. Inasmuch as the board president must evaluate the executive director, the vice president turns to trusted counsel for advice on how to approach the unique problems raised by the situation.     

Scared silent: the clash between malpractice lawsuits & expert testimony

As the Bush administration pushes Congress to place a $250,000 cap on pain and suffering awards in medical malpractice lawsuits, other moves quietly afoot by state medical boards, state medical associations, and specialty societies may reduce liability insurance premiums by limiting the number of suits.     

Feminae Populi: Popular Images of Women in Medieval Literature

Maureen Fries's essay, although not about witches, expands upon Elizabeth Tucker's paper. The duality of women i n the literature examined by Fries show them to be virgin or whore: the woman saint is a model of such desirable qualities as chastity, obedience, and fortitude, while the fabliau woman uses her sexuality for fun and for profit. The literature, in both instances, depicts male values in a male world. Ultimately, the popular image of women can be distilled into the roles of Mary, wholly above feminine weakness, and Eve, who represents theopposite. Possibly the only “mixed” image is that of the Magdalene, who recalls the fallen Eve, but who also is transformed into the virtuous woman. The Lack of flexibility, not noted elsewhere in medieval literature, in the perception of medieval women suggests that we need to know more about the society of the Middle Ages and women's place in it.     

Preferences for life saving programs: how the public discounts time and age

In surveys of 3,000 households, we have found that people attach less importance to saving lives in the future than to saving lives today, and less importance to saving older persons than to saving younger persons. For the median respondent, saving six people in 25 years is equivalent to saving one person today, while for a horizon of 100 years, 45 persons must be saved for every person saved today. The age of those saved also matters; however, respondents do not weight lives saved by number of life-years remaining: For the median respondent, saving one 20-year-old is equivalent to saving seven 60-year-olds.     

A value of information framework for assessing the trade-offs associated with uncertainty,duration, and cost of chemical toxicity testing

A number of investigators have explored the use of value of information (VOI) analysis to evaluate alternative information collection procedures in diverse decision-making contexts. This paper presents an analytic framework for determining the value of toxicity information used in risk-based decision making. The framework is specifically designed to explore the trade-offs between cost, timeliness, and uncertainty reduction associated with different toxicity-testing methodologies. The use of the proposed framework is demonstrated by two illustrative applications which, although based on simplified assumptions, show the insights that can be obtained through the use of VOI analysis. Specifically, these results suggest that timeliness of information collection has a significant impact on estimates of the VOI of chemical toxicity tests, even in the presence of smaller reductions in uncertainty. The framework introduces the concept of the expected value of delayed sample information, as an extension to the usual expected value of sample information, to accommodate the reductions in value resulting from delayed decision making. Our analysis also suggests that lower cost and higher throughput testing also may be beneficial in terms of public health benefits by increasing the number of substances that can be evaluated within a given budget. When the relative value is expressed in terms of return-on-investment per testing strategy, the differences can be substantial.