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.     

The minds of a medical director

This article is offered in a nod to all those readers who have been exposed to "whole brain" theory, either through the American College of Physician Executives or elsewhere. As managers struggle with balancing the "left brain" and "right brain" aspects of their work, the author says, they might consider exploiting a third area of activity, or inactivity--the "no brain." This center position can be especially effective in dealing with the high-technology aspects of delivering health care.     

The marriage of medicine and computers

Although computers, in one form or another have been around for several decades, they have only recently acquired the power, the simplicity of operation, and the cost-effectiveness to make their widespread application in health care a reality. But a reality it is, and no manager can be successful without a working understanding of how computers and information technology mesh with the information needs of health care delivery. Computer literacy is no longer a nice add-on--it is a basic weapon in every health care professional's armamentarium.     

Socio-Economic Characteristics and Life Expectancies in Nineteenth-Century England: A District Analysis

This paper presents an analysis of levels of life expectancy and their patterns of change among six socio-economically differentiated sub-populations of England and Wales for the period 1851–1911. Differences in mortality levels among these sub-groups and their rates of change are analyzed with respect to three groups of explanatory variables, viz., environmental, stratification and demographic variables. Their relative importance for different periods is assessed and discussed. The findings show consistency with two previous studies, which have suggested that medical advances had little effect on the increase in life expectancy during the second half of the nineteenth century. The present paper supports the results of one study in that public health measures affected life expectancies earlier, while subsequently, the increase in standards of living was more important.     

Herbivores and natural enemies of brassica crops in urban agriculture

Urban agriculture has been growing in popularity around the globe. As more land is allocated to urban agriculture, there is a greater need to understand arthropod herbivores and natural enemies in these sites. The area and production type of urban agriculture could influence the risk of pest outbreaks, since larger food production areas are hypothesized to host more abundant herbivore populations. To determine the potential for pest outbreaks, we sampled for pests and above-ground natural enemies at three types of sites with variable amounts of cultivated areas: residential gardens, community gardens, and urban farms. We focused on pests of brassica, a widely cultivated crop family attacked by cabbageworms and aphids. We investigated the relationships of garden characteristics and surrounding land cover on natural enemies and herbivores of brassica. More herbivores and plant damage were expected in larger community gardens and urban farms. However, herbivore populations were low across sites and not explained by garden characteristics or area of production. Herbivory on brassica averaged less than 15% at all sites. Limited plant damage and low herbivore numbers may be attributed to the positive effects of garden flowers on parasitoids and high numbers of parasitoids and generalist predators across sites. Garden area and floral resources had positive relationships with natural enemy abundance, although community composition was similar across sites. Since arthropod natural enemies were abundant across all types of food production, this suggests that urban agriculture is a beneficial habitat that could support regulating ecosystem services such as biological control.     

Contrasting Complex with Highly Complex Contact Disputes Between Parents

This article discusses the complexity of seeking a solution to problems associated at times with parental alienation. Two scenarios are presented. Both cases involve a child who does not wish to have contact with an absent parent after the separation of the parents due to implacable hostility between them. In the first case, the child had a good relationship with the now absent parent. In the second case the child never had a close relationship with the absent parent. Each case needs to be assessed on its own merits. Conclusions are drawn and recommendations are made as to how to deal with such issues.     

What if the Custodial Parent Refuses to Cooperate With Child Contact Decisions?

This article considers the failings at present of the judicial system in not being even handed in providing justice for the noncustodial parent, who has for whatever reason been ousted from the relationship and has poor, if any, contact with his or her children. The advice being provided by the current psychologist dealing with such cases is for the judiciary to adopt a much firmer approach. This will lead to the judiciary being respected rather than being considered unjust. The article is concerned with severe parental alienation and provides a solution to the situation to prevent further emotional abuse of children against an absent parent. The author encourages mediation to commence with and then continue when making decisions as to who should have custody of the children who have been emotionally abused via an alienating parent.     

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Attitude adjustment

How can you motivate physicians so that their decisions and behavior reflect what is best for the group practice, instead of themselves or their department? By clearly stating expectations and goals, physicians can learn that the priority must be the success of the group practice. Presented here is an example of how the Orlando Health Care Group (OHCG), a primary care medical group with 85 physicians in four specialties, addressed this challenge and the physicians' positive response to the change. To survive as a group, the OHCG had to abandon old ways of managing conflict and agree upon a list of core values around which it could evaluate all future physician behavior. The list became known as the "10 Commandments." They were meant to give every individual a sense of place and purpose within the group, knowing that the best way for an individual to prosper was to be part of a successful group.