Rationalizing Healthcare

2019 ◽  
pp. 35-48
Author(s):  
Robert L. Wears ◽  
Kathleen M. Sutcliffe

Healthcare changed dramatically during the 20th century; industrialization lead to contention for control over medical work and there was a shift from autonomous, professional control to managerial, hierarchical control, which included a strong belief in technical rationality. The rise of scientific-bureaucratic medicine combined ideas from Taylorism (i.e., the “one best way.” separation of planning from activity, and the rise of a managerial class) and a rationalizing turn in medicine (e.g., evidence-based medicine) to produce a hybrid group of clinician-managers, who can retain control of healthcare in health professionals’ hands. The quality improvement effort preceded the safety movement in health care by about a decade.

Author(s):  
I. Kukhtevich

Functional autonomic disorders occupy a significant part in the practice of neurologists and professionals of other specialties as well. However, there is no generally accepted classification of such disorders. In this paper the authors tried to show that functional autonomic pathology corresponds to the concept of somatoform disorders combining syndromes manifested by visceral, borderline psychopathological, neurological symptoms that do not have an organic basis. The relevance of the problem of somatoform disorders is that on the one hand many health professionals are not familiar enough with manifestations of borderline neuropsychiatric disorders, often forming functional autonomic disorders, and on the other hand they overestimate somatoform symptoms that are similar to somatic diseases.


2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Dong Huang ◽  
Yan-Qing Liu ◽  
Li-Shuang Liang ◽  
Xue-Wu Lin ◽  
Tao Song ◽  
...  

At present, there are many constantly updated guidelines and consensuses on the diagnosis and treatment of osteoarthritis both at home and abroad. The recommendations established using methods of evidence-based medicine has experienced strict research on controlling bias and promoting reproduction rate. As a result, the previous evidence was reevaluated, and a lot of changes were provoked in the diagnosis and treatment concept of osteoarthritis. However, several methods not recommended by foreign guidelines are still in use in the current clinical practice in China. On the one hand, Chinese experts have not reached extensive consensus on whether it is necessary to make changes according to foreign guidelines. On the other hand, almost all the current relevant guidelines are on osteoarthritis, but the lesions around knee joints which, as a whole, bear the largest weight in human body, cannot be ignored. For this purpose, Chinese Association for the Study of Pain (CASP) organized some leading experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of degenerative knee osteoarthritis (DKOA) in combination with the guidelines in foreign countries and the expert experience of clinical practice in China. The consensus, which includes the definition, pathophysiology, epidemiology, clinical manifestation, diagnostic criteria, and treatments of DKOA, is intended to be used by first-line doctors, including pain physicians to manage patients with DKOA.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S586-S587
Author(s):  
Caroline G Coleman ◽  
Timothy T Daugherty ◽  
Yooree G Chung ◽  
Angel X Xiao ◽  
Amy C Sherman ◽  
...  

Abstract Background The medical community has used Twitter as a learning tool during the COVID-19 pandemic to digest the high volume of rapidly evolving literature. However, Twitter contains educational content of varying quality and accuracy. To address this issue, we created and disseminated visual abstracts of COVID-19 literature on Twitter to educate health professionals. Methods Fellows and faculty members from multiple institutions collaborated with Emory University medical students to create visual abstracts of published COVID-19 literature (Figure 1). ID fellows and faculty identified and summarized 10-15 high-impact COVID-19 articles each week. Medical students created visual abstracts for each article, which fellows or faculty reviewed for accuracy. We disseminated them on Twitter (@JenniferSpicer4, 4,373 followers) and our website (Figure 2). We measured engagement with tweets using Twitter Analytics. Figure 1: COVID-19 Visual Abstract Example Figure 2: Website hosting COVID-19 weekly literature summaries and visual abstracts (https://med.emory.edu/departments/medicine/divisions/infectious-diseases/covid19-roundup/) Results Since March 2020, we have created, reviewed, and disseminated 139 graphics with 116 student authors and 33 fellow/faculty reviewers across three academic institutions (Table 1). Topics included public health & prevention, virology & basic science, epidemiology, transmission & infection control, clinical syndrome, diagnostics, therapeutics, vaccinology, and ethics & policy. Tweets had a median of 9,300 impressions (interquartile range [IQR] 5,432-13,233) with 766 engagements (IQR 432-1,288) and an engagement rate of 8.6% (IQR 7.1%-10.0%) (Table 2). Each tweet had a median of 25 retweets (IQR 17-38) and 55 likes (IQR 34-81). A few tweets had significantly higher metrics; maximum values were 84,257 impressions, 9,758 engagements, 19.0% engagement rate, 239 retweets, and 381 likes. In addition to disseminating graphics on Twitter, we received requests to use them as teaching aids from multiple health professionals worldwide, and the visual abstracts have been translated into Spanish and disseminated on Twitter and Instagram via @MEdSinFrontera. Table 1: Descriptive Statistics of COVID-19 Visual Series Table 2: Twitter Metrics for COVID-19 Visual Series (as of 6/10/2020) Conclusion Engagement rates with our visual abstracts were high, demonstrating the power of Twitter. ID educators can use visual abstracts to summarize and disseminate accurate information to a large audience on social media, which is especially important in the setting of an emerging infection. Disclosures All Authors: No reported disclosures


1995 ◽  
Vol 58 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Lucy Kamell ◽  
Suzanna S. Hoyler ◽  
Jennifer E. Seiffert ◽  
John L. Young ◽  
Donald E. Henson ◽  
...  

2021 ◽  
Vol 9 ◽  
Author(s):  
Cecilia Obeng

Purpose: There are several teaching and learning approaches but finding the one that is appropriate for a particular field or training program is an arduous task. The purpose of this paper is to introduce the “Skill Based Qualitative Learning Approach” (SBQLA) in training health professionals.Description: The SBQLA is a pedagogical approach via which learners are trained in developing qualitative questionnaires and interview skills to learn from experts in the Public Health (PH) field. This teaching approach arms students with interview skills that help them identify and address PH roadblocks and get them authentic information from experts. It also equips them with techniques on how to do formalized presentations and come up with projects and interventions that help mitigate and eliminate drivers of health problems among women, children and families.Assessment: Learners' field experiences are shared in a professional presentation style in a class to help trainees benefit from each other's information and to get formalized feedback on their presentation. Assessment in this learning approach is based on a synthesis and an analysis of data collected from professionals.Conclusion: Findings from this learning approach enables experts to shed light on true stories shared by real and authentic individuals whose faces can be associated with their shared experiences. This learning approach makes it possible for trainees to also initiate projects that help them tackle existing and emerging public health issues in their future work.


Author(s):  
Thomas Risse

This chapter focuses on hierarchical and non-hierarchical (including deliberative) governance modes in areas of limited statehood (i.e. on the ‘how’ of governance). Actorhood and modes of governance are orthogonal to each other. State actors are involved in non-hierarchical governance and non-state actors—including violent ones—sometimes exercise hierarchical control over people and territories. The effectiveness and problem-solving capacity of these modes of governance should not be underestimated. ‘New’ modes of governance appear to be more effective on average than hierarchical governance, particularly when the latter has to rely on force and coercion. Deliberative bodies, such as non-state justice institutions, can be rather effective in solving disputes and restoring peace within communities. Both hierarchical and non-hierarchical modes depend on two crucial conditions for their effectiveness, namely the social acceptance (legitimacy) of the governors and/or the governance institutions, on the one hand, and the institutional design of the governance arrangements, on the other.


2018 ◽  
Vol 120 (6) ◽  
pp. 2761-2774 ◽  
Author(s):  
Michaela Bruton ◽  
Nicholas O’Dwyer

At face value, the term “synergy” provides a unifying concept within a fractured field that encompasses complementary neural, computational, and behavioral approaches. However, the term is not used synonymously by different researchers but has substantially different meanings depending on the research approach. With so many operational definitions for the one term, it becomes difficult to use as either a descriptive or explanatory concept, yet it remains pervasive and apparently indispensable. Here we provide a summary of different approaches that invoke synergies in a descriptive or explanatory context, summarizing progress, not within the one approach, but across the theoretical landscape. Bernstein’s framework of flexible hierarchical control may provide a unifying framework here, since it can incorporate divergent ideas about synergies. In the current motor control literature, synergy may refer to conceptually different processes that could potentially operate in parallel, across different levels within the same hierarchical control scheme. There is evidence for the concurrent existence of synergies with different features, both “hard-wired” and “soft-wired,” and task independent and task dependent. By providing a comprehensive overview of the multifaceted ideas about synergies, our goal is to move away from the compartmentalization and narrow the focus on one level and promote a broader perspective on the control and coordination of movement.


2020 ◽  
pp. 79-97
Author(s):  
LaTonya J. Trotter

This chapter evaluates how the presence of the nurse practitioner (NP) does not just signal changes in nursing work; it portends changes in medical work. Although real tensions exist between nurses and physicians, broadly speaking, they have worked collegially alongside one another for well over a century. This collegiality has endured despite significant changes in what both physicians and nurses do for patients. Its endurance, however, has been predicated on the one thing that has not changed: the power relations between the two. It is the difference in authority, and not just the difference in work, that undergirds the stability of the relationship between the two professions. The NP threatens to disrupt that stability. When registered nurses (RNs) become NPs, they are not just learning new skills; they are crossing lines of authority that they had previously learned to treat as constitutive of their profession. The chapter then looks at the voices and experiences of the NPs of Forest Grove Elder Services. Their narrated and actual practices negotiated physician authority in very different ways.


Author(s):  
Dan P. McAdams

As a short digression into the world of psychiatric diagnosis, the chapter “Goldwater” discusses the controversy over whether or not mental health professionals should diagnose President Trump with a mental illness, such as narcissistic personality disorder (NPD). The chapter’s title recalls the 1964 U.S. presidential election wherein the results of a survey of psychiatrists were published in an American magazine, concluding that the Republican candidate Barry Goldwater was mentally unfit to hold office. Goldwater later sued the magazine, and the case led to what has become known as the Goldwater Rule, prohibiting psychiatrists from diagnosing public officials from afar. The chapter makes a clear distinction between psychiatric diagnosis, which adopts the language of medicine and illness, on the one hand, and psychological commentary on the other. The latter conception better characterizes what the current book aims to accomplish. Psychological commentary draws from psychological science to develop a personality portrait of a person, without diagnosis and without judgment regarding mental health and illness. Moreover, Donald Trump is much stranger than any psychiatric label can convey.


2020 ◽  
Vol 9 (1) ◽  
pp. e000708 ◽  
Author(s):  
Yuzeng Shen ◽  
Lin Hui Lee

Triaging of patients at the emergency department (ED) is one of the key steps prior to initiation of doctor consult. To improve the overall wait time to consultation, we have identified the need to reduce the wait time to triage for ED patients. We seek to determine if the implementation of a series of plan, do, study, act (PDSA) cycles would improve the wait time to triage within 1 year. The interventions related to the PDSA cycles include the refining of triage criteria, ‘eyeball’ triage by senior nurses to facilitate direct bedding of patients, formation of a triage nurse clinician role, and a needs analysis of required nursing manpower. The baseline period for this study was from January 2017 to April 2017, with the results following implementation of the respective PDSA cycles sequentially tracked from May 2017 to March 2019. There was an improvement in the wait time to triage from a baseline duration of 18 min to the postimplementation period duration of 13 min, with a 25% decrease in variance from 16 to 12 min. The improvements were sustained. Strategies to further reduce wait time to triage at the ED are discussed. We also highlight the importance of adequate triage manpower, data-driven decision making and continued engagement of stakeholders in enabling positive outcomes from this quality improvement effort.


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