Ernest Amory Codman, M.D., and end results of medical care

Ernest Amory Codman, M.D., was one of the most important figures in the history of outcomes research in medicine. While his contemporaries scorned his efforts to create systematic procedures to evaluate the end results of medical care, his work foreshadowed many of today's most pressing issues in technology assessment. This article traces Codman's career as an innovator and political gadfly at the Massachusetts General Hospital during the first three decades of this century, and examines the development and demise of his end-result system.     

Remembering Peter Drucker: inspiring the quality revolution in healthcare

The authors review the late Peter Drucker's most significant writings, especially as they pertain to contemporary quality improvement principles in healthcare. In order to determine Drucker's most influential works, the authors conducted an empirical review of his impact by examining academic citations to his work and ideas.     

Carotenoids as antioxidants.

Larry Machlin had many and varied interests in nutrition in general and antioxidants in particular. Although he was interested primarily in vitamin E, he shared a curiosity about the actions of carotenoids that most nutritionists have. He served on the Organizing Committee of the 8th International Symposium on Carotenoids that was held in Boston in June 1987. In that role, he was an active participant in helping to select sessions and then identifying the speakers who spoke at those sessions. As part of that Organizing Committee, I had the opportunity to grasp his breadth of science and his knowledge about the most current work, even in fields in which he was not directly involved. His loss has been felt, not only for his scientific contributions but also the warmth and kindness of his personality.     

Freire's contribution to practice and critical education in nursing

The authors present some biographical data about Paulo Freire, his main works and his most important production, showing the fertility of his legacy. This article aims to discuss the articulation of some concepts used by Freire in nursing practice and education, offering reflections for turning professional practice more critical and creative on the basis of this Brazilian educator's ideas.     

Karl Landsteiner (1868-1943) and the specificity of serological reactions, one hundred years ago and now

One hundred years after his discovery of the AB0 blood groups, the monumental work of Austrian physician Karl Landsteiner (1868-1943, Nobel Prize 1930) on the specificity of serological reactions is widely recognised. His work on isoantigen reactions included the discovery, together with Levine and Wiener, of the Rhesus factor. Landsteiner did much to develop our understanding of autoantibody reactions and also contributed insights into the aetiology of infectious diseases that were rampant in his time. His work in immunochemistry included the discovery of hapten antigenicity. However, most of all he wanted to be remembered for his theory on the specificity of serological reactions, which he had strongly substantiated with his own work. Landsteiner suffered from the shortages in Vienna at the end of World War I. He and his family moved to the Netherlands in 1919. There he worked as pathologist at the Red Cross Hospital in The Hague until his move to the Rockefeller Institute in New York in 1923. Nowadays, his work is celebrated for its numerous excellent contributions to the fields of transfusion and transplantation medicine, population genetics, immunology, and infectiology.     

Who is working for whom?

A recent trend in many medical groups toward management aiding in "employee self-fulfillment" leads to the question, "Who is working for whom?" The author of this article firmly believes that a manager's expectations, encouragement, and support of his employees must be used to balance his own personal intelligence, knowledge, and skills if he is to be successful in his job. A manager's strong desire and commitment to becoming involved in his employees' lives will bring many benefits to all involved--management, employees, and most importantly, the patients.     

Lorenzo Tomatis and primary prevention of environmental cancer

The leading 20th century proponent for primary prevention of environmental cancer was Dr. Lorenzo Tomatis, the former Director of the International Agency for Research on Cancer and founder of the IARC Monographs program. This paper is dedicated to the memory of Dr. Tomatis--eminent scientist, scholar, teacher, humanitarian, and public health champion--and includes many perspectives that he promoted throughout his career, with original quotations from some of his scientific writings on primary prevention of environmental cancer. Any attempt by us to simply summarize his views would only detract from the power and logic of his language."Cancer still remains a mainly lethal disease. Primary prevention remains the most relevant approach to reduce mortality through a reduction in incidence".     

Too little or just right? Bush lays his healthcare budget on the table, but Democrats--and some Republicans--say $190 billion falls short

In his State of the Union address last week, President Bush barely mentioned healthcare. But he tried to make up for it when he released his healthcare budget for 2003, which calls for $190 billion over 10 years to reform Medicare. The plan got a lukewarm reception from those in the industry, along with most Democrats and even some Republicans, who were hoping for a stronger stand.     

Probable non-vector-borne transmission of Zika virus, Colorado, USA

Clinical and serologic evidence indicate that 2 American scientists contracted Zika virus infections while working in Senegal in 2008. One of the scientists transmitted this arbovirus to his wife after his return home. Direct contact is implicated as the transmission route, most likely as a sexually transmitted infection.     

Reassurance reconsidered

Reassurance is a therapeutic intervention that is commonly employed by physicians in their practice of medicine. Although physicians most often save reassurance for the patient with benign and transient disease, it is an appropriate therapeutic intervention in patients with chronic and progressive conditions as well. The goals of reassurance include relieving the patient's anxiety and restoring his sense of autonomy. This requires that the physician clarify the meaning that the perceived illness has for the patient, characterize the patient's information needs and convey a message that addresses these needs in an empathic and unambiguous way. Ultimately, the success of reassurance relies as much upon the physician's ability to effectively communicate with the patient and his commitment to the doctor-patient relationship as it does to his understanding of human pathology.     

The Hospital Rehabilitation Officer and the Community

Whether he can go back to his job may well be the problem that matters most to the patient, but its solution is often delayed because neither physician nor employer has the expertise to reconcile the individual's job responsibilities with his medical situation. The gap can be bridged at low cost, a British hospital has found, by rehabilitation officers who serve as inhospital advisers, job analysts, and liaison with industry.     

美国总统与医改：从富兰克林·罗斯福到巴拉克·奥巴马詹姆斯·莫罗尼

2010年3月,美国总统巴拉克.奥巴马签署了医疗卫生改革法案,使之成为法律。促成这一法案花费了七十五年,自罗斯福总统开始,历任美国总统均致力于进行全国性的医疗改革,但大部分改革都失败了。本文探讨了奥巴马改革高度的政治化背景以及他运用的政治技巧。并将奥巴马取得的成绩与历届总统的经验进行了对比。今后,医疗改革的实施还将对民主党、共和党以及政治程序本身构成巨大的挑战。     

Shooting the messenger: the vilification of Irving J. Selikoff.

Dr. Irving J. Selikoff (1915-1992), a New York physician based at Mount Sinai Hospital, was the leading American medical expert on asbestos-related diseases between the 1960s and early 1990s. In a country that had been the world's greatest consumer of asbestos, he was also at the center of the key controversies connected with the mineral. In these controversies, Selikoff was consistently demonized as a media zealot who exaggerated the risks of asbestos on the back of bogus medical qualifications and flawed science. Since his death, the criticism has become even more vituperative and claims have persisted that he was malicious or a medical fraud. However, most of the attacks on Selikoff were inspired by the asbestos industry or its sympathizers, and for much of his career he was the victim of a sustained and orchestrated campaign to discredit him. The most serious criticisms usually more accurately describe his detractors than Selikoff himself.     

The competitive effects of horizontal mergers in the hospital industry: a closer look

Woolley (1989) attempted to analyze the competitive impact of horizontal hospital mergers using the 'event study' method. Woolley characterized his results as consistent with traditional 'oligopoly' theories of market behavior. We scrutinize in detail a large number of his events, however, and find that most either generated concentration increases too small to plausibly produce market power, or could not have conferred monopoly returns on firms improperly characterized as rivals. Accordingly, any observed abnormal returns are likely attributable to some other cause; we suggest some alternative interpretations of his results. Our paper highlights the need for care in the selection of events and the identification of rivals when applying the event study method to the analysis of mergers.     

An issue-charged first year for AHA's Davidson

Reclassification and reform were major issues in Richard Davidson's first year as president of the American Hospital Assn. Those issues, as well as a litany of other budget and legislative battles, promise to rank among his biggest challenges during his second year in office. He's cleared the first hurdle in the reform battle--finding a plan most AHA members can accept.     

What They Don’t See

The author is currently living with a chronic autoimmune disease known as Hashimoto’s Thyroiditis, which caused his hypothyroidism. Although this disease is most common in middle-aged women, he was diagnosed at age 23. This disease is unique, because it is not entirely visible to others. In this piece, he presents a personal narrative of his diagnosis process and utilizes poetic inquiry to demonstrate to readers what “they,” meaning individuals without an invisible chronic autoimmune disease, don’t see.     

DIAGNOSIS AND DETECTION OF RODENT PLAGUE

Stories of his own observations by one who has had experience are the most valuable kind of lessons. This authority places before his readers details of the diagnosis of plague and practical laboratory methods. He outlines the essential features of technique and determination clearly and accurately and has here really a preparatory course in plague detection that it is not easy to get from books.     

DIAGNOSIS AND DETECTION OF RODENT PLAGUE

Stories of his own observations by one who has had experience are the most valuable kind of lessons. This authority places before his readers details of the diagnosis of plague and practical laboratory methods. He outlines the essential features of technique and determination clearly and accurately and has here really a preparatory course in plague detection that it is not easy to get from books.