Making a difference. The physician liaison

Physician liaison profile ... Who are they and what role do they play in the physician hospital relationship? The Virginia hospital featured found even the smallest changes and improvements can make a big difference.     

Making a difference in curriculum reform and decision-making processes

CONTEXT: Although firmly grounded in Flexner's legacy of ideas, today's medical curriculum, as both an entity and a process, has become more and more complex. The curriculum as an entity is portrayed according to five key elements: the expected competencies and roles; the learners at the centre of the enterprise; assessment linking competencies and learners; the conditions and resources for learning; and a multifaceted socio-politico-cultural context in which the learning occurs. Significant developments have also occurred in the disciplines of curriculum studies, cognitive psychology and organisational change over the past century, as well as in institutional best practices, that help us to better understand and plan curricular innovations. DISCUSSION: Practical advice is offered to help curriculum developers in designing or reforming the medical curriculum. The key points of this are: (i) while focusing reform and innovation on specific elements of the curriculum, consider how those elements affect other elements and vice versa, in positive and negative ways; (ii) while grounding the reform or innovation in sound conceptual frameworks, seize any opportunities to formulate a research agenda that can build upon and advance our understanding of curricular innovations, and, (iii) moving beyond considering the curriculum as an entity, use deliberative and leadership processes that can lead to enduring curriculum reform.     

Making a difference. The World Health Report 1999

The World Health Report 1999 presents a summary of the accomplishments and challenges in world health and underscores their implications in the 21st century. A remarkable progress in health conditions was recognized during this century, as exemplified by the increase in life expectancy in high-income countries. Most of the world's low- and middle-income countries have also experienced improvements in the quality of life and contributed to economic growth. On the other hand, the world's poor populations continue to suffer from the burden of disease and malnutrition. The reduction of this inequality is considered a priority in international health, together with enhancement of growth and decreasing poverty. Provided that global leadership and advocacy for health are applied in the formula for progress, the achievement of these goals is feasible. However, there are certain challenges ahead which need to be overcome, such as the burden of excess mortality and morbidity; countering potential threats to health; development of a more effective health system; and the need to invest in expanding the knowledge base.     

Making a difference in differences for the health inequalities of individuals

Policy interventions should focus on the degree to which health conditions are persistent, avoidable, and treatable. Assistance should be targeted to people who are at greater risk for such conditions amid the most pronounced gaps between their available resources and likely economic needs. The highest-yield interventions should address prenatal and early childhood care and reformation of destructive lifestyle practices. Improving outreach, education, convenience of access, and service delivery represents a more important factor than expanding the level and scope of insurance coverage. Vulnerable people are better served by more pluralistic social processes that facilitate, but do not mandate, more effective choices and trade-offs.