"Patient Portals" and "E-Visits"

"Patient Portals" enable patients to review their medical record and add information to it. Clinics are using "E-Visits" to substitute for a face-to-face office visit. This article describes the experience of one healthcare system with "Patient Portals" and "E-Visits."     

"Precision" and "accuracy": two terms that are neither

OBJECTIVE: In some publications, the terms "precision" and "accuracy" are used as if they were synonyms for "reliability" and "validity." METHODS AND RESULTS: This article shows that these terms are neither precise nor accurate when used in this way. Scales can demonstrate high test-retest or interrater reliability (i.e., they are "precise") but still be unreliable in certain circumstances; and "imprecise" scales can still show good reliability. Further, "accuracy" as a synonym for validity reflects an outdated conceptualization of validity, which has been superseded by one that emphasizes that validity tells us what conclusions can be drawn about a person based on a test result. CONCLUSION: The article ends with a call for the use of the more traditional terms as better reflecting the process of scale development and the uses to which they are put.     

On the potential health effects of consuming "non-alcoholic" or "de-alcoholized" beverages

This paper reviews the potential health risks for persons who consume the newly available "non-alcoholic" or "de-alcoholized" beverages which may contain trace amounts of ethanol (less than 0.5% by volume). The discussion includes relative risk rates for chemical dependency, fetal alcohol syndrome, chemical and natural hypersensitivity, cancer, cardiomyopathy, hypertension and cirrhosis for those who drink standard alcoholic drinks and "non-alcoholic" drinks. It is concluded that non-alcoholic drinks pose little risk for developing alcohol related problems based on our current physiological and psychocultural knowledge.     

The use of "impotence" and "frigidity": why has "impotence" survived

The negative connotations and decreased utility of the terms "impotence" and "frigidity" prompted an investigation of their use in the literature. Psychological Abstracts were reviewed from 1940 to 1983 for titles containing these terms. It was found that both impotence and frigidity titles fluctuated at low levels from 1940 to 1969. Frigidity titles then increased slightly, but dropped to zero after 1979. Impotence titles, however, have continued to increase at a significant rate. Classic sexual behavior and therapy works are reviewed to explain this discrepancy since both terms are equally inappropriate.     

Doctors, "dirty work" patients, and "revolving doors"

Using information from research into the phenomenon of "revolving-door" psychiatric patients, the author explores general practitioners' perceptions of difficult patients and the consequences for patient management. He first considers the concept of "good and bad" as a possible subtype of dirty work. He then presents the evidence of medical irritation with patients from interview data and explores the rationalizations for the way in which patients are subsequently managed. In line with previous studies, the author argues that the construction of patients as difficult and the subsequent dynamics of exclusion lie in the breakdown of the "normal" doctor-patient relationship coupled with the doctor's need to get on with the day's workload. Moral judgments formed a part of the exclusion process.     

开辟就医“绿色通道” 创建诊疗“快捷方式”

病人在医院接受诊疗过程中希望时时顺利、处处方便;渴望尽早确诊,尽快治疗。几年来我院通过一系列改革,为病人开辟出就医“绿色通道”,创建了诊疗“快捷方式”。其内容是：提供充足信息,方便病人就医;改善医疗环境,科室合理布局;医疗资源重组,消除等待排队现象;建立“局域网络”,提高诊疗效率;改善服务观念,满足病人所需,开展高新技术,增强诊治能力;加强医疗环节管理,缩短平均住院日期。     

"门诊一体化"的实施

依托自主研发的医院门诊一卡通管理系统,针对"军字一号"系统在医院的实际应用情况,在管理及工作流程上进行合理的改造,设计"门诊一体化"系统.本系统简要介绍"门诊一体化"实施的必要性、功能和相关流程.系统应用后,改变传统的就医模式,减少患者不必要的等待时间,提高患者的就诊效率,充分利用医院的现有资源,有效缓解门诊就医"三长一短"的现象,使得医院现有资源在较大范围内得到有效配置,完善"军字一号"工程在门诊管理方面的不足,提高医院的信息服务质量,提升军队医院信息化建设.     

When to say "yes" and when to say "no": boundary issues for hospice palliative care volunteers

A total of 79 hospice palliative care volunteers from 2 community-based hospice programs responded to a 27-item Boundary Issues Questionnaire that was specifically developed for this study. Volunteers were asked to indicate whether or not they considered each item (eg, "Lend personal belongings to a patient or family," "Agree to be a patient's power of attorney," "Attend/go into a patient's medical appointment") to be something they should not do and to indicate whether or not they have ever done it. On the basis of the volunteers' responses, the authors distinguished between "definite boundary issues" (things volunteers should never do, for example, "Accept money from a patient or family"), "potential boundary issues" (things volunteers should stop and think twice about doing, for example, "Accept a gift from a patient or family"), and "questionable boundary issues" (things volunteers should be aware of doing, for example, "Give your home phone number to a patient or family"). The implications of these findings for training volunteers are discussed and the need for clear and unambiguous organizational policies and procedures to preserve boundaries is stressed. Without clear policies, etc, community-based hospice programs may be putting themselves at legal risk.     

Influences of "normal" and "prudent" diets on biliary and serum lipids in healthy women

The differential effect of two diets, taken in synchrony with the menstrual cycles for 2 wk each, on serum and bile lipids was investigated in young healthy women. The "normal" diet was high in cholesterol and total fat, and low in polyunsaturated fat and fiber; the "prudent" diet contained a high proportion of polyunsaturated fat and fiber, but was low in cholesterol and total fat; there was little difference in energy content. Both in whole serum and in low-density lipoprotein the concentrations of cholesterol and apolipoprotein B were almost 30% lower with the "prudent" than with the "normal" diet; HDL-cholesterol was 16.3% lower. Triglycerides were increased, only in the very-low-density lipoproteins while cholesterol and apolipoprotein B did not change much in this fraction. The risk to acquire cholesterol gallstones was not less with the use of the "prudent" diet as originally expected. While using the "prudent" diet five of the women had slightly higher lithogenic indices, in two there were much higher values (greater than 25%), and only in three the lithogenic index was unchanged or slightly lower than with the "normal" diet.     

Cultural characteristics of "high" and "low" performing hospitals

PURPOSE: To compare and contrast the cultural characteristics of "high" and "low" performing hospitals in the UK National Health Service (NHS). DESIGN/METHODOLOGY/APPROACH: A multiple case study design incorporating a purposeful sample of "low" and "high" performing acute hospital Trusts, as assessed by the star performance rating system. FINDINGS: These case studies suggest that "high" and "low" performing acute hospital organisations may be very different environments in which to work. Although each case possessed its own unique character, significant patternings were observed within cases grouped by performance to suggest considerable cultural divergence. The key points of divergence can be grouped under four main headings: leadership and management orientation; accountability and information systems; human resources policies; and relationships within the local health economy. PRACTICAL IMPLICATIONS: As with any study, interpretation of findings should be tempered with a degree of caution because of methodological considerations. First, there are the limitations of case study which proceeds on the basis of theoretical rather than quantitative generalisation. Second, organisational culture was assessed by exploring the views of middle and senior managers. While one should in no way suggest that such an approach can capture all important cultural characteristics of organisations, it is believed that it may be at least partially justified, given the agenda-setting powers and influence of the senior management team. Finally "star" performance measures are far from a perfect measure of organisational performance. Despite such reservations, the findings indicate that organisational culture is associated in a variety of non-trivial ways with the measured performance of hospital organisations. ORIGINALITY/VALUE: Highlights considerable cultural divergence within UK NHS hospitals.     

Physician "supply-side" economics

The medical group manager who fails to come face to face with competition and its future impact may be ignoring his fundamental administrative responsibility for strengthening his group for long-term growth and stability. The author has focused his attention on the broad effects of excess physician supply on internal group economics and external competitive economics, and quantitates their impact. Each manager will have to move from the broad to the specific in "bringing home" the points presented in this discussion. And, they must be "brought home," because they will soon be there whether you bring them or not!     

以健康重庆为契机推进医院科学发展

随着国家医改的深入推进,中共重庆市委于2008年做出<关于建设"健康重庆"的决定>,国家区域发展首次将"健康"纳入重要目标.我院以打造"健康重庆"为契机,积极探索医院改革和医院科学发展的思路和举措,提出由"疾病假设"调整为"健康假设",从"着眼伤病"调整为"着眼能力",从"塑形培养"发展到"适形培养",从医务人员单方面降低死伤,扩展到医患共同参与维护生命安全与健康等理念设想.围绕四个转变,医院着力从"技术引力、服务能力、创新动力、应急保障力、管理软实力"等方面展开战略转型的实践探索,以推动医院可持续性发展.     

"Probable" versus "confirmed" leptospirosis: an epidemiologic and clinical comparison utilizing a surveillance case classification

PURPOSE: For surveillance purposes, the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists (CDC/CSTE) have defined two case classifications for leptospirosis: "confirmed" and "probable." The objective of this study was to provide data to refine the current surveillance case classifications. METHODS: All reported leptospirosis infections from exposures within the State of Hawaii, 1974 to 1998 meeting CDC/CSTE "confirmed" and "probable" case classifications were compared on a number of clinical and epidemiologic parameters. RESULTS: Confirmed cases (n = 276) had more severe clinical manifestations than probable cases (n = 180); however, probable cases with higher peak microscopic agglutination test (MAT) titers (> or =1:800) were clinically and epidemiologically comparable to confirmed cases. In addition, 77 cases demonstrating fourfold or greater MAT titer increases in paired serum collected less than two weeks apart (currently excluded from the "confirmed" case classification) were also comparable to confirmed cases. CONCLUSIONS: Our findings support amending the current CDC/CSTE surveillance confirmed case classification to include demonstration of a fourfold or greater MAT titer increase in paired serum, irrespective of the interval between specimen collection. Consideration should also be given to including single MAT titer > or =1:800 as a criterion for "confirmation." These changes would both simplify and expedite the surveillance confirmation of leptospirosis.     

Effects of information about specific nutrient content on ratings of "goodness" and "pleasantness" of common foods

In a study of the effects of information concerning nutrient content on ratings of foods, subjects (247 male and female school students aged 13-14 years) rated a list of 21 common foods on two scales "good for you" and "pleasant", either without prior information (control group) or after being shown, and asked to memorize, a classification of the foods as "high" "medium" and "low" in terms of a specified nutrient. There were five experimental groups, each receiving classificatory information about a different nutrient (iron, protein, carbohydrate, calorie or fat). Compared with controls, experimental subjects rated the value of the foods in a way corresponding more closely with the specific classification presented to them. Ratings of pleasantness, however, showed no such consistent effects. These findings are interpreted in terms of models of attitudinal judgement concerned with factors influencing the salience to individuals of different stimulus attributes. Implications for the effects of selective information on judgements are discussed, with specific reference to advertising and nutrition education.     

Correlates of the "western" and "prudent" diet patterns in the us

PURPOSE: Underlying the diversity and changeability of US eating habits are fundamental dietary patterns shaped by common sociohistorical experiences. Currently, little is known of what patterns exist or their associations with sociodemographic/lifestyle factors. We examined these issues in third National Health and Nutrition Examination Survey data.METHODS: Analyses were based on 5,794 US-born, white participants. Interviews included a 60-item food frequency questionnaire (FFQ) and questions on sociodemographics and health behaviors. Dietary patterns were identified by principal components analysis on FFQ responses. Component scores representing intake level of each pattern were dichotomized at the median. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI).RESULTS: We identified two primary dietary patterns-a "western" pattern characterized by processed and red meats, eggs, potatoes, and refined grains, and a "prudent" pattern characterized by cruciferous vegetables, greens, carrots, salads, and fresh fruits. The two patterns occurred across geographic regions and in both women and men. After age- and sex-adjustment, the "western" diet was associated with rural residence (OR = 1.9, 95% CI 1.7-2.2), working class status (OR = 1.4, 95% CI 1.2-1.6), and lack of high school completion (OR = 1.6, 95% CI 1.4-1.8). The "prudent" diet was associated with high school completion (OR = 2.8, 95% CI 2.5-3.3) and behaviors reflecting greater health awareness, such as daily physical activity (OR = 2.0, 95% CI 1.8-2.2), non-smoking (OR = 2.1, 95% CI 1.8-2.4), and supplement use (OR = 1.8, 95% CI 1.6-2.0).CONCLUSIONS: The two dietary patterns resemble those found in previous US studies. Findings regarding correlates agree with social histories describing the emergence of those patterns. Principal components analysis is potentially useful for identifying fundamental dietary patterns for future investigations of diet-disease associations.     

"Wrongful life" claims

On 9 May 2006, the High Court of Australia dismissed "wrongful life" claims brought on behalf of two patients. One of the cases involved the alleged negligent failure by a general practitioner to diagnose prenatal rubella and to advise the mother of the risks to the fetus associated with rubella. This article outlines the case and discusses the nature of "wrongful life" and "wrongful birth" claims.     

The "Participatory" Movement

This study reports the trajectory of the Participatory Movement (MP), which was created in opposition to the policies carried out by the Brazilian Association of Nursing (ABEn). This article, written by the first president elected of the "participatory" movement, presents the principles of the movement, its organization, the struggle for leadership, and the work developed in the first administration.