Use of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire to monitor trends in patient satisfaction with foodservice at an acute care private hospital

Aim:  To demonstrate how the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire can be used to monitor trends in foodservice satisfaction.
Methods:  Three one-day surveys of foodservice satisfaction were conducted in 2003–05. All adult hospital inpatients with the exception of intensive care, cardiac post-operative care, labour ward and day surgery patients were eligible. The response rate was 48% (2003), 42% (2004) and 60% (2005). This took place in an acute care 440-bed private hospital. Overall foodservice satisfaction, dimensions of foodservice satisfaction (food quality, meal service quality, staff/service issues and the physical environment) and two independent statements (temperature of the hot foods, ability to choose different sized meals); satisfaction by gender, length of stay, age, diet type and appetite for 2005. Scores were calculated for overall satisfaction, four dimensions of satisfaction and two independent statements. Chi-squared analysis was used to determine the effect of gender, age, diet type and appetite on overall satisfaction. Correlation analysis was used to assess the association between overall foodservice satisfaction and length of stay.
Results:  Ratings of overall foodservice satisfaction, four dimensions of foodservice and two independent foodservice items were high, consistent with previous findings. Of the foodservice dimensions, the staff/service issues were the most positively rated and food quality the least positively rated. Patients' expectations of the foodservice were significantly associated with overall satisfaction. Quality improvement activities focused on the lowest scoring components of the questionnaire.
Conclusion:  The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire can be used to determine trends in foodservice satisfaction and identify areas to target for quality improvement initiatives.     

规范药品生产经营的法律思考

文章旨在探讨药品生产流通中的法律问题,运用实证分析的方法对近年来我国药品生产经营中出现的问题和安全隐患以及现行《药品管理法》立法、执法以及法律监督暴露出的若干不足与缺陷进行剖析。为此,必须重视解决以下问题:规范药品名称的使用,落实药品生产的飞行检查,维护公平竞争的环境,加强销售环节的管理,严查药品虚假广告,治理药品监管中的腐败。     

Motivations for physician-assisted suicide

OBJECTIVE: To obtain detailed narrative accounts of patients' motivations for pursuing physician-assisted suicide (PAS). DESIGN: Longitudinal case studies. PARTICIPANTS: Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individuals interested in PAS, as well as hospices and grief counselors. SETTING: Participants' homes. MEASUREMENTS AND RESULTS: We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fatigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when planning PAS. CONCLUSIONS: Patients in this study engaged in PAS after a deliberative and thoughtful process. These motivating issues point to the importance of a broad approach in responding to a patient's request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients' concerns over time, and tailoring care accordingly.     

Screening and Identifying Children with Autism Spectrum Disorders in the Public School System: The Development of a Model Process

Heightened public awareness of autism and increased prevalence estimates of autism spectrum disorders (ASDs) has generated a sense of urgency within the public school system to identify children with these disorders for targeted intervention. Two multidisciplinary groups of professionals, one each from two separate school districts, were identified and trained to provide diagnostic and consultative services. This paper outlines a model process for school personnel to develop a basic level of training and competence in recognizing and serving students who have an ASD by (1) providing an overview of the legal and clinical issues involved in screening for children with ASD within the school system, (2) defining a school-based professional training process and (3) outlining a school-based ASD screening process.     

Sexuality in the nursing home,part 2: Managing abnormal behavior-legal and ethical issues

Everyone, regardless of age, needs love, touch, companionship, and intimacy. The 1.6 million elderly in the 20,000 U.S. nursing homes are not an exception. The literature indicates that nursing home residents continue to have an interest in sexual activity regardless of age. Sexuality, however, is frequently overlooked by physicians and staff working with nursing home residents. Many staff members have only a vague understanding of the sexual needs of the elderly. This results in a perception of residents' sexual interests as behavioral problems rather than expressions of need for love and intimacy. Inappropriate sexual behaviors in the nursing home can create an intense burden for nursing home staff. This article discusses ways to dealing with inappropriate sexual behaviors in long-term care settings and the ethical issues involved.     

Regulation, religious experience, and epilepsy: a lens on complementary therapies

Complementary and alternative medical (CAM) therapies include chiropractic, acupuncture and traditional Oriental medicine, massage therapy, and herbal remedies; mind-body therapies (such as meditative practices and visualization); and folk practices and religious healing. Of these, modalities based on spiritual healing create a number of conundrums for the clinician, including legal, regulatory, and ethical issues. Further, the historic relationship between the study of epilepsy and religious experience suggests particular, potential associations between CAM therapies (and especially spiritual healing) and care for epileptic patients. There are at least two dimensions to this exploration: first, the widespread use of spiritual healing for treatment of epilepsy; and second, the hypothesized connection between epileptic seizures and mystical states. A number of legal rules help address potential abuse of authority by health care professionals, and include: (1) medical licensure; (2) scope of practice; (3) professional discipline; (4) malpractice; and (5) fraud. This article offers a preliminary resource for clinicians interested in these topics.     

Patients' rights, quality of life, and health care system performance

The purpose of this paper is to promote the development of a social contract between patient and clinician that permits patients to state how they want to live as they survive rather than what they are willing to lose to extend their survival. To do this, patients must have sufficient leverage to affect the nature of the care they receive. This leverage, it is proposed, can be achieved by first making a Declaration of Patients Rights Relative to Their Quality of Life' and then evaluating the extent to which the patient's providers comply with this rights statement. The paper also reviews The World Health Report 2000 [Health Systems: Improving Performance Geneva: WHO, 2000] as an example of an alternative approach to defining a health care social contract and evaluating a health system's performance. Also discussed, were steps that could be taken to facilitate the integration of the patients' rights statement into medical practice and health care systems performance.     

Ethical issues arising from a research, technology and development project to support frail older people and their family carers at home

The present paper provides an overview of the application of the key ethical issues which arose in an EU-funded research, technology and development project, Assisting Carers using Telematics Interventions to meet Older Persons' Needs (ACTION). The primary aim of the ACTION project was to support frail older people and their family carers in their own homes across England, Northern Ireland, the Republic of Ireland, Sweden and Portugal via the use of user-friendly information and communication technology. Ethical guidelines were developed in the project and used as a tool to enable the multidisciplinary project team to increase their awareness of ethical issues in their everyday work, and to act as a useful ethical framework for regular team discussions at international and local meetings across the partner countries. A range of ethical issues arose during the field-study phases of the project when the ACTION services were introduced into a number of families' own homes. It can be argued that these ethical issues reflect factors relating both to the application of research into practice, as well as those relating more directly to the use of new technology by families and care professionals. Key issues centre upon the ethical concepts of autonomy, independence, quality of life, beneficence, non-maleficence and justice, and more specifically, on ethical issues of security, privacy and confidentiality, increased expectations, and withdrawal of the service. This paper is intended to facilitate dialogue and debate in the area of enabling (assistive) technology in home care for older people and their families.     

AIDS policy modeling for the 21st century: an overview of key issues

Decisions about HIV prevention and treatment programs are based on factors such as program costs and health benefits, social and ethical issues, and political considerations. AIDS policy models – that is, models that evaluate the monetary and non-monetary consequences of decisions about HIV/AIDS interventions – can play a role in helping policy makers make better decisions. This paper provides an overview of the key issues related to developing useful AIDS policy models. We highlight issues of importance for researchers in the field of AIDS policy modeling as well as for policy makers. These include geographic area, setting, target groups, interventions, affordability and effectiveness of interventions, type and time horizon of policy model, and type of economic analysis. This paper is not intended to be an exhaustive review of the AIDS policy modeling literature, although many papers from the literature are discussed as examples; rather, we aim to convey the composition, achievements, and challenges of AIDS policy modeling.     

二十一世纪初中国的主要健康问题浅析

进入21世纪,人民群众所期待的卫生服务水准和追求的健康目标,正随着经济状况的改善而不断提高,社会主义市场经济制度要求构建与之相适应的卫生体系与运行机制。总体来说,目前中国卫生事业的发展滞后于经济发展,卫生改革滞后于社会主义市场经济发展进程所带来的相关体制变化。当前面临的主要卫生问题包括:多数人口缺乏基本的健康保障;医疗费用上涨超过居民收入增长和承受能力;政府卫生投入显著不足,卫生资源投入不公平、服务分配不公平及由此带来的健康不公平现象日益突出;因病致贫现象仍较严重,构成了社会不稳定不和谐因素;中国既面临仍在蔓延的传染病和地方病,又面临伴随城市化和人口老龄化的慢性非传染性疾病快速上升的双重负担,而政府和卫生系统尚缺乏足够的应对能力。这些问题同国家经济发展和社会进步息息相关,如果得不到妥善解决,将对构建和谐社会、保证社会公平稳定、巩固经济发展成果及促进人的全面发展造成严重的负面影响。