HIV／AIDS防治中的医患交往艺术——一个景颇村寨中的信任表达

本世纪以来，中国各艾滋病重度流行地区的防治运动往往面临着过度“行政依赖”的制度困境，然而，本文在中国西南边境线上的一个景颇村寨中发现了例外。当地的官方防疫体制通过在终端启用代理人——乡村医生——来进行实际干预，极大规避了阳性群体对于防疫体制的过度依赖，以及由此造成的消极的社会道德后果。来自田野的事实证明，围绕着防疫实践的医患交往在信任机制的组织下，不仅柔和了官方防疫体制与对象间的文化张力，还通过策略而技巧的实践过程增强了对阳性人群的控制能力，并反过来强化了医患间的信任纽带。总的来说，医患间的交往艺术让医学权力的运作得以情境化，实现了社会控制的本意。     

Reliability between nurse managers: the key to the high-reliability organization

Flawless execution rests in the hands of nurse managers. No one can work alone in health care any more. We are interdependent and know that the best outcomes happen when practices are organized around collegial supportive structures rather than autonomous competitive units. We are only as strong as our weakest link. If all managers see the big picture and look beyond their units for what is right for the common good, we will achieve high-reliability organizations in health care. In turn health care organizations will become very safe places to operate. Shared governance structures for nurse managers are the perfect vehicle to develop collaborative organizations and flawless execution, and to adopt high-reliability organization principles.     

Staffing excellence: moving from retrospective to prospective management of risk

Our complex health care system will not be error free for the foreseeable future. Certain interventions must be put into place to manage that risk, and staffing effectiveness is a critical part of clinical risk management. Application of research and practice can create a basis for a proactive risk management plan, and will build in an essential feedback loop to leadership. Pay for performance initiatives by the Centers for Medicare & Medicaid Services and other payers are creating further incentive to get to zero errors faster. By implementing what we know about staffing and avoidable errors, we are in a very good position to meet the challenges to create a safe health care system.     

Leaders and windshields: the art of deflecting essential information

Do you know how much information you deflect in a day? Do you know what techniques you use to keep information at bay? We all erect windshields. It is just a matter of degree. Sometimes we deflect information in spite of our good intentions. If we are not present when people are in dialogue with us, we soon lose the attention of that person. If we are leading a meeting and the feedback begins to get uncomfortable for us, we can interject the techniques of the alpha male or alpha female, or a variety of our own. But the audience knows you are not listening, and they soon go underground with their comments and interpretations. Soon you are cut out of valuable feedback. Deflecting information by surrounding yourself with windshields just won't work. We need second and third opinions continually. One of Warren Bennis' (2002) ten traits to becoming a "tomorrow leader" is that of ensuring that the leader's boundaries are porous and permeable. In his view, leaders need the foresight to see around the corner long before others do. His belief is that the only way to do this is to be in touch with your customers, and the outside world. But that only happens when the leader's boundaries are porous and permeable so that information can seep in. Effective leaders learn to lead without windshields.     

Learning to alternate

The Individual Evolutionary Learning (IEL) model explains human subjects’ behavior in a wide range of repeated games which have unique Nash equilibria. Using a variation of ‘better response’ strategies, IEL agents quickly learn to play Nash equilibrium strategies and their dynamic behavior is like that of humans subjects. In this paper we study whether IEL can also explain behavior in games with gains from coordination. We focus on the simplest such game: the 2 person repeated Battle of Sexes game. In laboratory experiments, two patterns of behavior often emerge: players either converge rapidly to one of the stage game Nash equilibria and stay there or learn to coordinate their actions and alternate between the two Nash equilibria every other round. We show that IEL explains this behavior if the human subjects are truly in the dark and do not know or believe they know their opponent’s payoffs. To explain the behavior when agents are not in the dark, we need to modify the basic IEL model and allow some agents to begin with a good idea about how to play. We show that if the proportion of inspired agents with good ideas is chosen judiciously, the behavior of IEL agents looks remarkably similar to that of human subjects in laboratory experiments.     

On the Efficiency of Decentralized Exchange with Resale Possibilities

This paper studies decentralized exchange by bilateral matching and bargaining when resale is possible. Decentralized exchange involves the risk that goods and services may be allocated inefficiently; if low-valuation buyers consume while high-valuation buyers do not, then social welfare is reduced. If resale is possible and transaction costs are negligible, we would nevertheless expect an efficient allocation to result from decentralized exchange. This paper suggests that this depends on the nature of the commodity; while the allocation of a durable good will be efficient, the allocation of a "consumable" good need not.     

Patient as center of the health care universe: a closer look at patient-centered care

We need to consider how the health care system should revolve around the patient, rather than the patient rotating around the hospital. Considering a patient-centric point of view when implementing and optimizing the use of health information technology (HIT) provides new perspectives on the meaning of "integrated" health care. ot only do we need to give patients the opportunities to participate as true partners in their health care, we must convince them why this partnership makes sense. We should not be naive and believe all patients want this involvement in their care today and are ready to do all their health care transactions electronically. But considering and using these practices are important steps in the health care reform journey to improve quality and decrease cost. Many patients will benefit by our working with them to demystify the health care experience through patient-centric practices and the use of HIT.     

Information aggregation in auctions with an unknown number of bidders

Information aggregation, a key concern for uniform-price, common-value auctions with many bidders, has been characterized in models where bidders know exactly how many rivals they face. A model allowing for uncertainty over the number of bidders is essential for capturing a critical condition for information to aggregate: as the numbers of winning and losing bidders grow large, information aggregates if and only if uncertainty about the fraction of winning bidders vanishes. It may be possible for the seller to impart this information by precommitting to a specified fraction of winning bidders, via a proportional selling policy. Intuitively, this could make the proportion of winners known, and thus provide all the information that bidders need to make winner's curse corrections.     

Using diagnostic clusters to evaluate patterns of treatment and develop capitation rates

Payers and providers of medical services need to understand what is effective in medical care and what determines patient outcomes. The diagnostic cluster methodology offers a way to analyze physicians' overall practice patterns in treating a specific medical condition and provides a good foundation for performing medical outcomes studies.     

Endogenous Growth in an Open Economy and the Real Exchange Rate

This paper is a step in the direction of a larger research project aimed at determining the long run equilibrium value of the euro/dollar real exchange rate. Given this value, one could then give a precise meaning to the notion of undervaluation or overvaluation of the euro, and calculate its misalignment. The problem however arises of how to assess the reliability of such misalignment calculations. In our opinion, we must have a benchmark (namely a period in which we exactly know from outside sources the misalignment itself), against which we can test the validity of the model underlying our calculations. This of course is not (yet) possible for the euro, so that all the calculations of the misalignment of the euro that have been made can only be compared with one another, without knowing which is the good one. Hence, before building a model to be applied to the euro/dollar, we tested our ideas incorporating them in a basic model to be applied to the lira/dollar in a period in which we do know the actual misalignment of the lira from outside sources.     

Community discussions: a vision for cutting the costs of end-of-life care

Palliative care involvement with patients with advanced disease has demonstrated significant cost savings at end of life (EOL). These financial benefits are largely due to improved EOL decision making. Assisting patients and families to examine their values and determine their preferences makes it possible to match patient goals with appropriate care. Often, comfort-oriented care is favored, avoiding the costs of medically aggressive, often futile, technology-driven interventions. Community-based EOL care discussions would demonstrate increased cost reductions while facilitating significant patient and family satisfaction with care.     

The CNO/CFO partnership: navigating the changing landscape

With increasing pressure to cut costs, both real and immediate, and those forecasted and anticipated, the partnership and collaboration between nursing and finance will continue to take on new challenges. This partnership has historically been strained and does not always come easy due to differences in focus, different priorities, and inadequate communication, listening, and hearing. That needs to change and a strong CNO-CFO partnership is needed. Nursing leaders need to understand and appreciate the financial constraints and balance them with expected outcomes, and financial leaders need to understand and appreciate the core clinical business and what gaps in care mean to the financial viability of the organization and to patient outcomes. One health system developed a platform for change and is dedicated to the hard work involved in continuously working on those partnerships so when it comes to patient quality, safety, and financial performance, nursing and finance leaders are well positioned for future health care challenges.     

Taking care of high-need patients in capitation-based payment schemes – an experimental investigation into the importance of market conditions

Many health-care systems use provider payment as an instrument to ensure an efficient and equitable delivery of care. Capitation-based payment schemes are popular because they contain costs. However, they are known to lead to underprovision of care, especially to high-need patients. Using a laboratory experiment, we test whether the availability of resources affects providers’ response to a capitation-based scheme. We find that the relative underprovision of care to high-need patients exists both when providers are resource abundant and constrained. Next, we introduce two different versions of the scheme and test whether they incentivize providers to take better care of high-need patients. One scheme ring-fences part of the capitation payment to a fixed physician salary, whilst the other scheme differentiates payments based on patients’ expected need of care. We find that high-need patients gain the most from a fixed provider salary under resource abundance, but find no difference in gains between patient types under resource constraint. Our results also show that differentiation of capitation makes providers take relatively better care of patients linked to an above average payment compared to a below average payment, regardless of resource constraints. Our findings suggest that both the design of the scheme and the market condition affect providers’ patient prioritization under capitation.     

Engaging patients and families in ehealth

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.     

Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance

Many doctors in developing countries provide considerably lower quality care to their patients than they have been trained to provide. The gap between best possible practice and actual performance (often referred to as the know-do gap) is difficult to measure among doctors who differ in levels of training and experience and who face very different types of patients. We exploit the Hawthorne effect-in which doctors change their behavior when a researcher comes to observe their practices-to measure the gap between best and actual performance. We analyze this gap for a sample of doctors and also examine the impact of the organization for which doctors work on their performance. We find that some organizations succeed in motivating doctors to work at levels of performance that are close to their best possible practice. This paper adds to recent evidence that motivation can be as important to health care quality as training and knowledge.     

GROWTH OF U.S. HEALTH CARE SPENDING

The share of output allocated to health care has more than doubled since 1960. This paper models the growth in this ratio and finds that the increase in the elderly population whose medical spending is heavily subsidized is a key factor behind this growth. Technological change is a symptom of the medical market structure rather than a cause of medical spending growth. The econometric model in the analysis here is based on a micro model composed of two groups. The first group is a healthier group that makes income transfers in order to finance the sicker group's health insurance premiums. In this model, a technical constraint places an upper bound on the healing ability of the medical good. This upper bound changes through an unobservable endogenous process. Estimating the health care model involves using estimation techniques that bypass the need to make any a priori assumptions about the functional form of the regressions or about the distribution of the residuals. The results suggest that technical change cannot indefinitely induce health care spending growth if no subsidies exist that provide full health care coverage with premiums fully paid by the subsidy. If subsidies provide full coverage and pay the entire premium, then new technical discoveries can induce constantly expanding medical expenditures.     

The Emotional Relationship Between The Teacher And Student

The emotional relationship between the teacher and student becomes more and more sensitive,and the active relation is good for teaching,but the passive is opposite.As a teacher,how deals with this relation is very important,because the teacher just play the vital role in class.The teacher also should know the principle that is how get along well with the student.So long as the teacher know about these,the collectivity will become more and more harmonic,and the emotional relationship would get more and more harmonious as well.     

Avoiding the mistreatment of bad risks in a democracy: Universal Health Insurance from a constitutional perspective

This paper examines the concept that social insurance for medical care may represent a kind of constitutional choice. The long-term stability of the U.S. Medicare program indicates that such programs are rarely altered. The primary reason postulated for treating subsidized medical insurance as a constitutional choice is to guard against a temporary majority of persons in good health or not at risk for a disease voting to deny benefits for the minority who are at higher risk. It is argued, however, that, although there needs to be constitutional status for social insurance, insurance need not and probably should not take the form of tax-financed equal coverage for all.     

论民办高校大学生公德的缺失与养成

民办高校大学生的公德教育应尽旱抓起，长抓不懈。大学生的公德教育不是小事，“千里之堤，溃于蚁穴”，我们应该从大学生进校园那天起，就培养他们的公德意识和公德观念，让大学生把“诚实守信、勤俭节约、爱护公物、团结友善、遵纪守法”作为自己最高的行为准则，养成良好的公德，成为即掌握了科学知识和技能，又有良好公德的高素质人才。     

Technicity in nursing and the dispensation of thinking

While technology and health care delivery are inextricably and increasingly intertwined and technology has driven major advances in quality and efficiency in health care, technology does not replace the need for a thinking human being in care delivery. The term "technicity" refers to the tension created by the ability of humans to think versus their risk of being exploited as objects subservient to technologies. Drawing upon the philosophical works of Thoreau, Heidegger, and others, the authors pause on the conundrum created by expanding technology with the assumption that technological "improvements" should be evaluated with caution. Health care information systems are an example of tools that have improved our ability to collect and store information, but when systems "go down," staff can be rendered helpless. Similarly, technology can impose personal distance between the patient and provider in instances where staff are positioned as a mechanism for collecting data rather than a person interacting with another person. In some cases, health care providers function as navigators helping patients reach the correct pharmaceutical, rather than as teachers helping patients seek better health. Lastly, the tendency toward systems analysis in the context of the complex hospital environment leads solely toward uniform solutions rather than instances where a customized solution is warranted.