Healthcare contexts

The Belmont Report (1979) contains the ethical principles on which the federal regulations for protection of human subjects are based. The three basic principles are respect for persons, beneficence, and justice. Respect is reflected by the consent process. As a result the term autonomy is used in the research and healthcare context. A patient is normally regarded as autonomous if he or she can make his or her own judgments and decisions. In the absence of such ability, for example, as in the case of children, prisoners, and those with mental disorders, the person must be protected. In the Belmont Report and Beneficence, beneficence is the process of minimizing harm (risk) and maximizing possible benefits (usually for the community as a whole). Justice is the term used for the criterion that subjects must be fairly drawn from a variety of ethnic, social, and other groups. 

Generalising from a number of dimensions suggested by former studies, safety culture dimensions can be classified into two parts (1) general, core elements that are conunonly applicable to any healthcare context, e.g. field, organisational type and coimtry, and (2) nation-dependent elements that are specific to a national culture or the coimtry s healthcare system. 

Looking at the Japanese healthcare context, a majority of reports (more than 90 percent in most hospitals) are submitted by nurses. Most cases reported by... 

This well-established framework highlights some of the benefits and pitfalls of seeking to change behaviours. Building on these ideas, we identify five common approaches to changing behaviours and cultures within the healthcare context. 

While the focus of almost all studies included in this chapter was the adaptation of a patient safety cUmate measure from the USAto their own national and healthcare contexts, maity of the questions we will have to answer in future might be better addressed at a cross-national level. At the level of the survey instmment this would require a certain amount of consistency regarding the use of terminology and the addition or removal of items - a minimal shared item set. Taking cross-national similarities and differences into account (especially with regard to internal consistencies of the various safety climate dimensions) might help to improve further the overall quality of the HSPSC and to further our understanding of factors at the level of healthcare systems that may have a considerable impact on safety climate. 

Before exploring the capabilities of the value chain model in the healthcare context, we should discuss the importance of establishing a workable view of value. 

Overall, the ftamework of this study provides quantitative influence of the logistics components and KPIs in healthcare context. It is a good input for making the strategic plan to improve healthcare logistics targeting eflfecliveness and efiiciency. 

Anxiety disorders are among the most frequent mental disorders encountered by clinicians. Anxiety disorders often are missed or attributed incorrectly to other medical illnesses, with most patients being treated inadequately. The burden of detection and diagnosis most often falls to primary-care clinicians, to whom most patients present in the context of other complaints. Untreated anxiety disorders may result in increased healthcare utilization, morbidity and mortality, and poorer quality of life. 

Egger M, Davey Smith G, Altman DG, eds. Systematic Reviews in Healthcare Meta-analysis in Context, 2nd edn. London BMJ Books, 2001. 

This requirement is usually met by means of the audit conducted by the pharmaceutical or healthcare company. The audit examines the quality assurance attributes of the supplier s process, the firm s general capability maturity, and the suitability of its equipment or service suggested for use on the project. Suppliers in this context may be understood to include equipment vendors, service suppliers, or the pharmaceutical or healthcare company s in-house software development department. Regulators hold pharmaceutical and healthcare companies accountable for the use of suppliers whose capability assessment indicates their inability to deliver validatable, compliant software. ... 

Audits are usually conducted by an audit team and led by a qualified, accredited auditor. Accredited auditors should have completed a certified development program, be accredited under an appropriate standard (ISO 9000 2000 TicklT in this context), and should have conducted a number of qualifying audits. Pharmaceutical and healthcare companies that do not have their own accredited auditors can engage an independent auditor, as we have seen. Names and addresses of accredited auditors can be found in national registers of certified auditors. The International Register of Certificated Auditors is one such register, associated with the Institute of Quality Assurance (IQA). 

Although these principles are particularly relevant to the conduct of clinical studies (see below), they may also apply to the ordinary practice of medicine and, indeed, all situations where one human being has a responsibility to care for another human being. Let us not forget that the fundamental goals of healthcare, even in this age of rapid technological progress, are to cure sometimes, relieve often and comfort always, and this should not be violated in the context of clinical studies. 

The Pew Commission Reports are a series of forward-looking documents that critically examine the education and training of health professionals in the context of the most dynamic decade ever faced by the nation s healthcare providers. Anchored by four Commission reports, the series is complemented by public policy papers, task force recommendations, and research reports on such topics as accreditation of educational programs, regulation of the healthcare workforce,and federal graduate medical education. 

Innovation is the key to the future. It means to be alert as to how society, the healthcare system, and the macro-and micro-context in which we live, will evolve. An... 

Chalmers I, Altman DG. Meta-analysis in context. In Systematic Reviews in Healthcare. London BMJ Publishing, 1995. 

The effectiveness of various measures to contain expenditure on medicines in the UK can only be assessed in the context of the situation in other European Union countries. Table 21.1 gives data for the total expenditure on health care as a percentage of gross domestic product (GDP), expenditure on medicines as a percentage of total healthcare spend, the national pharmaceutical industry s research and development expenditure in euro-millions, the general price index and the medicines price index nationally compared to a European price of 100, and the national pharmaceutical consumption per capita expressed as defined daily doses (DDD). These comparisons are based on OECD Health Data 2000. 

In the late twentieth century such thoughts about computers ensuring our survival were incorporated by some scientific philosophers into visions of the very distant future. This idea of healthcare ultimately placed in the context of computers that will sequester the universe and ourselves with it, will be resurrected in Chapter 10, along with mention of such thinkers as the Jesuit teacher Paul Teilhard de Chardin s thesis on the Omega Point, and other thinkers specializing in eschatology, the destiny of the universe, and see a role for humankind in that. 

Thus several of these researchers have begun to think about designing process-oriented healthcare information systems that adjust naturally to changes in resources and organizational structures. Computer-interpretable models based on clinical workflows have already been implemented within the context of specific different fields, such as stroke and cancer therapy. A snapshot of part of an automated laboratory workflow is in Table 7.1.2 These authors as well as others have considered special kinds of networks for healthcare workflow that issue simple reminders and serve as an organizer in a healthcare office environment in which duties are widely shared. 

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