434 Matching Annotations
  1. Apr 2021
    1. I managed to do half the work. But that’s exactly it: It’s work. It’s designed that way. It requires a thankless amount of mental and emotional energy, just like some relationships.

      This is a great example of how services like Facebook can be like the abusive significant other you can never leave.

    2. I realized it was foolish of me to think the internet would ever pause just because I had. The internet is clever, but it’s not always smart. It’s personalized, but not personal. It lures you in with a timeline, then fucks with your concept of time. It doesn’t know or care whether you actually had a miscarriage, got married, moved out, or bought the sneakers. It takes those sneakers and runs with whatever signals you’ve given it, and good luck catching up.
    3. Pinterest doesn’t know when the wedding never happens, or when the baby isn’t born. It doesn’t know you no longer need the nursery. Pinterest doesn’t even know if the vacation you created a collage for has ended. It’s not interested in your temporal experience.This problem was one of the top five complaints of Pinterest users.
  2. Mar 2021
    1. Can we occupy technology with love?

      An interesting re-framing of the social media problem. Similar to the IndieWeb philosophy, but a bit more pointed.

    1. “Follow your blisters” implies something that you come back to so many times that you eventually move past the blister stage, into toughened skin. Eventually, the activity “marks you” through use and practice, and you develop a special competence. When you practice an activity a bit more obsessively than other people, you build unique character – you earn some wear and some healing that makes you idiosyncratic, and a little unbalanced.It is something that you don’t need to put on your to-do list, something you care enough about to return to repeatedly, even though it causes discomfort. Over time, you develop a layer of protection that enables you to do that something more easily.
    1. the community is both endlessly creative and genuinely interested in solving big issues in meaningful ways. Whether it's their commitment to careful (and caring) community stewardship or their particular strain of techno-ethics, I have been consistently (and pleasantly) surprised at what I've seen during the last twelve months. I don't always see eye-to-eye with their decisions and I don't think that the community is perfect, but it's consistently (and deliberately) striving to be better, and that's a fairly rare thing, online or off.
    1. Will it also help accomplish another goal — communicating to my students that a classroom of learners is, in my mind, a sort of family?

      I like the broader idea of a classroom itself being a community.

      I do worry that without the appropriate follow up after the fact that this sort of statement, if put on as simple boilerplate, will eventually turn into the corporate message that companies put out about the office and the company being a tight knit family. It's easy to see what a lie this is when the corporation hits hard times and it's first reaction is to fire family members without any care or compassion.

    2. <small><cite class='h-cite via'> <span class='p-author h-card'>Remi Kalir</span> in Annotate Your Syllabus 3.0 (<time class='dt-published'>03/13/2021 14:18:33</time>)</cite></small>

  3. Feb 2021
    1. identity theft

      Saw this while scrolling through quickly. Since I can't meta highlight another hypothesis annotation

      identity theft

      I hate this term. Banks use it to blame the victims for their failure to authenticate people properly. I wish we had another term. —via > mcr314 Aug 29, 2020 (Public) on "How to Destroy ‘Surveillance C…" (onezero.medium.com)

      This is a fantastic observation and something that isn't often noticed. Victim blaming while simultaneously passing the buck is particularly harmful. Corporations should be held to a much higher standard of care. If corporations are treated as people in the legal system, then they should be held to the same standards.

    1. Dr Phil Hammond 💙. (2020, December 6). In some parts of the country, 31% of care home staff come from the EU. Some areas already have a 26% vacancy rate. And on January 1, EU recruitment will plummet because workers earn less than the £26,500 threshold. A very predictable recruitment crisis on top of the Covid crisis. [Tweet]. @drphilhammond. https://twitter.com/drphilhammond/status/1335490431837200384

    1. Thomas Van Boeckel. (2020, November 30). Https://t.co/s7o808PE3U now shows the ‘ad-hoc’ bed capacity as well as the bed capacity certified by the Swiss Society of Intensive Care Medicine. Data from partners the Coordinated Sanitary Service of @vbs_ddps. Thanks @nico_criscuolo @ChengZhao20, PhDs at @ETH_en https://t.co/5XxTexVyy9 [Tweet]. @thvanboeckel. https://twitter.com/thvanboeckel/status/1333323133592408064

    1. These days I find myself away from broadcast tools and more in the insular channels of my friend groups. What I want from technology is to share life with my friends; to be given the opportunity, and the power, to share that life, and all it includes… showing them care, or sharing the bits of knowledge that seem important to us as a group.
    1. Yes, you do face difficult choices (moral) but you don't care about it. All you care are the reputation bars. So... Let's kill this guy, who cares if he is innocent, but this faction needs it or I'm dead. Sounds great on paper but to be honest... you just sit there and do whatever for these reputation bars. If you won't, then you lose
  4. Jan 2021
    1. Despite some implementation challenges, patient portals have allowed millions of patients to access to their medical records, read physicians’ notes, message providers, and contribute valuable information and corrections.

      I wonder if patients have edit - or at least, flag - information in their record?

  5. Dec 2020
  6. Nov 2020
    1. Svelte by itself is great, but doing a complete PWA (with service workers, etc) that runs and scales on multiple devices with high quality app-like UI controls quickly gets complex. Flutter just provides much better tooling for that out of the box IMO. You are not molding a website into an app, you are just building an app. If I was building a relatively simple web app that is only meant to run on the web, then I might still prefer Svelte in some cases.
  7. Oct 2020
    1. Before you start a weight-loss program, it’s crucial to identify and create a treatment plan for any obesity related illnesses or diseases.

      Find out more about medical weight loss here.

    1. We believe the best care is preventative care, and well child checkups are a critical part of our preventative care services.

      To find out more about pediatric care in Castle Rock visit our page here.

    1. Your time and money.  Compare the typical fees for some of the most common patient needs:

      Visit the link to find out more.

    1. Why, though, do we not romanticize our preservation? The same matter of chance, of the fleeting nature of fate exists on the other side of the coin. What would have happened if we were better rested, if our energy was better preserved, if we managed our time and said what we really mean? Rarely do we approach whether we get eight hours of sleep with the same guilt as we do whether or not we attended a party, even when, according to sleep expert Matthew Walker, sleep deprivation prevents the brain from remembering information, creating new memories, and sustaining emotional well-being.

      A great observation!

  8. Sep 2020
    1. This dynamic is playing out during the pandemic among the many people who refuse to wear masks or practice social distancing.

      Many people say they care for each other but when it comes to a pandemic that many think is a hoax, they don't care for the health of others. Even if it is a hoax, wouldn't you still be careful?

    1. Don’t really give much a hoot of “image” problems. We diagnose problems, device solutions, and then if that appeals, great, and if it doesn’t appeal, also great
    1. You must: reference each element you are extending using refs or an id add code in your oncreate and ondestroy for each element you are extending, which could become quite a lot if you have a lot of elements needing extension (anchors, form inputs, etc.)
    2. This is where hooks/behaviors are a good idea. They clean up your component code a lot. Also, it helps a ton since you don't get create/destroy events for elements that are inside {{#if}} and {{#each}}. That could become very burdensome to try and add/remove functionality with elements as they are added/removed within a component.
    1. Most instructors will have the experience and knowledge of their students’ situation to make wise choices about activities that will work best.

      Academic professors are acknowledging their students well-being which is important and shows care from both sides of the professor and student. This allows the student know that even though the professor is mainly involved with education, they still care.

    1. Customers care more about the value our application adds to their lives than the programming language or framework the application is built with. Visible Technical Debt such as bugs and missing features and poor performance takes precedence over Hidden Technical Debt such as poor test code coverage, modularity or removing dead code
  9. Aug 2020
    1. die Notwendigkeit, neben der als typisch männlich betrachteten Gerechtigkeitsmoral ("voice of justice") auch die feminine Fürsorgemoral ("voice of care") anzuerkennen, die sich statt an formalen Gerechtigkeitsprinzipien eher an der Qualität der Beziehung orientiert und Gefühle sowie soziales Engagement in den Vordergrund der Betrachtung rückt.[3]
  10. Jul 2020
  11. Jun 2020
    1. Beachum, L., national, closeLateshia B. assignment reporter E. H. closeAlex H. assignment reporter covering, & newsEmailEmailBioBioFollowFollow, breaking. (n.d.). Is social isolation getting to you? Here’s how to know — and what experts say to do. Washington Post. Retrieved April 9, 2020, from https://www.washingtonpost.com/health/2020/04/04/social-isolation-mental-health-help/

    1. Goldman, P. S., Ijzendoorn, M. H. van, Sonuga-Barke, E. J. S., Goldman, P. S., Ijzendoorn, M. H. van, Bakermans-Kranenburg, M. J., Bradford, B., Christopoulos, A., Cuthbert, C., Duchinsky, R., Fox, N. A., Grigoras, S., Gunnar, M. R., Ibrahim, R. W., Johnson, D., Kusumaningrum, S., Ken, P. L. A., Mwangangi, F. M., Nelson, C. A., … Sonuga-Barke, E. J. S. (2020). The implications of COVID-19 for the care of children living in residential institutions. The Lancet Child & Adolescent Health, 0(0). https://doi.org/10.1016/S2352-4642(20)30130-9

  12. May 2020
    1. It should be every elected official’s goal to help find ways to free employers from dictatorial rules that hinder their growth. ObamaCare does the opposite, and that’s why the self-insurance option needs to be preserved.
    2. That’s why the escape hatch is so appealing. Self-insured companies can tailor their health benefits to meet the needs of their workers. They don’t have to pay for services their employees neither need nor want. And self-insured plans pay their own medical costs, without having to subsidize the health-care costs of other groups.
    3. The administration and its allies fear that the more people gravitate toward the successful, free-market self-insurance approach, the worse their government-engineered health “reform” will look. We’re already seeing the beginning of this trend.
    4. Meanwhile, ObamaCare penalties and onerous rules have forced many companies to lay off workers or cut hours to turn full-time employees into part-timers. Small-business owners should not have to make their hiring decisions based upon tens of thousands of pages of regulations in the Affordable Care Act.
  13. Apr 2020
  14. Feb 2020
    1. If immediate admission is not possible, start emergency treatment in primary care

      1) lie flat

      2) pilocarpine drops

      • 2% in blue eyes
      • 4% in brown eyes

      3) acetazolamide 500 mg orally

  15. Dec 2019
    1. p. 174-175

      Ce livre, que vous m'avez vu tout à l'heure lire […] ce livre, comme vos yeux en se penchant vers lui ne pourraient déchiffrer son titre à vingt ans de distance, ma mémoire, dont la vue est plus appropriée à ce genre de perceptions, va vous dire quel il était […]

      L'immersion du lecteur, entravé dans sa perception du support matériel (« ce livre »). Un éthos du care (de la sollicitude) produit par le narrateur qui vient au secours de l'instance du lecteur par la médiation d'un autre support, immatériel : sa mémoire.

      Cette relation de care (entre le narrateur et le lecteur) se trouvait déjà fictionnalisée en p. 165 :

      […] cette opération, en apparence si simple, d'ouvrir ou de fermer ma croisée, je n'en venais jamais à bout sans le secours de quelqu'un de la maison […]

      Ouvrir la fenêtre de la chambre et lire le titre d'un livre : deux opérations de lecture impliquant la matérialité des supports.

  16. Nov 2019
    1. It needs to be fully repealed, because the first step out of the gate for Obamacare is a step in the wrong direction and that is for government control over every aspect of health care, so it’s hard to fix the system that they have put in place without ending that premise that government ought to be running and controlling health care.
    1. CARE Framework

      Thanks to @mkcow below for providing a direct link to the CARE Framework.

  17. Oct 2019
  18. Sep 2019
    1. At MONSAM Portable Sinks, get a wide range of portable sinks. They offer portable changing stations for baby, day care portable sinks and toddler sinks. Their range of child-friendly portable sinks that are perfectly suited for preschool, kindergarten and child care centers.

  19. Aug 2019
    1. ObamaCare, is the product of a Conservative Think-Tank. 60% of citizens get private insurance from their employers, 15% receive Medicare (65 and older), and the federal gov’t funds Medicaid for low-income families (the allocation to this fund has been declining).

      Lucky, Trump removed that

    2. United States and its Health care:      The gov’t has some government-run programs and private insurance.

      U.S. health care system

    3. Health care spending was 12.4% of GDP in 2016. That is approximately $7,919.00 per person. There were 11.6% of people who skipped prescriptions because of cost.

      Switzerland Health Care System

    4. Mandate: The gov’t mandates that everyone buy health insurance, funding comes from payroll taxes.

      3

    5. Health care spending was 11% of GDP in 2016. Approximately $4,600.00 per person. 7.8% of patients skipped prescriptions because of cost. The life expectancy was 85.5 years in 2015.  

      France health care system

    6. 2-Tier: The gov’t pays two-thirds, and the private sector pays one-third.  

      2

    7. Health Care spending was 10.6% of Canada’s GDP in 2016 and 10.5% of patients skipped prescriptions because of cost.

      Canada health care system

    8. Single-Payer: The gov’t taxes its citizens to pay for health care.

      1

    9. Single-Payer, 2-Tier, and Mandate systems.

      three definitive models for Universal Health Care

  20. Jun 2019
    1. a wealthy nation with unhealthy lifestyles, little interest in preventive medicine, and expectations of limitless, top-notch specialist care would empower its health-care system to accommodate these preferences
    2. his very first patient shocked him by refusing the moderately expensive but effective treatment he prescribed for her cancer—a choice that turns out to be common among patients in Singapore, who like to pass the money in their government-mandated health-care savings accounts on to their children
    3. “value-based care,” which rewards providers who keep costs down while achieving good outcomes, is not going well
  21. May 2019
    1. John Robert, a microbiologist in New Mexico did an experiment on whether the beard contained bacteria. Results from the experiment that beards contain a lot of bacteria as dirty as a toilet. That’s a lot of bacteria and it’s a bit unsettling. He advised men with a beard should wash hands frequently and wash beard if they want to have a clean and healthy beard. Also, take care not to get food on your beard when you eating. If you exercise outside for a long time under the hot weather, there will be massive secretion of oil and have a lot of dust in your beard. If you haven’t clean your beard in the time it’s very easy to damage your sink. In particular, the bacteria on the surface of the face will take advantage of this, causes folliculitis and sebaceous adenitis, even cause swelling of the lips and face.

      Is Growing A Beard Easy To Nourish Germ?

  22. Mar 2019
    1. The HMO Act of 1973 changed that premise. It authorized for-profit IPA-HMOs in which HMOs may contract with independent practice associations (IPAs) that, in turn, contract with individual physicians for services and compensation. By the late 1990s, 80 percent of MCOs were for-profit organizations, and only 68 percent or less of insurance premiums went toward medical care.

      The HMO Act of 1973 resulted in for profit health care.

    1. Nixon signed into law, the Health Maintenance Organization Act of 1973, in which medical insurance agencies, hospitals, clinics and even doctors, could begin functioning as for-profit business entities instead of the service organizations they were intended to be. 

      In the 1970s health care was allowed to change from a non-profit to a for profit.

    1. a group of teachers created a program through Baylor University Hospital where they would agree to pre-pay for future medical services (up to 21 days in advance). The resulting organization was not-for-profit and only covered hospital services. It was essentially the precursor to Blue Cross.

      Baylor University's teacher's created one of the first "employee insurance companies" which turned into Blue Cross.

    2. Since U.S. businesses were prohibited from offering higher salaries, they began looking for other ways to recruit new employees as well as incentivizing existing ones to stay. Their solution was the foundation of employer-sponsored health insurance as we know it today.

      The result of the Stabilization Act of 1942 was for employers to provide health care benefits to employees.

    1. Because health benefits could be considered part of compensation but did not count as income, workers did not have to pay income tax or payroll taxes on those benefits. Thus, by 1943, employers had an increased incentive to make health insurance arrangements for their workers, and the modern era of employer-sponsored health insurance began

      After WWII companies started providing health insurance to employees. Somewhere along the way this translated into employers co-oping with private insurance companies to provide health insurance as opposed to paying the employees medical bills or providing their own doctors and clinics.

  23. Jan 2019
    1. have the knowledge and skills to help navigate the hospital system, explain your diagnosis in detail, and explain potential outcomes.  We are also here to help decipher the information from doctor visits, set up meetings with care teams, and organize home care, and medications

      Using specialist in a field saves time, and ultimately saves lives.

  24. Nov 2018
    1. Initial resistance to the hospitalist movement among physicians often focused on the unavoidable discontinuity in care created by the model and the potential loss of information across the hospital threshold.45,49-52 Effective hospitalist programs have created mechanisms to mitigate the impact of this discontinuity, including calling primary care physicians on admission and discharge, faxing daily progress notes, and encouraging primary care physicians to visit or call their hospitalized patients. Though some concerns about information transfer linger, 2 recent surveys suggest that most physicians now accept the hospitalist model. In a national telephone survey of 400 internists, 51% (204) thought hospitalists might provide better care and 46% (184) thought patients might get more cost-effective care. Although 73% were concerned about the impact of hospitalists on continuity, physicians with hospitalists in their community were more approving.10 In a survey of 524 California primary care physicians, physicians perceived hospitalists as increasing (41%) or not changing (44%) the overall quality of care and most (55%) thought that hospitalists increase inpatient efficiency.11 In both surveys, primary care physicians stated their belief that patients generally preferred to be cared for in the hospital by their regular physician. Surveys of both generalists and specialists at Park Nicollet showed high levels of physician satisfaction several years after the implementation of a hospitalist program.28
    2. A major early concern was that patients accustomed to having their primary physician as their inpatient attending would not accept hospitalists.45 In general, however, surveys of patients who were cared for by hospitalists show high levels of satisfaction, no lower than that of similar patients cared for by their own primary physicians28,31,32 or by traditional academic ward attendings.18,21 We have postulated that patients may be willing to trade off the familiarity of their regular physician for the availability of the hospitalist.45
    1. And while hospitalists have already moved into post-acute-care settings, Dr. Bessler says that will become an even bigger focus in the next 20 years of the specialty. “It’s not generally been the psyche of the hospitalist in the past to feel accountable beyond the walls of the hospital,” he says. “But between episodic care [and] bundled payments … you can’t just wash your hands of it. You have to understand your next site-of-care decision. You need to make sure care happens at the right location.”
    2. Five years ago, it was accountable care organizations and value-based purchasing that SHM glommed on to as programs to be embraced as heralding the future. Now it’s the Bundled Payments for Care Improvement initiative (BCPI), introduced by the Center for Medicare & Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services (CMS) back in 2011 and now compiling its first data sets for the next frontier of payments for episodic care. BCPI was mandated by the Patient Protection and Affordable Care Act (ACA) of 2009, which included a provision that the government establish a five-year pilot program by 2013 that bundled payments for inpatient care, according to the American Hospital Association. BCPI now has more than 650 participating organizations, not including thousands of physicians who then partner with those groups, over four models. The initiative covers 48 defined episodes of care, both medical and surgical, that could begin three days prior to admission and stretch 30, 60, or 90 days post-discharge. <img class="file media-element file-medstat-image-flush-right" height="220" width="220" alt="Dr. Weiner" typeof="foaf:Image" src="https://www.the-hospitalist.org/sites/default/files/styles/medium/public/images/weinerweb.jpg" title="" />Dr. Weiner “The reason this is so special is that it is one of the few CMS programs that allows providers to be in the driver’s seat,” says Kerry Weiner, MD, chief medical officer of acute and post-acute services at TeamHealth-‎IPC. “They have the opportunity to be accountable and to actually be the designers of reengineering care. The other programs that you just mentioned, like value-based purchasing, largely originate from health systems or the federal government and dictate the principles and the metrics that as a provider you’re going to be evaluated upon. “The bundled model [BCPI] gives us the flexibility, scale, and brackets of risk that we want to accept and thereby gives us a lot more control over what physicians and physician groups can manage successfully.”
    3. “If we can’t build what I think of as a pyramid of care with one doctor and many, many other people supporting a broad group of patients, I don’t think we’re going to be able to find the scale to take care of the aging population that’s coming at us,” she says. Caring for patients once they are discharged means including home nurses, pharmacists, physical therapists, dietitians, hired caregivers, and others in the process, Dr. Gorman says. But that doesn’t mean overburdening the wrong people with the wrong tasks. The same way no one would think to allow a social worker to prescribe medication is the same way that a hospitalist shouldn’t be the one checking up on a patient to make sure there is food in that person’s fridge. And while the hospitalist can work in concert with others and run many things from the hospital, maybe hospital-based physicians aren’t always the best physicians for the task. “There are certain things that only the doctor can do, of course, but there are a lot more things that somebody else can do,” Dr. Gorman says, adding, “some of the times, you’re going to need the physician, it’s going to be escalated to a medication change, but sometimes maybe you need to escalate to a dietary visit or you need to escalate to three physical therapy visits. “The nitty-gritty of taking care of people outside of the hospital is so complex and problematic, and most of the solutions are not really medical, but you need the medical part of the dynamic. So rather [than a hospitalist running cases], it’s a super-talented social worker, nurse, or physical therapist. I don’t know, but somebody who can make sure that all of that works and it’s a process that can be leveraged.” Whoever it is, the gravitation beyond the walls of the hospital has been tied to a growing sea change in how healthcare will compensate providers. Medicare has been migrating from fee-for-service to payments based on the totality of care for decades. The names change, of course. In the early 1980s, it was an “inpatient prospective payment system.”
    4. Hospitalists are often referred to as the quarterbacks of the hospital. But even the best QB needs a good team to succeed. For HMGs, that roster increasingly includes nurse practitioners (NPs) and physician assistants (PAs).
    5. “The day is upon us where we need to strongly consider nurse practitioners and physician assistants as equal in the field,” he says. “We’re going to find a much better continuity of care for all our patients at various institutions with hospital medicine and … a nurse practitioner who is at the top of their license.”

      Hospitalists as QB should play leadership role in integrating all members of care team

    6. “The role of the hospitalist often is to take recommendations from a lot of different specialties and come up with the best plan for the patient,” says Tejal Gandhi, MD, MPH, CPPS, president and CEO of the National Patient Safety Foundation. “They’re the true patient advocate who is getting the cardiologist’s opinion, the rheumatologist’s opinion, and the surgeon’s opinion, and they come up with the best plan for the patient.”
    1. Despite the hospitalist field’s unprecedented growth, there have been challenges. The model is based on the premise that the benefits of inpatient specializa-tion and full-time hospital pres-ence outweigh the disadvantages of a purposeful discontinuity of care. Although hospitalists have been leaders in developing sys-tems (e.g., handoff protocols and post-discharge phone calls to pa-tients) to mitigate harm from dis-continuity, it remains the model’s Achilles’ heel.
    2. Finally, financial penalties for readmis-sions have led many hospitalists to staff post–acute care facilities to improve coordination with col-leagues at acute care hospitals.
    1. Conversely, some traditional programs may develophospitalist tracks that emphasize acquisition of theskills most relevant to inpatient practice. If suchtracks are developed, it will be important not to re-duce training in ambulatory care too aggressively,since the competent hospitalist will need a full un-derstanding of what can — and cannot — be donein the outpatient setting
    2. As with anymajor transition, the medical community must con-tinually reevaluate the new approach to ensure thatany possible discontinuity in care is outweighed byimproved clinical outcomes, lower costs, better edu-cation for physicians, and greater satisfaction on thepart of patients.
    3. Equally pressing is the question of value, definedas the quality of care divided by its cost.10
    4. Two of the principles underlying generalism,whether in the form of internal medicine, pediatrics,or family medicine, have been comprehensivenessand continuity.7,8 Ideally, the primary care physicianwould provide all aspects of care, ranging from pre-ventive care to the care of critically ill hospitalizedpatients. This approach, argued the purists, wouldresult in medical care that was more holistic, less frag-mented, and less expensive.9 To its proponents, thenotion was so attractive — the general internist ad-mits the patient to the hospital, directs the inpatientworkup, and arranges for a seamless transition backto the outpatient setting — that questioning it wouldhave seemed sacrilegious merely a few years ago
    1. Polls show that doctors are trusted by the public more than politicians, which means it’s hard for public policy to shape the healthcare system unless medical associations sign off on it.
    1. “It’s about embracing the inscrutable nature of human interactions,” says Chang. Evidence-based medicine was a massive improvement over intuition-based medicine, he says, but it only covers traditionally quantifiable data, or those things that are easy to measure. But we’re now quantifying information that was considered qualitative a generation ago.

      Biggest challenges to redesigning the health care system in a way that would work better for patients and improve health

    2. “Our biggest opportunity is leaning into that. It’s either embracing the qualitative nature of that and designing systems that can act just on the qualitative nature of their experience, or figuring how to quantitate some of those qualitative measures,” says Chang. “That’ll get us much further, because the real value in health care systems is in the human interactions. My relationship with you as a doctor and a patient is far more valuable than the evidence that some trial suggests.”

      Biggest challenges to redesigning the health care system in a way that would work better for patients and improve health

    3. Duffy points to the increase in health care interactions online and adds that he would like to see a pervasive culture of in-person care as last resort. “If every organizational decision, technology decision, process decision — assuming all the payment stuff, that’s kind of ticket of entry, transpires — if you view in-person as last resort, that will help pull systems across the country to a more consumer-forward Uber-like experience,” he says

      Biggest challenges to redesigning the health care system in a way that would work better for patients and improve health

    1. As with other forms of value-based health care, patient-centered care requires a shift in the way provider practices and health systems are designed, managed, and reimbursed. In keeping with the tenets of patient-centeredness, this shift neither happens in a vacuum, it driven by traditional hierarchies in which providers or clinicians are the lone authority. Everyone, from the parking valet and environmental services staff to c-suite members, are engaged in the process, which impacts hiring, training, leadership style, and organizational culture. Patient-centered care also represents a shift in the traditional roles of patients and their families from one of passive “order taker” to one of active “team member.” One of the country’s leading proponents of patient-centered care, Dr. James Rickert, has stated that one of the basic tenets of patient-centered care is that “patients know best how well their health providers are meeting their needs.” To that end, many providers are implementing patient satisfaction surveys, patient and family advisory councils, and focus groups, and using the resulting information to continuously improve the way health care facilities and provider practices are designed, managed, and maintained from both a physical and operational perspective so they become centered more on the individual person than on a checklist of services provided. As the popularity of patient- and family-centered health care increases, it is expected that patients will become more engaged and satisfied with the delivery of their care, and evidence of its clinical efficacy should continue to mount.

      Cultural shift to patient-centered care

    2. The concept of patient-centered care extends to the treatments and therapies clinicians provide. Not only are care plans customized, but medications are often customized as well. A patient’s individual genetics, metabolism, biomarkers, immune system, and other “signatures” can now be harnessed in many disease states — especially cancer — to create personalized medications and therapies, as well as companion diagnostics that help clinicians better predict the best drug for each patient.

      Patient-centered care via personalized medicine

    3. Strict visiting hours and visitor restrictions are a thing of the past in a patient-centered care model. Patients are given the authority to identify who can visit and when. Family members (as defined by the patient and not limited to blood relations) are invited to visit during rounding and shift changes so they can be part of the care team, participating in discussions and care decisions. When not in the room with the patient, they are kept informed of their loved one’s progress through direct and timely updates. A patient-centered care hospital’s infrastructure encourages family collaboration through a home-like environment that not only meets the needs of the patient, but also meets the needs of family members. For example, maternity wards are being redesigned with family-friendly postpartum rooms that can accommodate the mom, new baby, and family members, who are encouraged to spend up to 24 hours a day together in the room to foster family bonding.

      Patient-centered care in the hospital

    4. The primary goal and benefit of patient-centered care is to improve individual health outcomes, not just population health outcomes, although population outcomes may also improve. Not only do patients benefit, but providers and health care systems benefit as well, through: Improved satisfaction scores among patients and their families. Enhanced reputation of providers among health care consumers. Better morale and productivity among clinicians and ancillary staff. Improved resource allocation. Reduced expenses and increased financial margins throughout the continuum of care.

      Benefits of patient-centered care

    5. Patient- and family-centered care encourages the active collaboration and shared decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan. Most definitions of patient-centered care have several common elements that affect the way health systems and facilities are designed and managed, and the way care is delivered: The health care system’s mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals. Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place. Care focuses on physical comfort as well as emotional well-being. Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected. Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level. The presence of family members in the care setting is encouraged and facilitated. Information is shared fully and in a timely manner so that patients and their family members can make informed decisions.

      Elements of patient-centered care

    6. In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.

      What is patient-centered care?

    1. Koh et al. (11) detailed a cycle of crisis care elaborating the nature of high medical costs, possibly resulting from fear and denial. First, an individual is in need of medical help, so he or she goes to a physician's office where the staff asks the individual to fill out a complex and confusing form. The physician examines the patient and explains the condition and treatment options using medical jargon. Numerous prescriptions, laboratory tests, and referrals are given without confirmation of the patient's comprehension. The staff sends the patient home with complicated instructions. Inevitably, the patient may consume medication incorrectly or miss follow-up appointments, and his or her condition worsens. Eventually, the patient presents to the emergency department, and the hospital staff develops a new treatment plan. Again, no one confirms the patient's understanding. When the patient is discharged, he or she is likely to get sick again and repeat the cycle (11)
  25. Oct 2018
  26. Sep 2018
    1. We want better children—but not by turning procreation into manufacture or by altering their brains to gain them an edge over their peers. We want to perform better in the activities of life—but not by becoming mere creatures of our chemists or by turning ourselves into tools designed to win or achieve in inhuman ways. We want longer lives—but not at the cost of living carelessly or shallowly with diminished aspiration for living well, and not by becoming people so obsessed with our own longevity that we care little about the next generations. We want to be happy—but not because of a drug that gives us happy feelings without the real loves, attachments, and achievements that are essential for true human flourishing.

      This paragraph draw my attention. It is a important notice for this and the future generation. There are so many things that we are wondering and fight for but there are some temptation and wrong expectation in our world. i think that people really need to think about what are they wondering, such as happiness, career, family. after we recognize what we want then we need to figure out the right way to achieve our goal.

    1. medical care

      Improve medical care infrastructure and inter-provincial agreements to be able to cover LC-LD workers and their families in source, host and hub communities in a timely manner. the improvement of such services should be flexible enough to adapt to the ups and downs of the predominant industries.