...Reflection of Better, by Atul Gawande In Better, Atul Gawande takes the reader to courtrooms, clinics, war zones, and execution chambers to demonstrate the incredible environments in which doctors care for and treat patients. While drawing on a vast array of sources, including his own personal experience, Gawande interweaves into nearly every chapter fascinating vignettes about the most important person in his view of medicine: the patient. By ensuring that every message is personalized in this manner, he brings a warm, humane touch to this superb book. His idea of the “three core requirements” for successful performance in medicine— diligence, doing right, and ingenuity — and in turn considers specific problem areas in each. He cites three distinct examples in which diligence is essential to the successful execution of medical therapy: the WHO’s and their work in India with the polio outbreak, US military’s medical staff in Iraq, and the work of infection-control specialists with hand washing and disease prevention. All of their efforts are demonstrably linked by the almost obsessive diligence of the clinicians responsible. When talking about ‘doing right,’ Gawande takes on a number of compelling issues which includes the litigious nature of our society toward health care providers. We meet two intriguing people, a physician colleague of the author whose son was harmed by medical error and an ex-clinician who is now working as a medical malpractice lawyer and gains the novel...
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...Atul Gawande in his book “Letting Go” is trying to point out a medical system that is not effective in caring for the needs of patients who are terminally ill and approaching death. He writes that these patients can be placed under hospice and palliative care and end up living better and quality lives, even longer than what was expected. According to Gawande, this is a better choice than struggling to find means to stay alive when all means have been exhausted and there's no hope left. We should know when to let go. Gawande gives us the experiences of a few terminally ill individuals receiving different forms of treatment. Among those was Sarah Monopoli's touching story. She was diagnosed with an inoperable lung cancer while she was pregnant. Her long battle against this disease and trying to survive led her to trying many different types of aggressive treatments which left her weaker and more prone to infections. Although her wish was to die at home and not in the hospital, she ended dying in the hospital where she went to seek treatment for pneumonia. At last when she was in the hospital, her family decided to bring her suffering to an end and stopped medical intervention. Through her treatments, she suffered greatly...
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...Kelly Smithson Professor Rose English 15 17 April 2013 Improving Food Safety in Restaurants Atul Gawande is a surgeon, writer, and public health researcher. His current research is centered on improving performance in surgery, childbirth, and care of the terminally ill. He wrote an article in 2004 titled “The Bell Curve” It is about the need for improving health care for patients diagnosed with cystic fibrosis. In the article he made claims about treatment centers for cystic fibrosis being extremely successful in prolonging the life of the patients, but most are in just an average range. Gawande explains that “what you tend to find is a bell curve: a handful of teams with disturbingly poor outcomes for their patients, a handful with remarkably good results, and a great undistinguished middle”(4). This same concept of a bell curve could also be applied to restaurant health and safety rankings. I’m sure there is some restaurants that are just average when it comes to the hygiene of the facility, while other restaurants are so clean you could eat off of the floor. As restaurant owners there are many steps that you can do to be above average when it comes to the cleanliness of their facilities. One extremely important or even first step when operating a successful restaurant is to make sure that local health inspectors are investigating the establishment properly. This is important to ensure that the restaurant owners are doing things correctly. It has been know that throughout...
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...Legalizing Euthanasia: A Practical Approach Theressa Thacker RN Excelsior College Abstract We are all in the process of dying from the day we are born. The prevalence of catastrophic diseases that once killed swiftly such as pneumonia, cholera, and massive heart attacks, have been replaced by chronic and, often, degenerative diseases such as advanced cancers, diabetes, lung disease, and Alzheimer’s, leading to a slow death for most (Gardner, 2012). This places a great financial burden on the Medicare system as well as patient’s families. Atul Gawande (2010) reports that twenty five percent of all Medicare spending is for the five percent of patients who are in their final year of life, and most of that money goes for care in their last couple of months, which is of little apparent benefit (p. 3). Even more concerning is the suffering that many patients are forced to endure due to the lack of other options. Patients must have the right to make autonomous decisions regarding the end of their lives. They need to be confident that those decisions will be upheld, even if they conflict with the wishes of their families or physicians. However, patient confidence in knowing that their final wishes will be met is complicated by a lack of education and empowerment for those who face these difficult decisions (Frank & Anselmi, 2011). The purpose of this essay is to discuss the benefits to patient autonomy and the Medicare budget, by the legalization of physician-assisted...
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...The more I learn about the human body and its intricacies, the more I am fascinated by how it responds to illness and injury and how doctors can transform a patient's life. During my work experience at John Radcliffe Children’s Hospital, I spent time with medical students, junior doctors and consultants in different specialities, which gave me an overview of the healthcare system. In a multidisciplinary meeting for a child with complex regional pain syndrome, I recognised the importance of effective communication. With the expertise of different disciplines, a better understanding was gained of the patient's individual case and the treatment options available. I noticed that the style of communication is important to engage young children, which I applied while volunteering at Lighthouse Children's Camp. My learning proved effective as the children talked to me in confidence about their feelings regarding starting secondary school and I offered them reassurance and advice. Working as a healthcare assistant and phlebotomist at Crosby House Surgery has been an enjoyable challenge to engage with patients of varying ages and backgrounds. Helping out with different aspects of primary care has given me a broader...
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...Grade Received - "A" You are a paramedic arriving at an emergency scene. A group of scouts have entered a cave that is now filling with water. They were led into the cave by a rather large scoutmaster. Unfortunately, while leading them out of the cave, the scoutmaster somehow managed to get stuck in a narrow opening with only his head and shoulders protruding out. With his upper torso stuck outside the cave, it appears the scoutmaster will survive, but all the boys below will drown if they cannot escape. After you have checked all possible escape routes and have attempted to extricate the scoutmaster, it becomes clear that the only way to save the boys is to sacrifice the scoutmaster and remove him from the hole so the rest of the scouts can escape. What is the correct action for this case? Justify your decision using each of the following: Duty-oriented reasoning (1 to 2 Paragraphs) Consequence-oriented reasoning (1 to 2 Paragraphs) Virtue-ethics reasoning (1 to 2 Paragraphs) Based on your analysis, consider what might be the ultimate dilemma of ethics and include your answer to each of the following questions: What happens when people apply differential standards (all valid) to health care decisions? Explain with supporting examples. (2 to 3 Paragraphs) How does an individual determine who is ultimately right when different decisions are reached? (2 to 3 Paragraphs) Abstract I am a paramedic who has arrived at an emergency scene or a group of scouts enter...
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...Reabsorption of Sodium Chloride — Lessons from the Chloride Channels PERSPECTIVE prostaglandin inhibitors, and the molecular challenge is substantial as well. The molecular delineation of the genetic defects that result in tubulopathies can lead to a better understanding of their physiology. However, the DNA sequencing of the genes that encode transporters and channels (as well as their subunits) is not a trivial matter and must be complemented by experiments determining expression patterns. The Xenopus oocytes that have been used for such studies are transfected cells rather than “real” polarized cells of the thick ascending limb of the loop of Henle surrounded by the sophisticated hypertonic environment of the renal medulla. The complex polyuria–polydipsia syndrome described by Schlingmann et al. is attributable to the concomitant loss-of-function mutations in both CLCNKA and CLCNKB; the syndrome results in ion selectivity, demonstrating the means whereby a renal tubular cell lets one type of ion (chloride) through the lipid membrane to the exclusion of others. It thus provides yet another example of the molecular basis of Bartter’s syndrome (see Figure). The contributions of Roderick McKinnon and Peter Agre to solving these two complementary problems of the resorption of renal solute and renal solvent earned them the 2003 Nobel Prize in chemistry.5 We live in a fascinating time in which clinical syndromes can be deciphered at the molecular and even...
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...INTRODUCTION I am working at the medium sized company, Silky Road (SR), has success in the electronic industry, as a general manager. The main office is located in the Kyout Ta Tar Township. We imported high quality electronic items such as Hand phone, telephone, TV, laptop, computer, DVD, etc., from Thailand, South Korea, Hong Kong, USA. We are now 5th place in the market. Therefore we interest in expanding our market share not only in Yangon but also Mandalay and other cities. Vision Our vision is to be the most successful company among top 3 companies in Myanmar by distributing our high quality electronic items to our valuable customers. And we aim to expand our market the whole Myanmar. Mission - To provide high quality items to our customers. - To give the best service to customers. Objective - In 5 years, we must get our aim of to become one of the top companies. Organization structure In this organization structure, my position is under CEO. I am responsible for my under departments, marketing, finance, HR, IT and warehousing. In this assignment I am going to discuss my personal development plan and how I will develop my personal skills which will help me in my current situation. Personal development plan (PDP) is a structured and supported process undertaken by an individual to reflect upon their own learning, performance and achievement and to plan for their personal, educational and career development. In...
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...INTRODUCTION I am working at the medium sized company, Silky Road (SR), has success in the electronic industry, as a general manager. The main office is located in the Kyout Ta Tar Township. We imported high quality electronic items such as Hand phone, telephone, TV, laptop, computer, DVD, etc., from Thailand, South Korea, Hong Kong, USA. We are now 5th place in the market. Therefore we interest in expanding our market share not only in Yangon but also Mandalay and other cities. Vision Our vision is to be the most successful company among top 3 companies in Myanmar by distributing our high quality electronic items to our valuable customers. And we aim to expand our market the whole Myanmar. Mission - To provide high quality items to our customers. - To give the best service to customers. Objective - In 5 years, we must get our aim of to become one of the top companies. Organization structure In this organization structure, my position is under CEO. I am responsible for my under departments, marketing, finance, HR, IT and warehousing. In this assignment I am going to discuss my personal development plan and how I will develop my personal skills which will help me in my current situation. Personal development plan (PDP) is a structured and supported process undertaken by an individual to reflect upon their own learning, performance and achievement and to plan for their personal, educational and career development. In accordance with...
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...Journal for Critical Animal Studies, Volume 10, Issue 2, 2012 (ISSN1948-352X) Beyond Dehumanization: A Post-Humanist Critique of Solitary Confinement Lisa Guenther Abstract What does it mean to be treated like a nonhuman animal? In this paper, I analyze the discourse of “dehumanization” in Madrid v Gomez, a 1995 Eighth Amendment case concerning the treatment of prisoners at California’s Pelican Bay Supermax Penitentiary. I argue that the language of dehumanization fails to describe the harm of solitary confinement because it remains complicit with a hierarchical opposition between human and nonhuman animal that rebounds against prisoners, especially those who have been racialized and/or sexualized as less than human. Humanist discourse neglects the sense in which both human and nonhuman animals are affective, corporeal beings who rely upon the support of others for their own capacity to orient themselves within a mutually-perceived world. Drawing on the testimony of inmates in solitary confinement, and situating this testimony in relation to the political and scientific history of US incarceration practices, I develop a post-humanist critique of solitary confinement. Keywords: Solitary confinement, sensory deprivation, intercorporeal Malebranche would not have beaten a stone as he beat his dog, saying that the dog didn’t suffer. Merleau-Ponty, Nature, 166 Certain carceral practices are often condemned – both by prisoners and by their legal or political advocates –...
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...THE AUSTRALIAN HEALTH CARE SYSTEM: THE POTENTIAL FOR EFFICIENCY GAINS A REVIEW OF THE LITERATURE Background paper prepared for the National Health and Hospitals Reform Commission June 2009 This paper was prepared at the Commission’s request by staff of the secretariat to the Commission. The lead author was Emily Hurley. Ian McRae Ian Bigg Liz Stackhouse Anne-Marie Boxall and Peter Broadhead provided some input and commented on drafts. This is a paper prepared as background for the NHHRC. The views and findings expressed in it should not be taken to be the views of the NHHRC or of the Australian Government. 2 TABLE OF CONTENTS Introduction ....................................................................................................4 International overview of efficiency .............................................................4 Health status – due to more than the health care system ............................7 An Australian focus ......................................................................................8 Summary ......................................................................................................8 A framework for efficiency............................................................................9 Operational Efficiency .................................................................................10 Health sub-sectors .....................................................................................11 Hospitals...........
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...WHO Guidelines on Hand Hygiene in Health Care: a Summary First Global Patient Safety Challenge Clean Care is Safer Care a WHO Guidelines on Hand Hygiene in Health Care: a Summary © World Health Organization 2009 WHO/IER/PSP/2009.07 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable...
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...Patient Safety Workshop Learning From Error PATIENT SAFETY WORKSHOP LEARNING FROM ERROR WHO Library Cataloguing-in-Publication Data Patient safety workshop: learning from error. Includes CD-ROM 1.Patient care - standards. 2.Medical errors - standards. 3.Patient rights. 4.Health facilities - standards. 5.Health Management and Planning. I.World Health Organization. ISBN 978 92 4 159902 3 (NLM Classification: WX 167) This publication is a reprint of material originally distributed as WHO/IER/PSP/2008.09. © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies...
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...DIAGNOSES presents analyses of the management case by academicians and practitioners Infosys Technologies Ltd.: Growing Share of a Customer’s Business James A Narus and D V R Seshadri Case Analysis I Janaki Anant Principal Solution Architect i-flex solutions Ltd e-mail: janaki.anant@iflexsolutions.com his case has multiple dimensions of analysis to it. While there is certainly an immediate short-term issue of winning the Ariba® e-procurement project of the existing client, Prairie Four Square (PFS), and gaining an increased share of the customer’s business that the Infosys team is trying to address, there is also an overall long-term strategic issue that needs to be addressed as well – that of the pricing mechanism based on value that needs to be deployed for long-term sustainability and growth of the relationship. This case offers an insight into the various dimensions of moving up the value chain and increasing the economic value of a customer relationship, identifying the differentiation strategy, communicating the positioning effectively, and the impact of local competition in the global scenario. The case also effectively illustrates the general growth path followed by most Indian software services companies, the issues they face in this progression, the changing scenarios in the global competitive arena, and the relentless pressure to lower costs in a diminishing labour cost arbitrage advantage scenario. T The April-June, 32(2), 2007 issue of Vikalpa had published...
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...Last “Mark Graban is the consummate translator of the vernacular of the Toyota Production System into the everyday parlance of healthcare. With each concept and its application, the reader is challenged to consider what is truly possible in the delivery of healthcare if standardized systems borrowed from reliable industries were implemented. Graban provides those trade secrets in an understandable and transparent fashion.” — Richard P. Shannon, MD, Frank Wister Thomas Professor of Medicine, Chairman, Department of Medicine, University of Pennsylvania School of Medicine “There is an enormous shortfall between the healthcare we are promised and what we actually get. Mark Graban explains how those in the system can make care delivery better for everyone –patients, providers, and payers.” — Steven Spear, Senior Lecturer, MIT, Senior Fellow, IHI “Mark Graban’s work has been a steady companion in the three years I have been studying and applying lean in healthcare. He...
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