Health care organizations are increasingly asked to show accountability about their performance. This paper proposes that accountability can best be achieved through evaluative methods that are based on evidence regarding the relationship between processes of care and expected outcomes. Root cause analysis (RCA) is used as an illustration of how a generic method of inquiring can be transformed into an ongoing monitoring, evaluation, user education and accountability strategy. The role of performance indicators, as well as patient and community expectations, is (...) discussed. (shrink)

In philosophical analyses of the value of sport, a relatively unheralded feature is the opportunity that sport offers for admiration. While we readily salute many of the things that people admire (...

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

The dissociation between the domains of knowledge continues to perpetuate the fragmentation of people’s health and healing experiences. Of particular significance are the polarities that have been created between the objective, subjective and spiritual dimensions of knowledge and human experience. This paper offers a consideration of how faith might serve as a pragmatic avenue towards assuaging the polarities between knowledges and enhancing nurses’ ability to attend to the complex and mulitdimensional nature of health and healing processes.

Is truth a supreme value? At times, we doctors have to contend with a complex dilemma in which we face the value of truth on the one hand and conflict with another value on the other. Is it sometimes permissible and even necessary not to report the truth in favour of another, more important value? This is a description of an experience in which a doctor had to handle such an issue when a pregnant Muslim woman asked for a document (...) that she wasn’t pregnant when in fact she was, in order to avert the possibility of being murdered to preserve the honour of the family. The doctor decided that the value of life was more important than the value of truth. (shrink)

This book is a theoretical and completely rigorous analysis of voting in committees that provides mathematical proof of the existence of democratic voting systems, which are immune to the manipulation of preferences of coalitions of voters. The author begins by determining the power distribution among voters that is induced by a voting rule, giving particular consideration to choice by plurality voting and Borda's rule. He then constructs, for all possible committees, well-behaved representative voting procedures which are not distorted by strategic (...) voting, giving complete solutions for certain important classes of committees. The solution to the problem of mass elections is fully characterised. (shrink)

Resisting Contextual Information: You Can't Put a Salient Meaning Down Two experiments support the graded salience hypothesis, which assumes that early processing involves distinct mechanisms-linguistic and contextual-that do not interact but run parallel. While contextual processes make up an integrative, top-down mechanism that benefits from linguistic and extra-linguistic information, the linguistic mechanism is modular. Using Vu et al.'s materials, Experiment 1 shows that the sentential position of a target word is crucial for the operation of the global, predictive mechanism, whose (...) effects, accumulated in prior discourse, mask lexical effects in final, but not in initial position. Experiment 2 shows that even in a sentential position that favors contextual effects, lexical access is not affected: Salient meanings are activated upon encounter of the lexical stimulus, regardless of contextual information to the contrary. Taken together, these findings argue against direct access models, which suggest that context can selectively activate the appropriate meaning, regardless of salience. (shrink)

Plagiarism is increasingly evident in business and academia. Though links between demographic, personality, and situational factors have been found, previous research has not used actual plagiarism behavior as a criterion variable. Previous research on academic dishonesty has consistently used self-report measures to establish prevalence of dishonest behavior. In this study we use actual plagiarism behavior to establish its prevalence, as well as relationships between integrity-related personal selection and workplace deviance measures. This research covers new ground in two respects: (a) That (...) the academic dishonesty literature is subject to revision using criterion variables to avoid self bias and social desirability issues and (b) we establish the relationship between actual academic dishonesty and potential workplace deviance/white-collar crime. (shrink)

Environmental ethics is the subject in philosophy that examines the moral relationship of human beings to the environment and its non-human species. It concerns human’s ethical relationship with the natural environment. The central question concerning environmental ethics is essentially – what is human being’s moral obligation concerning the natural environment? The paper will firstly provide a review of the ethical relations of humans and the environment, secondly examine how value-based education can assist in inculcating environmental ethics among learners.

(2013). A Passion for Pushing the Limits. World Futures: Vol. 69, The Complexity of Life and Lives of Complexity, pp. 359-381.