The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG) in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training (...) users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries. (shrink)

Health information technology in hospitals can be approached as a tool to reduce health care costs and improve hospital efficiency and profitability, increase the quality of healthcare services, and make the transition to patient-centered healthcare. A hospital’s efficiency and profitability depends on linking IT with the knowledge and motivation of medical personnel. It is important to design and execute a knowledge management strategy as a part of the implementation of IT in hospital management. A Diagnosis-Related Groups system was introduced (...) in Poland in 2008 as a basis for settlements between hospitals and the National Health Fund. The importance and role of a DRG system in management of healthcare entities was emphasized based on a survey of medical professionals from two hospitals in the Lubelskie province. The goal of a survey is to assess the knowledge of medical professionals about the DRG system and how the medical personnel uses the DRG system in order to achieve the strategic goals of the organization. A newly developed survey was used to assess the medical personnel’s knowledge of DRG, using 12 closed and 5 open questions. The survey was conducted on 160 medical employees from two hospitals in the Lubelskie province. In conclusion, medical personnel’s DRG knowledge unambiguously contributes to reducing hospital costs and increasing profitability. The DRG related knowledge enables personnel to obtain value from data by applying DRG data-driven decisions. (shrink)

En 1983, un groupe de femmes japonaises francophiles, très intéressées par le féminisme français et les changements rapides de la vie des femmes en France depuis les années 1970, créent la Société Franco-japonaise des Études sur les Femmes. Le but est de promouvoir une meilleure compréhension entre les deux cultures et de développer des liens avec les Françaises sur un grand nombre de questions féminines. Le projet se révéla vite être un succès. Parmi les études entreprises par la Société, l’analyse (...) comparée de l’histoire des Françaises et des Japonaises, domaine très peu exploré alors, a suscité un vif intérêt chez les participantes. Cet article revient sur vingt années de réflexion, de recherche, et d’échange par un groupe d’historiennes non-professionnelles sur les relations entre histoire et expériences de vie personnelles. Il nous montre comment l’étude de l’histoire des femmes dans un contexte international peut être fructueuse et bénéfique, et combien une libre discussion collective, sans tabous, sur ce sujet peut éveiller ou approfondir la conscience féministe. (shrink)

We would like to open some questions here about the institutional and cultural conditions of anything that might be called cultural studies or multiculturalism. By introducing cultural studies and multiculturalism many intellectuals aim at a more democratic culture. We share this aim. In this essay, however, we would like to argue that the projects of cultural studies and multiculturalism require: a more international model of cultural studies than the dominant Anglo-American versions; renewed attention to the institutional environments of cultural studies; (...) and a questioning of the relations between multiculturalism and identity politics. We seek less to “fix” these problems than to provide a critical analysis of the languages, the methods of criticism, and the assumptions about identity, culture, and politics that present the problems to us. Because the thickets entangling what our group calls cultural studies are so deeply rooted in Western academia, which to a large degree constitutes our own group, the counterexample of cultural criticism in other contexts can be more than usually instructive. We begin by considering the position of cultural studies in China, since our group includes a number of Chinese intellectuals, on whose experience the following section is largely based. The Chicago Cultural Studies Group began meeting in June 1990. It includes Lauren Berlant, David Bunn, Vinay Dharwadker, Norma Field, Dilip Gaonkar, Marilyn Ivy, Benjamin Lee, Leo Ou-fan Lee, Xinmin Liu, Mathew Roberts, Sharon Stephens, Katie Trumpener, Greg Urban, Michael Warner, Jianyang Zha, and Jueliang Zhou. (shrink)

En 1983, un groupe de femmes japonaises francophiles, très intéressées par le féminisme français et les changements rapides de la vie des femmes en France depuis les années 1970, créent la Société Franco-japonaise des Études sur les Femmes. Le but est de promouvoir une meilleure compréhension entre les deux cultures et de développer des liens avec les Françaises sur un grand nombre de questions féminines. Le projet se révéla vite être un succès. Parmi les études entreprises par la Société, l’analyse (...) comparée de l’histoire des Françaises et des Japonaises, domaine très peu exploré alors, a suscité un vif intérêt chez les participantes. Cet article revient sur vingt années de réflexion, de recherche, et d’échange par un groupe d’historiennes non-professionnelles sur les relations entre histoire et expériences de vie personnelles. Il nous montre comment l’étude de l’histoire des femmes dans un contexte international peut être fructueuse et bénéfique, et combien une libre discussion collective, sans tabous, sur ce sujet peut éveiller ou approfondir la conscience féministe. (shrink)

Originally published between 1982 and 1991 the 3 volumes in this set Reflect the diversity in Hegelianism and every branch of philosophy which he contributed to. Examine Hegel's work in relation to Marx and Wittgenstein Discuss Hegel's social theory Examine British Hegelian thinking and the lines of its development Offer an interpretation of Hegelian theory that is relevant for the understanding of modern republican constitutions.

In Germany the question whether to uphold or repeal the judicial prohibition on Pre-implantation Genetic Diagnosis is being debated from quite different standpoints. This paper differentiates the major arguments according to their reasons as a) moral, b) evaluative , and c) legal. The arguments for and against PGD can be divided by content into three groups: arguments relating to the status of the embryo, focusing on individual actions in the implementation of PGD, and relating to the foreseeable or probable (...) consequences of PGD.In Germany, from a legal perspective, the status of the embryo does not permit the intervention of PGD; from a purely moral perspective, a prohibition on PGD does not appear defensible. It remains an open question, however, whether the moral argument permitting PGD should be restricted for evaluative reasons. The paper discusses the species-ethical reasons, for which Jürgen Habermas sees worrisome consequences in the wake of PGD to the extent that we comprehend it as the forerunner of a ‘positive eugenics’. It would so disrupt the natural preconditions of our universal morality. The question of whether to prohibit or allow PGD is not merely a question of simple moral and/or legal arguments, but demands a choice between evaluative, moral and species-ethical arguments, and the question remains open. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to much feminist (...) bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

IntroductionCerebral visual impairment is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according (...) to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23. 2. Ophthalmological and orthoptic assessment 37. 3. Neuropsychological assessment 5. 4. Neuroradiological evaluation and magnetic resonance imaging 9. 5. Genetic assessment 5.ConclusionIn medical history taking, prematurity low birth weight and APGAR Scores are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups. In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments can be necessary to complete the diagnosis of CVI and/or to reveal the etiology. (shrink)

Background: Dengue Disease is a mosquito-borne tropical disease caused by the dengue virus, symptoms typically begin three to fourteen days after infection. This may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. Dengue serology is applied in different settings, such as for surveillance, in health care facilities in endemic areas and in travel clinics in non-endemic areas. The applicability and quality of serological tests in dengue endemic regions has to be judged against a (...) background of potential cross reactivity with other flavi-viruses, difficulties in distinguishing primary from secondary infections and technological problems related to the fact that most dengue endemic regions are relatively poor of resources .Objectives: to help doctors and patients in diagnosing Dengue Disease and give them the information of how to prevent Dengue Disease and to be able to understand the signs and symptoms of Dengue Disease. Methods: We collected all relevant material for Dengue Disease. Then we designed and implemented a knowledge based system for diagnosing Dengue Disease using SL5 Object Language. Results: The knowledge based system was evaluated by a group of Patients and specialized doctors and they found it very friendly and easy to use. (shrink)

Disruptions in theory of mind faculties and the ability to relate to an intersubjective reality are widely thought to be crucial to schizophrenic symptomology. This paper applies a cognitive linguistic framework to analyze spontaneous perspective-taking in two corpora of stories told by people with a schizophrenia diagnosis. We elicited natural narrative language use through life story interviews and a guided storytelling task and analyzed the linguistic construal of viewpoint in these stories. For this analysis, we developed a reliable and widely (...) applicable viewpoint model that allows for the categorization and quantification of speakers’ linguistic presentation and navigation of spatiotemporal domains. We found that our participants skillfully presented, navigated and embedded different narrative viewpoints through a variety of linguistic viewpoint devices. They presented complex viewpoints of other people in both the here-and-now of the interaction and the there-and-then of a narrative, and made use of transition markers to demarcate spatiotemporal discourse domains. We found no differences in viewpoint variables when comparing their guided stories to a control group. If problems with intersubjectivity are indeed an essential part of schizophrenia, an explanation of how this group can take on and navigate complex linguistic viewpoints in natural narrative interaction is called for. (shrink)

This paper investigates the role of the concept of group heritability in group selection theory, in relation to the well-known distinction between type 1 and type 2 group selection (GS1 and GS2). I argue that group heritability is required for the operation of GS1 but not GS2, despite what a number of authors have claimed. I offer a numerical example of the evolution of altruism in a multi-group population which demonstrates that a group heritability coefficient of zero is perfectly compatible (...) with the successful operation of group selection in the GS2 sense. A diagnosis of why group heritability has wrongly been regarded as necessary for GS2 is suggested. (shrink)

Objective:Prior research examining sexual and intimacy concerns among metastatic breast cancer patients and their intimate partners is limited. In this qualitative study, we explored MBC patients’ and partners’ experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.Methods:We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews (...) with intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.Results:Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: the heavy disease/treatment burden leads to significant, long-term sexual concerns and consequent heightened emotional distress for both patients and partners ; viewing the relationship as having “an expiration date” influences patients’ and partners’ concerns related to sex/intimacy and complicates coping efforts; and information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.Conclusion:Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients’ and partners’ perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients’ health and quality of life. (shrink)

Background Medical aid in dying (MAID) is legal in a number of countries, including some states in the U.S. While MAID is only permitted for terminal illnesses in the U.S., some other countries allow it for persons with psychiatric illness. Psychiatric MAID, however, raises unique ethical concerns, especially related to its effects on mental illness stigma and on how persons with psychiatric illnesses would come to feel about treatment and suicide. To explore those concerns, we conducted several focus groups (...) with persons with lived experience of mental illness.Methods We conducted three video-conference-based focus groups involving adults residing in the U.S. who reported a prior diagnosis of any psychiatric illness. Only participants who reported thinking that MAID for terminal illness was morally acceptable were included. Focus group participants were asked to respond to a series of four questions. Groups were facilitated by a coordinator who was independent of the research team.Results A total of 22 persons participated in the focus groups. The majority of participants had depression and anxiety disorders; no participants had psychotic disorders such as schizophrenia. Many participants strongly favored permitting psychiatric MAID, generally on the basis of respect for autonomy, its effects on stigma, and the severe suffering caused by mental illness. Others expressed concerns, typically related to difficulties in ensuring decision-making capacity and to the risk that MAID would be used in lieu of suicide.Conclusions Persons with a history of psychiatric illness, as a group, have a diverse array of views about the permissibility of psychiatric MAID, reflecting nuanced consideration of how it relates to the public perception of mental illness, stigma, autonomy, and suicide risk. (shrink)

Background: Previous studies on the effectiveness of psychological interventions in oncology mainly used quantitative measures and no study was conducted with regard to both caregivers and patients. Aim: This study evaluates the effectiveness of psychoeducational support groups, both for women with breast cancer, and for their informal caregivers through the use of quantitative and qualitative measures. Methods: A longitudinal design was used comparing two psychoeducational support groups with other two groups in a standard care control condition. Participants (...) were 28 women with a diagnosis of breast cancer in the care of a hospital in Northern Italy, and 21 family caregivers. The quantitative data were collected by Cognitive Behavioral Assessment for Outcome Evaluation (CBA-OE) and the qualitative data through the use of semi-structured interviews. Results: The statistical analysis showed a significant change attributable to the psychological intervention that proves the effectiveness of such an intervention in the patients’ and caregivers’ group. The qualitative analysis allowed us to interpret the behavioral and psychological profile emerging from CBA-OE, by considering the subjective experience of the treatment groups. The group experience offered affective, relational and informative support, and allowed participants to create a network and to feel understood and reassured. Conclusions: The results suggest the usefulness of psychoeducational support groups for women with breast cancer and for their caregivers. The value of this kind of intervention is not only at an individual level but also at a systems level, and family involvement ensures the best positive outcomes. (shrink)

Understanding the neural basis of schizophrenia (SZ) is important for shedding light on the neurobiological mechanisms underlying this mental disorder. Structural and functional alterations in the anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), hippocampus, and medial prefrontal cortex (MPFC) have been implicated in the neurobiology of SZ. However, the effective connectivity among them in SZ remains unclear. The current study investigated how neuronal pathways involving these regions were affected in first-episode SZ using functional magnetic resonance imaging (fMRI). Forty-nine patients (...) with a first-episode of psychosis and diagnosis of SZ—according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision—were studied. Fifty healthy controls (HCs) were included for comparison. All subjects underwent resting state fMRI. We used spectral dynamic causal modeling (DCM) to estimate directed connections among the bilateral ACC, DLPFC, hippocampus, and MPFC. We characterized the differences using Bayesian parameter averaging (BPA) in addition to classical inference (t-test). In addition to common effective connectivity in these two groups, HCs displayed widespread significant connections predominantly involved in ACC not detected in SZ patients, but SZ showed few connections. Based on BPA results, SZ patients exhibited anterior cingulate cortico-prefrontal-hippocampal hyperconnectivity, as well as ACC-related and hippocampal-dorsolateral prefrontal-medial prefrontal hypoconnectivity. In summary, spectral DCM revealed the pattern of effective connectivity involving ACC in patients with first-episode SZ. This study provides a potential link between SZ and dysfunction of ACC, creating an ideal situation to associate mechanisms behind SZ with aberrant connectivity among these cognition and emotion-related regions. (shrink)

ObjectiveThis study aims to investigate the lived experience in patients with obstructive sleep apnea syndrome and comorbid obesity following after continuous positive airway pressure therapy made with the disease the device, and to identify barriers and facilitators to the use of CPAP to improve rehabilitation provision and aid in disease self-management.MethodsQualitative research was conducted using three focus groups with a representative sample of 32 inpatients undergoing a 1-month pulmonary rehabilitation program at the IRCSS Istituto Auxologico Italiano San Giuseppe Hospital, (...) Verbania, Italy. The focus groups were recorded on tape, and contemporaneous notes were made. The tapes were transcribed verbatim, and Interpretative Phenomenological Analysis was used to develop themes.ResultsSix main themes were extracted: Living the diagnosis as a shock; You should not sleep on it: the importance of prevention; The adjustment to CPAP; Barriers and facilitators to the use of CPAP; Three in a bed; and The relationship with the healthcare system.ConclusionResults of this study suggest potential avenues for interventions to increase adherence to CPAP, including the provision of information and continued support. Individual counseling providing strategies aimed at helping the person to cope with the emotional problem and relational difficulties associated with the use of CPAP, and at strengthening self-efficacy and self-management skills are also encouraged for optimal care during the rehabilitation program. (shrink)

Nurses and midwives are part of health care in all the stages of our lives from preconception to death. Recent scientific advances have introduced new techniques of screening and diagnosis linked to stem cell isolation and therapies. These could affect us at any age and therefore nurses will be involved as carers and patients advocates for these techniques. In this article stem cell techniques and therapies are outlined, as well as some of the ethical challenges faced by various nursing (...) class='Hi'>groups, whether in adult, learning difficulties, mental health, paediatric, primary care, public health or health visiting areas. Nurses have to understand the ethical issues and the rights of all parties (donor, recipient and families), which may conflict with each other, to be able to weigh up the benefits and costs to each group involved. Answers have to be found on a case-by-case basis within local moral frameworks and law. Nurses represent all parties in these therapies and act as advocates for every patient group. They need to act in an interprofessional environment to promote the best interests of all their clients, both clinically and ethically. (shrink)

BackgroundThe diagnosis of Attention deficit hyperactivity disorder is primarily dependent on parents’ and teachers’ reports, while children’s own perspectives on their difficulties and strengths are often overlooked.GoalTo further increase our insight into children’s ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children’s self-reports, parents’ and teachers’ reports, and standardized continuous performance test data. We also examined whether the addition of children’s perceptions of ADHD-symptoms to parents’ and teachers’ reports would be reflected by objective (...) and standardized data.MethodsThe study included 190 children with ADHD, aged 7–10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children’s self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist, Teacher’s Report Form, and CPT scores.ResultsChildren’s self-evaluations of their functioning were globally associated with their teachers’ and parents’ evaluations, but not uniquely. Children’s self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not.ConclusionPrimary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children’s perspectives into account during ADHD diagnosis and treatment is highlighted. (shrink)

At the present time, when we are experiencing one of the extraordinary conditions in which the basics of life are shaken, exceptional practices concerning the sources of the meaning of the world of life have become one of the urgent issues for the sociology of religion to consider. This study discusses the reactions of people to the effects of the COVID-19 pandemic on the regularity of social life in the early stages in the framework of Muslim religious groups. Since (...) the forms of social organization reveal reactions in their own specific forms, a research design that considers the differences were preferred. The provision that ‘man is social by nature,’ which is the indispensable principle of social sciences, has been the main feature of important issues to elaborate in the restrictions of today’s pandemic. Religious socialization, which is important for the inquiry, is a phenomenon that is desired to be carried out on a continuous basis. Its performative dimension draws attention to important elements that affect the formation and the social ontology of the group, such as consciousness and solidarity. While some religious groups insist on face-to-face interaction and rituals, some of them prefer to use effectively digital tools and channels. This differing approach has become a public issue, especially during the pandemic process. On the other hand, there is a discussion in the context of the digital world of new media tools and the travel possibilities of transportation technology. The theoretical basis of this study, which deals with the insistence of religious groups on face-to-face interaction and rituals is represented from the scope of Erving Goffman. His analyzes face-to-face communication and his comments emphasizing the ritualistic nature of daily life are operationalized through two basic case studies: the first case is the persistence and practice of Tablīghī Djamā‘at, in its annual meetings in the early days of the pandemic. The discussion started with the practice of the religious group in Delhi (Nizamuddin Markaz), since they did not cancel their annual meeting despite the diagnosis of the disease. The second case is based on the ritual insistence of pilgrims in visiting shrines in the Iranian city of Qom. The insistence of the Shiite Islamic understanding on ritual and pilgrimage and the solidarity built with the consciousness based on it is a well-known phenomenon. In the Covid-19 pandemic, the risk of contamination caused by the mobility of the pilgrims coming to the city of Qom from countries such as Pakistan was discussed, as well as the contact and social distance during the Hajj. Two cases were handled with a qualitative design including case analysis method and descriptive analysis technique. The main purpose and intended contribution of the article are to reveal the insistence of face-to-face interaction through the performative based on rituals as an analytical explanatory on the social level. Inferences based on the analysis of religious groups’ response to restrictions in times of emergency build the importance of the issue. Case information identified in the context of the case study shows that groups with traditional interaction forms insist on their own practice in the field of uncertainty and initiative. Unless necessity eliminates the initiative, the determination of this insistence of traditional religious groups is not only theological but also ontological confirmation. It is understood that the members of the group took the initiative to represent their reputation within the group and their extent to dedicate to the group. The fact that Tablīghī Djamā‘at, the largest group of the transnational Islamic da‘wa (call), did not give up on a method based on demographic mobility, has been a matter of discussion. The insistence of the group is because of the methods that require every ordinary believer to accept to convey the da‘wa as his primary duty. On the other hand, Shiism, which stands out with its traditional structure and ritual intensity in the Islamic world, insisted on the initiative process in the pilgrimage phenomenon, on which it attached special importance and built its solidarity and identity on this phenomenon. This insistence aims preserving the dynamics and social ontology of the religious group in the performance of the membership system. Essentially, the individual in the group insists on his position in face-to-face interaction because having a role in a group also means having a face. Thus, this insistence performance by religious groups should also be read as a reflection of self-technologies. In the final analysis, the insistence put forward should be considered essentially in relation to the insistence on the position in social ontology. (shrink)

Mit der Einführung der Diagnosis Related Groups wurde die Qualitätssicherung für Krankenhäuser verpflichtend. Vor diesem Hintergrund werden im vorliegenden Beitrag die gebräuchlichen Definitionen für Qualität der Gesundheitsversorgung und ihre Umsetzung in Maßnahmen der Qualitätsförderung analysiert. Auswirkungen des Umgangs mit Qualität sind u. a. eine Verbesserung der objektiven Qualität von Gesundheitsleistungen und eine Veränderung der Kultur der Medizin im Sinne einer Zergliederung der Behandlung in messbare Einzelschritte und der Standardisierung von Behandlungsabläufen. Im Kontrast zu diesem objektiven Verständnis von Qualität steht (...) die Forderung nach Patientenorientierung und nach einer subjektiven Qualität, die vor allem auf das Gelingen der therapeutischen Interaktion verweist und darauf, dass erst in der Interaktion der Maßstab für Qualität festgelegt wird. Demzufolge ist es die Aufgabe einer guten Krankenhausorganisation, einen geschützten Raum für die therapeutische Interaktion zu schaffen. (shrink)

ZusammenfassungMit der Einführung der Diagnosis Related Groups wurde die Qualitätssicherung für Krankenhäuser verpflichtend. Vor diesem Hintergrund werden im vorliegenden Beitrag die gebräuchlichen Definitionen für Qualität der Gesundheitsversorgung und ihre Umsetzung in Maßnahmen der Qualitätsförderung analysiert. Auswirkungen des Umgangs mit Qualität sind u. a. eine Verbesserung der objektiven Qualität von Gesundheitsleistungen und eine Veränderung der Kultur der Medizin im Sinne einer Zergliederung der Behandlung in messbare Einzelschritte und der Standardisierung von Behandlungsabläufen. Im Kontrast zu diesem objektiven Verständnis von Qualität steht (...) die Forderung nach Patientenorientierung und nach einer subjektiven Qualität, die vor allem auf das Gelingen der therapeutischen Interaktion verweist und darauf, dass erst in der Interaktion der Maßstab für Qualität festgelegt wird. Demzufolge ist es die Aufgabe einer guten Krankenhausorganisation, einen geschützten Raum für die therapeutische Interaktion zu schaffen. (shrink)

With the introduction of diagnosis-related groups, German hospitals were obliged to develop quality assurance schemes. This article analyses (1) commonly used definitions for quality in health care and (2) their implementation in terms of interventions for improving quality in hospitals. -/- Consequences of current quality assurance practices include advances in objective quality, but also a shift within the culture of medicine towards dividing the treatment of patients into measurable and standardized steps. In contrast to this objective meaning of quality, (...) there is a demand for more patient orientation and for more attention to the subjective quality of treatment which refers to a therapeutic interaction-based notion of quality standards. Besides technical quality standards, there are important quality standards that are being defined in and through interpersonal therapeutic interaction. Good hospital management should, therefore, protect the cultivation of therapeutic interaction in its essentially interpersonal qualities. (shrink)

Stroke survivors undergo a thorough cognitive diagnosis that often involves administration of multiple standardized tests. However, patient’s narrative discourse can provide clinicians with additional knowledge on patient’s subjective experience of illness, attitude toward current situation, and motivation for treatment. We evaluated the methods of analyzing thematic content and story types in relationship to cognitive impairment in stroke survivors with no aphasia. Cognitive impairment was evaluated in comparison to a group of 25 patients with orthopaedic injury not involving the brain. Our (...) findings primarily show that higher elaboration on own cognitive problems, physical ailments or coping strategies in LHD patients and cognitive problems, emotional issues and circumstances of illness onset in RHD patients is related to deficits in executive functions and retrieval of information from memory. Furthermore, RHD patients who use more chaos story type show lower executive functioning. However, these results did not survive the significance threshold of p < 0.05 after Bonferroni adjustment for multiple comparisons. In conclusion, this study provides preliminary evidence that stroke survivor’s narrative can constitute an additional source of clinically-relevant information regarding patient’s experience of illness and attitude toward recovery. This knowledge can aid clinicians and nurses in everyday interactions with the patients and support individualized strategy to treatment. Still, the current results need be confirmed with future studies in a larger cohort of stroke patients. (shrink)

In recent decades, group autonomy approaches to have gained kgitimacy within both academic and policy circles. This article examines the centrality of group autonomy in the multiculturalism debate, particuhrly in the highly influential approach of Will Kymlicka. I argue that his response to the dilemmas of liberd-democratic multiculturalism relies on an underdeveloped conceptualization of group autonomy. Despite presumably good intentions, his narrow notion of cultural group autonomy obscures the requirements of minority group members' democratic capabilities and thereby works against the (...) kind of transformative change that "accommodated" groups are seeking from the state. Although some critics (Young 1990; Benhabh 2002) have gone so far as to reject autonomy-based approaches to accommodation altogether (Young 1990,251) I suggest that this position goes too far. In response, I offer an intermediary position between those that defend and those that reject an autonomy-based approach. Instead of fully rejecting autonomy as a guiàng principle for multiculturalism, I devebp an ethics of care approach to group autonomy based on relationality, which addresses the inadequacies of the dominant approach to multiculturalism. Such an account of group autonomy is a vital step toward recondling multiculturalism with the necessary components of Uberd-democratic citizenship. (shrink)

We present a hypothetical process of mind coalescence, where arti cial connections are created between two or more brains. This might simply allow for an improved form of communication. At the other extreme, it might merge the minds into one in a process that can be thought of as a reverse split-brain operation. We propose that one way mind coalescence might happen is via an exocortex, a prosthetic extension of the biological brain which integrates with the brain as seamlessly as (...) parts of the biological brain integrate with each other. An exocortex may also prove to be the easiest route for mind uploading, as a person's personality gradually moves away from the aging biological brain and onto the exocortex. Memories might also be copied and shared even without minds being permanently merged. Over time, the borders of personal identity may become loose or even unnecessary. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Resources in Bioethics*Mary Carrington Coutts (bio)OrganizationsKennedy Institute of Ethics Georgetown University Washington, DC 20057 National Reference Center for Bioethics Literature 800-MED-ETHX or 202-687-3885The Hastings Center 255 Elm Road Briarcliff Manor, NY 10510 914-762-8500Society for Health and Human Values 6728 Old McLean Village Drive McLean, VA 22101 703-556-9222NOTE: There are numerous organizations in the United States and abroad that deal with bioethical issues. For a more comprehensive listing of (...) those organizations, see:American Hospital Association. Directory of Biomedical Ethics Organizations. Chicago: American Hospital Association, 1989.National Reference Center for Bioethics Literature. International Directory of Bioethics Organizations edited by Robert Iosco. Washington, DC: Georgetown University, 1986.Encyclopedia and DictionaryDictionary of Medical Ethics. Edited by A.S. Duncan, G.R. Dunstan, and R.B. Welborn. New rev. ed. New York: Crossroad, 1981. [End Page 75]Encyclopedia of Bioethics. Edited by Warren T. Reich. 4 vols. New York: Macmillan-Free Press, 1978; or 1982 reprint in 2 volumes available to members of the Kennedy Institute of Ethics through the membership office, 202-687-8099.Online DatabaseBioethicsline. Produced by the Kennedy Institute of Ethics for the National Library of Medicine. Searchable through the MEDLARS system. Focuses on questions of ethics and public policy in the fields of health care and biomedical research. Searches available upon request to the National Reference Center for Bioethics Literature. For information on securing a personal access code from the National Library of Medicine, call 800-638-8480.BibliographiesBibliography of Bioethics. Edited by LeRoy Walters and Tamar Joy Kahn. Washington, DC: Kennedy Institute of Ethics, Georgetown University. Issued annually since 1975. Corresponds to the BIOETHICSLINE database. Provides references to resources on ethical and public policy issues in medicine and biomedical research. Includes abstracts; arranged by broad subject categories.Ethics in Nursing. Edited by Terry Pence. 2nd ed. New York: National League for Nursing, 1986. An annotated bibliography of nursing ethics. Includes author and subject indexes.Goldstein, Doris M. Bioethics: A Guide to Information Sources. Detroit: Gale Research, 1982. A selected, annotated bibliography to the literature of bioethics.The Hastings Center's Bibliography of Ethics, Biomedicine and Professional Responsibility. Compiled by the staff of the Hastings Center. Frederick, MD: University Publications of America, 1984.Medical Ethics: An Annotated Bibliography. Edited by Mark Siegler, Peter A. Singer and David L. Schiedermayer. Philadelphia: American College of Physicians, 1988.Current Awareness ServicesNOTE: Several journals have sections where they highlight new publications. See, for example, the "In The Literature" section of the Hastings Center Report, or the "Medicolegal Reference Shelf" section of Law, Medicine and Health Care. Other services include:BioLaw. Edited by James F. Childress and Ruth D. Gaare. Frederick, MD: [End Page 76] University Publications of America, 1983 to present. Annual with bimonthly updates. (Previous title: Bioethics Reporter.) A compendium of articles and legal documents on ethical and legal issues in medicine, health care administration and human experimentation. Includes the text of important legal decisions in the Resources section.New Titles in Bioethics. Edited by Luanda Fitch Huttlinger. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. Published monthly 1975-1989; quarterly 1990—present. List of acquisitions by the National Reference Center for Bioethics Literature. Organized by subject categories. Includes ordering information for difficult-to-find items. Annual cumulation available.Scope Notes Series. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. A series of issue briefs including annotated bibliographies on the following popular bioethical topics:No 1. Dangerousness, September 1982, 5 p.No 2. Living Wills and Durable Powers of Attorney: Advance Directive Legislation and Issues, Revised February 1990, 15 p.No 3. Ethics Committees in Hospitals, Revised June 1989, 12 p.No 4. Diagnosis Related Groups and the Prospective Payment System, June 1984, 11 p.No 5. Baby Fae, January 1985, 19 p.No 6. Surrogate Mothers, Revised January 1988, 12 p.No 7. Withholding or Withdrawing Nutrition or Hydration, Revised September 1988, 12 p.No 8. AIDS: Law, Ethics and Public Policy, April 1988, 12 p.No 9. Bioethics Audiovisuals 1982 to Present, September 1988, 12 p.No 10. Ethical Issues in... (shrink)

Matters of hospital management do not figure prominently on the medical ethics agenda. However, management decisions that have to be taken in the area of hospital care are in fact riddled with ethical questions and do have significant impact on patients, staff members, and the community being served. In this decision making process evidence based medicine plays an increasingly important role as a tool for rationalising as well as rationing health care resources. In this article, ethical issues of hospital management (...) and the role of EBM will be explored, with particular reference to disease management programs, diagnosis related groups, and clinical pathways as recent developments in the German health care system. (shrink)

The high-tech health service work done by amateur family caregivers in U.S. homes challenges the conventional division of the social world into public and private. Under new federal reimbursement systems, the diagnosis-related groups, patients are being discharged sicker than before from hospitals and nursing homes, or after treatments in outpatient clinics. Health care facilities depend on a work transfer, shifting their earlier responsibilities for the sick to the family. There, women family members do for free the work once done (...) by paid health service workers in health care facilities, caring for family members who need their nursing and housekeeping services. Women's unpaid work knits together “public” and “private,” demonstrating how capitalism reorganizes the labor process to make use of free service labor. (shrink)

Introduction US data reveal a Caesarean rate discrepancy between insured and uninsured patients, with the C-section rate highest among the privately insured. The data have prompted concern that financial incentives associated with insurance status might influence American physicians' decisions to perform Caesarean deliveries. Objective To determine whether differences in medical risk factors account for the apparent Caesarean rate discrepancy between Medicaid and privately insured patients in Michigan, USA. Method A retrospective review was performed of 617 269 live birth deliveries in (...) Michigan hospitals during 2004–8. All live birth records that were able to be linked to their mothers' hospital discharge records were utilised. Diagnosis-related group codes from the hospitalisation records were used to identify Caesarean deliveries. Regression models determined Caesarean probability for the time period under study, adjusted for insurance type, maternal age, race, maternal medical conditions, multiple births, prematurity and birth weight. Results From 2004 to 2008, Caesarean rates were 33% for privately insured patients and 29% for Medicaid patients. The probability of Caesarean delivery was significantly greater for privately insured than Medicaid patients on univariate analysis (OR 1.2, 95% CI 1.19 to 1.22) but not on multivariate analysis (adjusted OR 1.01, 95% CI 0.99 to 1.02). Conclusion No significant disparity was found in the odds of Caesarean delivery between privately insured and Medicaid patients in Michigan after adjusting for other Caesarean risk factors. A positive disparity would have provided de facto evidence that financial incentives play a role in physician decision-making regarding Caesarean delivery. (shrink)

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a (...) systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. (shrink)

Die Einführung der kostenkalkulierten und landesweit einheitlich bepreisten DRGs hat die Möglichkeiten gewinnorientierter Krankenhausträger, ehemals kommunale, defizitäre Krankenhäuser in die Gewinnzone zu führen, erschwert. Diese reagieren darauf mit dem Einsatz bisher nicht gekannter Werkzeuge wie beispielsweise der Steuerung von Patientenströmen, Anreizsystemen, Gründung von Privatkliniken sowie erlösorientierten Therapien und Abrechnungen. Mittlerweile bedienen sich auch andere Trägergruppen dieser Instrumente, so dass sich die Frage stellt, ob angesichts der Wettbewerbssituation nicht gewinnorientierte Träger eines besonderen wirtschaftlichen Schutzes bedürfen, damit die bisher im Krankenhaus gültigen (...) ethischen Prinzipien auch weiterhin Anwendung finden können. (shrink)

A series of nonrepresentable relation algebras is constructed from groups. We use them to prove that there are continuum many subvarieties between the variety of representable relation algebras and the variety of coset relation algebras. We present our main construction in terms of polygroupoids.

We discuss some new properties of the natural Galois connection among set relation algebras, permutation groups, and first order logic. In particular, we exhibit infinitely many permutational relation algebras without a Galois closed representation, and we also show that every relation algebra on a set with at most six elements is Galois closed and essentially unique. Thus, we obtain the surprising result that on such sets, logic with three variables is as powerful in expression as full first order logic.

Detection of Alzheimer’s disease in an early stage is receiving increasing attention for a number of reasons, such as the failure of drug trials in more advanced disease stages, the demographic evolution, the financial impact of AD, and the approval of amyloid tracers for clinical use. Five focus group interviews with stakeholders were conducted.. The verbatim transcripts were analysed via the Nvivo 11 software. Most stakeholder groups wanted to know their own amyloid PET scan result. However, differences occurred between (...) FGs: two groups wanted to know, whilst in the three other groups FG members opted not to know or were still in doubt about their decision. Stakeholders provided insight into their reasons for wanting to know their amyloid PET scan result, for not wanting to know their result, or why they were in doubt about their decision. Several advantages and disadvantages were mentioned as part of knowing their amyloid PET scan result. Certain considerations were clustered in a grey zone, in between advantage and disadvantage, such as the emotional consequences. Clinicians, researchers, and policymakers ought to be aware of the diversity of reasons for wanting to know their result and how possible benefits and risks can be viewed differently. The current findings are of importance for future early diagnosis and disclosure of results in the research setting. (shrink)

This article brings together two debates in contemporary political philosophy: on the one hand, the dispute between the distributive and relational approaches to equality and, on the other hand, the field of intergenerational equality. I offer an original contribution to the second domain and by doing so, I inform the first. The aim of this article is thus twofold: shedding some light on an under-researched and yet crucial question – ‘which inequalities between generations matter?’ and contributing to a far-reaching debate (...) that touches upon the nature of egalitarianism. After showing that there are two key problems that fall within the scope of intergenerational equality – questions of justice between age groups and questions of equality between birth cohorts – I argue that, contrary to what the default distributive view states, some inequalities between age groups matter independently of their diachronic impact, and so partly for relational reasons. I argue that, even if we are distributive egalitarians, we must endorse the relational egalitarian conception to successfully make sense of some inequalities between age groups. I infer from this both that the putative view that the ‘relational’ conception of equality can be redescribed as distributive must be rejected and that the distributive view requires supplementation by the relational view. (shrink)

Unethical acts and reported cases of corruption and commercial crimes in South African business are increasing. Literature studies showed that risk groups (for instance South African managers in affirmative action positions) are functioning in a stressful environment which can give rise to unethical acts. Results pointed out that high stress correlates substantially with: to claim credit for a subordinate's work; to fail to report a co-worker's violation of company policy, to offer potential clients fully paid holidays; and to purchase (...) shares upon hearing privileged company information. In the light of this a number of recommendations were made. (shrink)