J.R.’s Zaphne Blog News for 07-16-2018


Soul of Business

United Arab Emirates Government type

Authoritarian – a form of government in which state authority is imposed onto many aspects of citizens’ lives. Communist – a system of government in which the state plans and controls the economy and a single – often authoritarian – party holds power; state controls are imposed with the elimination of private ownership of property or capital while claiming to make progress toward a higher social order in which all goods are equally shared by the people. Confederacy – a union by compact or treaty between states, provinces, or territories, that creates a central government with limited powers; the constituent entities retain supreme authority over all matters except those delegated to the central government. Constitutional – a government by or operating under an authoritative document that sets forth the system of fundamental laws and principles that determines the nature, functions, and limits of that government. Federal – a form of government in which sovereign power is formally divided – usually by means of a constitution – between a central authority and a number of constituent regions so that each region retains some management of its internal affairs; differs from a confederacy in that the central government exerts influence directly upon both individuals as well as upon the regional units. 

Federal republic – a state in which the powers of the central government are restricted and in which the component parts retain a degree of self-government; ultimate sovereign power rests with the voters who chose their governmental representatives. Islamic republic – a particular form of government adopted by some Muslim states; although such a state is, in theory, a theocracy, it remains a republic, but its laws are required to be compatible with the laws of Islam. Monarchy – a government in which the supreme power is lodged in the hands of a monarch who reigns over a state or territory, usually for life and by hereditary right; the monarch may be either a sole absolute ruler or a sovereign – such as a king, queen, or prince – with constitutionally limited authority. Parliamentary democracy – a political system in which the legislature selects the government – a prime minister, premier, or chancellor along with the cabinet ministers – according to party strength as expressed in elections; by this system, the government acquires a dual responsibility: to the people as well as to the parliament. Parliamentary government – a government in which members of an executive branch are nominated to their positions by a legislature or parliament, and are directly responsible to it; this type of government can be dissolved at will by the parliament by means of a no confidence vote or the leader of the cabinet may dissolve the parliament if it can no longer function. 

Socialism – a government in which the means of planning, producing, and distributing goods is controlled by a central government that theoretically seeks a more just and equitable distribution of property and labor; in actuality, most socialist governments have ended up being no more than dictatorships over workers by a ruling elite. Theocracy – a form of government in which a Deity is recognized as the supreme civil ruler, but the Deity’s laws are interpreted by ecclesiastical authorities; a government subject to religious authority. 

Keywords: [“government”,”state”,”power”]
Source: https://www.indexmundi.com/united_arab_emirates/government_type.html

Patients’ Perception of Hospital Care in the United States

HCAHPS and the Domains of Patients’ Experiences The HCAHPS survey, developed by the Agency for Healthcare Research and Quality, asks patients 27 questions about their experiences in the hospital and about their demographic characteristics. Other domains reflect individual questions about whether the rooms were clean and whether they were quiet and two overall ratings: a global rating of the hospital on a scale of 0 to 10, with 0 being the worst and 10 being the best a hospital can be, and a question about whether the patient would recommend the hospital to family and friends. Under the CMS’s authority to monitor providers of care and to oversee care for Medicare patients, the CMS and its Quality Improvement Organizations can require that the HCAHPS survey be administered to patients who are being discharged from hospitals that receive Medicare payment. HQA Data on Provision of High-Quality Clinical Care The HQA also provides data on the compliance of hospitals with 24 measures of evidence-based processes with respect to care for three conditions – acute myocardial infarction, congestive heart failure, and pneumonia – and with respect to the prevention of complications from surgery. To create condition-specific summary scores, we used a common method,11 in which the summary score is a percentage derived from the sum of the number of times a hospital performed the appropriate action across all measures for that condition divided by the number of opportunities the hospital had to provide appropriate care. 

Composite scores for a condition were calculated only if a hospital had at least 30 patients for at least one measure. Structural Characteristics of Hospitals We linked the HCAHPS data to the annual survey of the American Hospital Association, which collects the following information from hospitals: nurse-staffing levels, profit status, status of membership in the Council of Teaching Hospitals and Health Systems, number of beds, census region, location, percentage of patients receiving Medicaid, and presence or absence of a medical intensive care unit. Statistical Analysis We used chi-square tests and t-tests to compare hospital characteristics between hospitals that reported HCAHPS data and those that chose not to do so. We focused primarily on the fraction of patients who rated the hospital in the highest category as the primary indicator of patient satisfaction. We examined bivariate relationships between each of these characteristics and HCAHPS ratings and subsequently constructed multivariable linear regression models that adjusted for the other two characteristics as well as other characteristics that might be potential confounders: number of beds in the hospital, census region, location, presence or absence of a medical ICU, and percentage of patients receiving Medicaid. 

We examined the relationship between a hospital’s performance with respect to the overall experience of the patients and measures of clinical process using the HQA summary scores described above. We then calculated the performance on each of the HCAHPS measures for each hospital-referral region by averaging the ratings for all hospitals in that hospital-referral region, weighted by hospital size. 

Keywords: [“hospital”,”patient”,”rated”]
Source: https://www.nejm.org/doi/full/10.1056/NEJMsa0804116

J.R.’s Zaphne Blog News for 05-11-2018


Compassionate Capitalism – by Sanjiv Mehta at the #India2022Exchange

The Ethics of Health Care Reform: Issues in Emergency

This paper describes the basic provisions of the PPACA of 2010 and addresses important ethical issues of health care reform, including the moral foundations of reform, the American College of Emergency Physicians Code of Ethics as a guiding document, and health care reform’s likely effects on cost containment, public health, access to care, ED crowding, and end of life issues. The Patient Protection and Affordable Care Act is a federal statute signed into law along with its amendment, the Health Care and Education Reconciliation Act, by President Obama in March 2010.[i] It is designed to take effect in stages over the next 8 years and includes reforms such as prohibiting insurers from denying coverage for pre-existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, and providing incentives for businesses to provide health care benefits. To understand the moral dimensions of the health care reform debate, it is useful to begin by examining the fundamental goals of our health care system. Evaluation of health care reform practices according to this Code of Ethics will provide guidance to ensure the ethical delivery of emergency medical care. An accountable care organization is defined in the PPACA as an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare patients for whom they provide the bulk of primary care services. 

Xvi] ACOs have been suggested as a strategy to deliver integrated health care by promoting evidence-based medicine, reporting data about quality and cost of care, and coordinating health care. Finding the balance between provision of value in health care and cost containment remains a fundamental ethical challenge for health care reform. ACEP’s policy on Medical Screening of Emergency Department Patients states that ACEP strongly opposes deferral of care for patients presenting to the ED. Furthermore, ACEP believes that deferring care for patients presenting to the ED reflects a void in the health care system. Further bolstering an expanded scope of care argument is the fact that racial and ethnic disparities may be increased by expanded health insurance coverage by the PPACA. 

Those who have difficulties in obtaining PCP care are often from disadvantaged backgrounds, and in Massachusetts health reform did exacerbate this health care disparity. This reform will invest in community health centers and pay for primary care, to give patients options to receive non-urgent care and follow-up care in settings more appropriate than the ED. Unfortunately, PPACA does not address the underlying issues that influence ED crowding. Lxx] Health care reform provisions, including the possible future adoption by law or regulation of funding for advance care planning consultations, demonstrating the value of expert symptom management in parallel with standard therapies and improving pain management, would enhance ethical care by promoting patient autonomy and well-being, avoiding harm, and matching resources with patients’ goals for medical therapy. Ethical issues of health care reform include moral foundations, cost containment, public health, access to care, ED crowding, and end-of-life issues. 

Keywords: [“care”,”Health”,”Patient”]
Source: https://www.acep.org/Content.aspx?id=80871

The American Conservative

A few years ago I began a book about cruelty to animals and about factory farming in particular, problems that had been in the back of my mind for a long while. Industrial livestock farming is among a whole range of animal-welfare concerns that extends from canned trophy-hunting to whaling to product testing on animals to all sorts of more obscure enterprises like the exotic-animal trade and the factory farming of bears in China for bile believed to hold medicinal and aphrodisiac powers. Surveying the various uses to which animals are put, some might be defensible, others abusive and unwarranted, and it’s the job of any conservative who attends to the subject to figure out which are which. A certain moral relativism runs through the arguments of those hostile or indifferent to animal welfare-as if animals can be of value only for our sake, as utility or preference decrees. If one animal’s pain-say, that of one’s pet-is real and deserving of sympathy, then the pain of essentially identical animals is also meaningful, no matter what conventional distinctions we have made to narrow the scope of our sympathy. 

Often applying felony-level penalties to protect certain domestic animals, these state and federal statutes declare that even though your animal may elsewhere in the law be defined as your property, there are certain things you may not do to that creature, and if you are found harming or neglecting the animal, you will answer for your conduct in a court of justice. Our pets are accorded certain protections from cruelty, while the nameless creatures in our factory farms are hardly treated like animals at all. If conservatives do nothing else about any other animal issue, we should attend at least to the factory farms, where the suffering is immense and we are all asked to be complicit. If we are going to have our meats and other animal products, there are natural costs to obtaining them, defined by the duties of animal husbandry and of veterinary ethics. Factory farming came about when resourceful men figured out ways of getting around those natural costs, applying new technologies to raise animals in conditions that would otherwise kill them by deprivation and disease. 

Actually, all of factory farming proceeds by a massive denial of reality-the reality that pigs and other animals are not just production units to be endlessly exploited but living creatures with natures and needs. Factory farming is a predatory enterprise, absorbing profit and externalizing costs, unnaturally propped up by political influence and government subsidies much as factory-farmed animals are unnaturally sustained by hormones and antibiotics. 

Keywords: [“animal”,”farm”,”factory”]
Source: http://www.theamericanconservative.com/articles/fear-factories