Improving Diagnosis in Health Care

Improving Diagnosis in Health Care
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 473
Release: 2015-12-29
Genre: Medical
ISBN: 0309377722

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

Legal and Ethical Concerns in Treating Kidney Failure

Legal and Ethical Concerns in Treating Kidney Failure
Author: E.A. Friedman
Publisher: Springer Science & Business Media
Total Pages: 221
Release: 2012-12-06
Genre: Medical
ISBN: 9401143552

Once dialysis treatment, in 1960, permitted life prolongation for some but not all patients in kidney failure, an `ethical genie' was released. The introduction of peritoneal dialysis and kidney transplantation compounded the physician's dilemma by underscoring those left untreated. Who should be selected for uremia therapy? Should exclusion from treatment be properly delegated to administrators or physicians, or better left to a committee? Are some candidates more worthy than others? As examples: Do Presidents and Kings warrant priority in cadaver organ allocation over ordinary citizens? Are rich people more deserving than the poor? Is it ethical to choose a younger over an older patient? Can children and/or mentally incompetent persons serve as living organ donors? Is it proper to market organs under controlled circumstances? Eli A. Friedman, an experienced nephrology training program director, and Medical Advisor to the American Association of Kidney Patients, has collected 24 difficult cases that focus on these and other vexing though common stressful issues faced by those who manage kidney patients. Using a novel approach to each case, the opinions of lawyers, nephrologists, patients, and a transplant surgeon are proffered sequentially. Friedman asks and then answers searching questions arising from the debate. The quality of information presented is positively flavored by the fact that three of the respondents (one an attorney) are kidney transplant recipients. Members of the kidney team, those immersed in seeking truth in medical ethics, and all participating in exploring the legality or ethical basis of organ replacement will find this book pertinent to their effort.

A Problem of Fit

A Problem of Fit
Author: Phillip B. Levine
Publisher: University of Chicago Press
Total Pages: 201
Release: 2022-04-22
Genre: Business & Economics
ISBN: 0226818551

"A college education doesn't come with a sticker price. Maybe it should. Millions of Americans miss out on the economic benefits of a college education because of concerns around the costs. Financial aid systems offer limited help and produce uneven distributions. In the United States today, the systems meant to improve access to education have added a new layer of deterrence. In Mismatch, economist Philip B. Levine examines the role of financial aid systems in facilitating (and discouraging) access to college. If markets require prices in order to function optimally, then the American higher-education system--rife as it is with hidden and variable costs--amounts to a market failure. It's a problem of price transparency, not just affordability. Ensuring that students understand exactly what college will cost, including financial aid, could lift the lid on not only college attendance for more people, but for greater representation across demographics and institutions. As Levine illustrates, our conversations around affordability and free tuition miss a larger truth: that the opacity of our current college-financing systems is a primary driver of inequities in education and society. Mismatch offers a bold, trenchant new argument for an educational reform that is well within reach"--

Homelessness, Health, and Human Needs

Homelessness, Health, and Human Needs
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 257
Release: 1988-02-01
Genre: Medical
ISBN: 0309038324

There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.

Complaint!

Complaint!
Author: Sara Ahmed
Publisher: Duke University Press
Total Pages: 225
Release: 2021-08-09
Genre: Social Science
ISBN: 1478022337

In Complaint! Sara Ahmed examines what we can learn about power from those who complain about abuses of power. Drawing on oral and written testimonies from academics and students who have made complaints about harassment, bullying, and unequal working conditions at universities, Ahmed explores the gap between what is supposed to happen when complaints are made and what actually happens. To make complaints within institutions is to learn how they work and for whom they work: complaint as feminist pedagogy. Ahmed explores how complaints are made behind closed doors and how doors are often closed on those who complain. To open these doors---to get complaints through, keep them going, or keep them alive---Ahmed emphasizes, requires forming new kinds of collectives. This book offers a systematic analysis of the methods used to stop complaints and a powerful and poetic meditation on what complaints can be used to do. Following a long lineage of Black feminist and feminist of color critiques of the university, Ahmed delivers a timely consideration of how institutional change becomes possible and why it is necessary.

The Problem with Software

The Problem with Software
Author: Adam Barr
Publisher: MIT Press
Total Pages: 317
Release: 2018-10-23
Genre: Computers
ISBN: 0262348217

An industry insider explains why there is so much bad software—and why academia doesn't teach programmers what industry wants them to know. Why is software so prone to bugs? So vulnerable to viruses? Why are software products so often delayed, or even canceled? Is software development really hard, or are software developers just not that good at it? In The Problem with Software, Adam Barr examines the proliferation of bad software, explains what causes it, and offers some suggestions on how to improve the situation. For one thing, Barr points out, academia doesn't teach programmers what they actually need to know to do their jobs: how to work in a team to create code that works reliably and can be maintained by somebody other than the original authors. As the size and complexity of commercial software have grown, the gap between academic computer science and industry has widened. It's an open secret that there is little engineering in software engineering, which continues to rely not on codified scientific knowledge but on intuition and experience. Barr, who worked as a programmer for more than twenty years, describes how the industry has evolved, from the era of mainframes and Fortran to today's embrace of the cloud. He explains bugs and why software has so many of them, and why today's interconnected computers offer fertile ground for viruses and worms. The difference between good and bad software can be a single line of code, and Barr includes code to illustrate the consequences of seemingly inconsequential choices by programmers. Looking to the future, Barr writes that the best prospect for improving software engineering is the move to the cloud. When software is a service and not a product, companies will have more incentive to make it good rather than “good enough to ship."

To Err Is Human

To Err Is Human
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 312
Release: 2000-03-01
Genre: Medical
ISBN: 0309068371

Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

The Alignment Problem: Machine Learning and Human Values

The Alignment Problem: Machine Learning and Human Values
Author: Brian Christian
Publisher: W. W. Norton & Company
Total Pages: 459
Release: 2020-10-06
Genre: Science
ISBN: 039363583X

A jaw-dropping exploration of everything that goes wrong when we build AI systems and the movement to fix them. Today’s “machine-learning” systems, trained by data, are so effective that we’ve invited them to see and hear for us—and to make decisions on our behalf. But alarm bells are ringing. Recent years have seen an eruption of concern as the field of machine learning advances. When the systems we attempt to teach will not, in the end, do what we want or what we expect, ethical and potentially existential risks emerge. Researchers call this the alignment problem. Systems cull résumés until, years later, we discover that they have inherent gender biases. Algorithms decide bail and parole—and appear to assess Black and White defendants differently. We can no longer assume that our mortgage application, or even our medical tests, will be seen by human eyes. And as autonomous vehicles share our streets, we are increasingly putting our lives in their hands. The mathematical and computational models driving these changes range in complexity from something that can fit on a spreadsheet to a complex system that might credibly be called “artificial intelligence.” They are steadily replacing both human judgment and explicitly programmed software. In best-selling author Brian Christian’s riveting account, we meet the alignment problem’s “first-responders,” and learn their ambitious plan to solve it before our hands are completely off the wheel. In a masterful blend of history and on-the ground reporting, Christian traces the explosive growth in the field of machine learning and surveys its current, sprawling frontier. Readers encounter a discipline finding its legs amid exhilarating and sometimes terrifying progress. Whether they—and we—succeed or fail in solving the alignment problem will be a defining human story. The Alignment Problem offers an unflinching reckoning with humanity’s biases and blind spots, our own unstated assumptions and often contradictory goals. A dazzlingly interdisciplinary work, it takes a hard look not only at our technology but at our culture—and finds a story by turns harrowing and hopeful.