The negative consequences of natural hazard events are staggering and growing. Governments are acting to increase community resilience, reduce losses, and facilitate recovery, but these actions do not always yield anticipated consequences. This book is a compelling interdisciplinary analysis of California s efforts to ensure that acute care hospitals survive earthquakes and continue to function in the aftermath. The book weaves together several threads essential to understanding the effectiveness of public policies intended to reduce the consequences of natural hazard events: public policy design and administration, the hazard mitigation investment decision made by targeted organizations, and contextual dynamics.

""A terrific study of shortfalls in the implementation of risk-reduction policy -- highly readable, full of insights, and very policy relevant." "Peter J. May, Donald R. Matthews Distinguished Professor of American Politics, University of Washington, Seattle USA

""This is an exceptional book by three of the leading hazard mitigation researchers and must reading for both scholars and practitioners in the field."" William A. Anderson, National Research Council, National Academy of Sciences."

This timely guide to communication in patient-centered medicine argues for greater clarity in explaining health risks versus benefits of an array of screening tests, procedures, and drug regimens. It reviews the growing trend toward patients' involvement in their own care, particularly in terms of chronic conditions, and details approaches physicians can use to prepare patients (and themselves) for collaborative decision-making based on informed choices and clear, meaningful knowledge. Chapters apply this lens to a wide range of common interventions as contentious as estrogen replacement therapy and antibiotics, and as widely prescribed as the daily aspirin and the annual physical. With this goal in mind, the authors also introduce an innovative decision-making tool that translates risks and benefits into a clear graphic format for fewer chances of miscommunication or misunderstanding. Among the topics covered: Involving the patient in decision making. Towards a universal decision aid. BRCT: the Benefit/Risk Characterization Theater. Breast Cancer Screening-Mammograms. Prostate Cancer Screening. Colon cancer screening with colonoscopy. Screening for and treating dementia. Statins, cholesterol, and coronary heart disease. Physicians in family and internal medicine will find Interpreting Health Benefits and Risks: A Practical Guide to Facilitate Doctor- Patient Communication a valuable resource for communicating with patients and new possibilities for working toward their better health and health education. This book considers several common and important situations where faulty decision-making makes overtreatment a serious risk. Clear, fair, referenced, and useful information is provided. And a powerful intuitive technique is introduced which allows patient and doctor to talk as equals as they work together in the exam room. The authors emphasize that some patients who have been fully educated will still accept high risks of harm for a small chance of avoiding premature death. But as this book is accepted and its ideas and technique are extended, I feel sure that net harm to patients will be curtailed. And what is more, the integrity of the decision-making process will be improved. -Thomas Finucane, MD, Professor of Medicine, Division of Gerontology and Geriatric Medicine, The Johns Hopkins University School of Medicine

"Silent Ischemia, Current Concepts and Management" contains the proceedings of a conference held in Rottach-Egern, West Germany, March 5 to 7, 1987. We are most grateful to the authors for the effort to provide manuscripts before the meeting, to the sponsor, Bayer AG, for their generous support and to the publishers for their efficient collaboration, all of which have made the appearance of this book possible. When discussing silent myocardial ischemia, the first question is: "why is it silent?". To approach this question, a deeper look has to be taken into the pathophysiology of cardiac pain and the excitatory and inhibitory mechanisms involved. It has to be borne in mind that - in contradiction to what the poets have told us so beautifully for many centuries - the heart is a visceral and not a sensitive organ. If asymptomatic ischemia did not carry prognostic significance comparable to the symp tomatic manifestations of ischemia, then the problem of silent ischemia would be very academic and without consequences for treatment. Therefore studies on prognosis of silent ischemia are of great importance, as their results should indicate how aggressively patients are to be managed.

Medical Applications of Microcomputers deals with microcomputer applications in a wide area of clinical medicine. Recent developments are discussed in several clinical specialties including medicine, surgery, urology, anaesthesia and oncology. Topics include the storage of analysis of clinical audit data, the display of processing of data from direct physiological measurements and computers in control of therapy. The authors draw on their practical experience and knowledge of specific areas to which they have applied modern microcomputer techniques and give detailed descriptions of the means by which the problems that may be encountered may be overcome. Those wishing to implement their own computer systems will find this book a useful further source of ideas and techniques which add to those described in the earlier volume "Microcomputers in Medicine" by the same editors.

This book is based on the proceedings of the fourth Medical Microcomputer Workshop held at the Middlesex Hospital Medical School on 3-5 September 1986. The workshop was attended by clinicians and computer scientists with an interest in applying computer technology to current medical practice. The problems ranged from audit and patient management through to the more complex applications of data analysis obtained from current diagnos tic techniques. The choice of microcomputers has never been greater with low cost making them readily available. A single microcomputer has limita tions in clinical practice and the use of networks for multi-user tasks has expanded its capability but increased the complexity both in terms of hardware and the software needed to run it. Although comprehensive commercial packages are available, none of these are entirely suitable for medical applications without modification. Many of the chapters presented in this book describe the problems encountered and the solutions achieved by configuring and modifying applications software.

This book is an introduction to health care as a complex adaptive system, a system that feeds back on itself. The first section introduces systems and complexity theory from a science, historical, epistemological, and technical perspective, describing the principles and mathematics. Subsequent sections build on the health applications of systems science theory, from human physiology to medical decision making, population health and health services research. The aim of the book is to introduce and expand on important population health issues from a systems and complexity perspective, highlight current research developments and their implications for health care delivery, consider their ethical implications, and to suggest directions for and potential pitfalls in the future.

Since adapting the principles of the Toyota Production System to health care in 2002, Virginia Mason Health System has made enormous leaps forward in quality, safety, patient experience of care, and affordability. It has achieved world-class levels of patient satisfaction and has been honored as one of the safest hospitals in the country. A Leadership Journey in Health Care: Virginia Mason's Story supplies an inside look at process improvement from the world leader in applying Lean methods to health care. It presents key lessons learned as well as the best practices developed at Virginia Mason during its 12-year process improvement journey. Just as important, Virginia Mason's culture of leadership at all levels sets it apart from others in the health care universe. Describing why it's critical for leadership to be actively involved in any process improvement initiative, the book illustrates exactly what leadership looks like at all levels within Virginia Mason. In the book, bestselling author Charles Kenney introduces breakthrough new work at Virginia Mason that most health care audiences have yet to read about. He details the reasons why governance has played such a big role in Virginia Mason's success and discusses a game-changing initiative concerning respect for people. After reading this book, you will better understand the active leadership style that has propelled Virginia Mason's success. By following the best practices and lessons learned, you will be prepared to teach, coach, and encourage your team to achieve streamlined and standardized work, sustained improvements, and increased patient satisfaction. Foreword by Carolyn Corvi, Virginia Mason Health System/Virginia Mason Medical Center Boards of Directors; Retired Vice President and General Manager, Boeing Commercial Airplanes

The relationship between hospitals and the environment is defined by a glaring contradiction: as health care facilities deliver care at any cost, their environmental footprint -- pollution, waste production, unsustainable food services -- contributes to harming community health. Greening Health Care examines the intersections of health care and environmental health, both in terms of traditional failures and the revolution underway to fix them. Authored by one of the pioneers in health care's green movement, it presents practical solutions for health care organizations and clinicians to improve their environments and the health of their communities. Topics include: making food services sustainable, managing hospital waste, and relevant impacts/mitigating measures related to climate change. As environmental protection grows into an imperative for all aspects of society, Greening Health Care offers an historical and practical approach to sustainable health care delivery.

Appointment Planning in Outpatient Clinics and Diagnostic Facilities provides a concise overview of the medical and mathematical aspects of appointment planning in healthcare. This SpringerBrief specifically focuses on outpatient clinics and diagnostic facilities. It begins by introducing the topic from a medical perspective, discussing the kinds of clinics and facilities that are out there, while exploring the appointment systems they use and the problems they face. Next, the mathematical aspects of appointment planning are examined, including Markov decision modelling, queueing theory, etc. Subsequently the book addresses implementation issues that may arise, whether they be technical, medical or cultural. Finally Appointment Planning in Outpatient Clinics and Diagnostic Facilities provides an outlook on the appointment systems of the future and what they will require as a consequence of current and future developments in the medical sector.

Personal health budgets are an important new tool to improve the lives of people living with long-term conditions and disabilities by giving them greater choice and control over their healthcare.This is the first step-by-step guide to their implementation. Using current evidence and best practice identified by pilot sites, Delivering personal health budgets contains everything there is to know about the purpose and history of personal health budgets, the evidence for their effectiveness and the challenges they pose to traditional healthcare systems. It describes the essential infrastructure needed for personal health budgets and includes implementation checklists.The book focuses on how personal health budgets can be implemented to achieve the best possible outcomes for individuals, while real life stories from personal health budget holders bring their potential vividly to life. Delivering personal health budgets is essential reading for commissioners, healthcare providers, clinicians and policy makers who are looking for an informative and authoritative guide.

In Part I, the impact of an integro-differential operator on parity logic engines (PLEs) as a tool for scientific modeling from scratch is presented. Part II outlines the fuzzy structural modeling approach for building new linear and nonlinear dynamical causal forecasting systems in terms of fuzzy cognitive maps (FCMs). Part III introduces the new type of autogenetic algorithms (AGAs) to the field of evolutionary computing. Altogether, these PLEs, FCMs, and AGAs may serve as conceptual and computational power tools.

In a world where there is increasing demand for the performance of health providers to be measured, there is a need for a more strategic vision of the role that performance measurement can play in securing health system improvement. This volume meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand. It examines the various levels at which health system performance is undertaken, the technical instruments and tools available, and the implications using these may have for those charged with the governance of the health system. Technical material is presented in an accessible way and is illustrated with examples from all over the world. Performance Measurement for Health System Improvement is an authoritative and practical guide for policy makers, regulators, patient groups and researchers.

Despite its high cost, the US healthcare system produces relatively short life spans, and is wasteful, inefficient and has serious safety and quality issues. While other industries have surmounted similar challenges by transforming themselves through information technology, healthcare lags behind. Major reasons are that our approaches to care delivery and financial incentives were designed for a bygone era. Beyond that the technology offered to practitioners has often been overly expensive, poorly designed, overly proprietary, hard to implement and difficult to use. Spurred by a unique, one-time Federal stimulus and the new mobile, wireless and cloud technologies now available, this landscape is rapidly changing. To succeed going forward practitioners, and those interested in entering the field, need to understand the new driving forces and have a basic understanding of contemporary clinical informatics. Practitioners, in particular, need to understand the alternative technologies and approaches available for their use in individual patient care and more continuous management of their chronic disease patients. To efficiently meet these needs, this book provides an introduction to the rationale for care transformation through clinical informatics; its application to patient care outside of hospitals; and a look at its future. Key points are illustrated throughout by actual examples of open source and commercial health IT products and services. While written with practitioners and students entering the field of clinical informatics in mind, the book eschews technical terminology and is easily accessible by the lay reader not proficient in clinical medicine or information technology."

This book discusses current health care challenges and new strategies for innovative solutions in this area from an interdisciplinary perspective of health care management, business economics, and medicine. It presents the idea of a "boundaryless hospital", a conceptual model of a patient-centric, value-based health network that overcomes typical sectorial, organizational, and geographical boundaries and offers greater efficiency and better quality outcomes for patients. Effective health care for a growing and aging population is a major challenge for economies all over the world. New breakthroughs in medical technology and pharmaceuticals as well as digitization provide scope for more efficiency and for a better quality of health care. Novel organization forms and management concepts are key for coping with the increasing cost pressure observed in most health care systems. The contributions in this volume present innovative strategies for developing and implementing the concept of a boundaryless hospital. They highlight experiences from various countries and with different treatments. The book project was initiated and carried out by the Center for Advanced Studies in Management (CASiM), the interdisciplinary research center of HHL Leipzig Graduate School of Management for business administration in the 21st century.

After many years of relative neglect, the importance of study of factors governing blood flow has at last achieved recognition; in this volume are documented many of the techniques, and the basic scientific and clinical observations, which have helped to open up understanding of this highly important aspect of human physiology and pathology in recent years. The text is logically divided into five sections beginning with blood cell deformability, then moving on to theoretical consideration of blood rheology, followed by accounts of the interrelationships between rheology, blood flow and vascular occlusion. The final two sections deal with blood rheology in clinical practice and therapeutic aspects of the study of blood flow. As regards blood cell deformability (Section A), the basic problem is set out by Kiesewetter and colleagues in the first paragraph of chapter 1 (p. 3), in which they point out that whereas human erythrocytes at rest have a diameter of approxi mately 7. 5 /-tm, nutritive capillaries have diameters ranging from 3-5 /-tm, and chapters in section A give an account of the ways in which the red cell can undergo deformation to permit capillary perfusion and the maintenance of the microcirculation."

This book examines how healthcare organisations shape, adapt and resist developments in healthcare policy and practice. This is an international text bringing together contributions from around the globe and covers a wide range of different discussions in relation to the policy/practice gap.

Team training has become a tradition in healthcare, where it has helped produce significantly positive results in patient safety. It is widely acknowledged that medical teamwork is essential, yet the coordination, communication, and cooperation behind it has never been carefully examined. This book provides a comprehensive study of the science behind improving team performance in the delivery of clinical care. Leaders in the field, Eduardo Salas and Karen Frush, have assembled scholars, practitioners, and professionals to offer a combination of practical advice and insight as well as a look into the scientific foundation of teamwork. Chapters offer helpful guidelines and lessons on how to improve performance in the team setting, including how to measure success, how to monitor training, pitfalls and challenges, and how the different needs of various clinical situations.

At the 1975 Winter Conference on Brain Research a series of workshops were held to discuss the role of the sensory environment in the etiology and therapy of brain dysfunction. The participants represented a broad range of disciplines ranging from basic neuro science through human development psychology. They were linked by a common belief that the role of the sensory environment in brain dysfunction had received insufficient attention. Each had made contributions to this question in their own respective disciplines and it was hoped that this meeting would provide an opportunity for cross fertilization and synthesis. From these workshops this book evolved. Its production would have been impossible without the help of many people. Anna Taylor's flexibility allowed the holding of a larger than normal workshop, while the authors bore up well under editorial pressure to meet deadlines. Linda Coleman and Phyllis Straw provided excellent support from Plenum while Therese Linden gave editorial assistance. Valarie Munden, Rosemary Schmele, and Estelle Hoffman did an excellent job of typing. RNW was supported by a Fellowship from the Foundations' Fund for Research in Psychiatry. As always, our families provided continuous support and encouragement. To all these people and more we say thank you. Roger N. Walsh M.D., B.Med.Sc., Dip.Psychol., Ph.D. William T. Greenough, Ph.D."

In 1983, the first patient classification system to be used on a national basis, the Diagnosis Relate Groups (DRGs), was adopted as part of the Prospective Payment System in the United States. This system caught the attention of health policy makers in other countries, and a number of them began to implement similar approaches. What motivated them to adopt these systems? What similarities and differences were there among their experiences in implementing these systems? What can we learn about introducing change into national health systems by comparing their experiences? The Globalization of Managerial Innovation in Health Care answers these and other questions by examining patient classification systems in fifteen different countries throughout the world. The result is a remarkable collection of case studies of how change can be introduced effectively into national health systems as well as a careful synthesis of what can be learned from them.

In 1983, the first patient classification system to be used on a national basis, the Diagnosis Relate Groups (DRGs), was adopted as part of the Prospective Payment System in the United States. This system caught the attention of health policy makers in other countries, and a number of them began to implement similar approaches. What motivated them to adopt these systems? What similarities and differences were there among their experiences in implementing these systems? What can we learn about introducing change into national health systems by comparing their experiences? The Globalization of Managerial Innovation in Health Care answers these and other questions by examining patient classification systems in fifteen different countries throughout the world. The result is a remarkable collection of case studies of how change can be introduced effectively into national health systems as well as a careful synthesis of what can be learned from them.

This document was commissioned by the Facility Guidelines Institute as the sole reference for acoustics in health care facilities. It was written by the Health Care Acoustics Working Group, a permanent committee of the Acoustics Research Council (ARC), comprised of members of leading professional societies in acoustics, noise control engineering, acoustical consulting and related professions. ARC organized the health care Working Group in 2004-5 drawing its members from ten constituencies that range from medicine to law, public policy, architecture, design and engineering in order to provide constructive, guidance on sound and vibration based on research and best practices. "Sound and Vibration 2.0" has been adopted as the sole reference standard for acoustics in health care facilities by: the 2010 FGI/ASHE "Guidelines for the Design and Construction of Healthcare Facilities" (used in 60 countries); the US Green Building Council s "LEED for Healthcare" (used in 87 countries); The Green Guide for Health Care V2.2; and the International Code Council's IGCC (2011).

Sound and vibration are topics of increasing prominence in the design, construction, and operation of healthcare facilities. A satisfactory acoustical environment in a healthcare facility is now viewed as an essential component of effective healthcare.

Sensible acoustical and privacy planning in the early design stages of a healthcare facility project can be solved effectively and affordably with a few strokes of the designer's pencil. The recommended minimum design requirements presented in this work are therefore intended to aid designers in achieving satisfactory acoustical and privacy environments in healthcare facilities. This handbook includes comprehensive, practical, and measureable guidelines for all aspects of acoustics in the design, construction, and evaluation of all types of healthcare facilities, including large general hospitals, specialized patient care facilities, and ambulatory patient care facilities.

Intensive care medicine is one of the fastest growing services provided by hospitals and perhaps one of the most expensive. Yet in response to the global financial crisis of the last few years, healthcare funding is slowing or decreasing throughout the world.

How we manage health care resources in the intensive care unit (ICU) now and in a future that promises only greater cost constraints is the subject of this book, the third in an informal series of volumes providing a global perspective on difficult issues arising in the ICU.

Taking 12 developed countries as their focus, leading experts provide a country-by-country analysis of current ICU resource allocation. A second group of experts use the chapters as a departure point to analyze current ICU resource allocation at the level of the global medical village. The process is repeated, but with an eye toward the future - first country by country, then at the global level - that takes into account initiatives and reforms now underway.

A fictional healthcare plan, the "Fair & Equitable Healthcare Plan," is put forth to address weaknesses in existing approaches, and healthcare experts and ethicists are invited to respond to its often provocative provisions.

Itself structured as a dialogue, the book is an excellent way to start or to continue serious discussion about the allocation of ICU healthcare resources now and in the years ahead.

"

after heated and often bitter debates, SIEBENMANN'S opinion finally prevailed, i. e. , a contribution to cochlear lesions due to vibrations of the floor transmitted via bone conduction could not be demonstrated. For one thing, it was hard to see how appreciable amounts of energy could reach the ears in this manner, considering the attenuation that is bound to occur across each of the many joints along the pathway involved. In some older audiological surveys conducted in industry (e. g. , TEMKIN, 1933), groups of workmen were found who displayed signs of apical-turn lesions, i. e. , low-tone hearing losses for air and for bone. Such lesions could not be expected to results from exposure to air-borne sounds because of the low-frequency attenu ation of the middle ear. Although WITTMAACK'S explanation, which was frequently invoked in such reports, does no longer appear tenable, such apical-turn lesions could conceivably be caused by bone conduction components of high-intensity noise in the sense of BEKESY (1948). - As far as I am aware of, no newer studies have been conducted in this problem area, and the older experiments and/or surveys were done at times before signal parameters could be precisely controlled or measured. A detailed, critical review of the older studies on the potential contribution of bone-conducted energy to industrial hearing loss and its underlying pathology may be found in Werner (1940) who, incidently, favored SIEBENMANN'S point of VIew.

In den letzten Jahren hat sich der Workshop "Bildverarbeitung fur die Medizin" durch erfolgreiche Veranstaltungen etabliert. Ziel ist auch 2012 wieder die Darstellung aktueller Forschungsergebnisse und die Vertiefung der Gesprache zwischen Wissenschaftlern, Industrie und Anwendern. Die Beitrage dieses Bandes - einige davon in englischer Sprache - umfassen alle Bereiche der medizinischen Bildverarbeitung, insbesondere Algorithmen, Hard- und Softwaresysteme sowie deren klinische Anwendung, u.a.: Bildgebung und -akquisition, Sichtbares Licht, Endoskopie, Mikroskopie, Visualisierung und Animation, Patientenindividuelle Simulation und Planung, Computerunterstutzte Diagnose, Biomechanische Modellierung, Computergestutzte Operationsplanung, Bildverarbeitung in der Telemedizin, Bildgestutzte Roboter und Chirurgische Simulatoren."