Next-generation informatics. A new picture of quality medicine

It's up to the physician executive to make an informed choice when selecting a "next-generation" information system. Look for systems that truly integrate (not merely interface) managed care components, clinical capabilities, and other features in a model that mimics the workflow of an actual practice. Take the time to learn about the technology. Consider how a vendor's product will work at every point within your organization. Seven critical features that physician executives should consider in their decision-making are described.     

The minds of a medical director

This article is offered in a nod to all those readers who have been exposed to "whole brain" theory, either through the American College of Physician Executives or elsewhere. As managers struggle with balancing the "left brain" and "right brain" aspects of their work, the author says, they might consider exploiting a third area of activity, or inactivity--the "no brain." This center position can be especially effective in dealing with the high-technology aspects of delivering health care.     

The marriage of medicine and computers

Although computers, in one form or another have been around for several decades, they have only recently acquired the power, the simplicity of operation, and the cost-effectiveness to make their widespread application in health care a reality. But a reality it is, and no manager can be successful without a working understanding of how computers and information technology mesh with the information needs of health care delivery. Computer literacy is no longer a nice add-on--it is a basic weapon in every health care professional's armamentarium.     

State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

International adoption and the formation of new family attachments

Clinical studies of children in international adoption reveal unique patterns of psychological adjustment to permanent family care. Pre‐adoption history often includes early object loss, medical and nutritional deprivation, multiple care‐giving disruptions, and the lack of primary care‐giving relationships. These factors and the age at the time of adoption are risks to positive emotional and cognitive development. Adoptive parents may be unprepared for the resulting developmental problems. Most significantly, parents and children are often at different points in readiness to establish an attachment relationship. The parents are eager to claim their child, but the child is unready to respond because of emotional fragility and lack of previous attachment experiences. Two clinical vignettes illustrate the importance of a developmental and medical framework in assessing the unique needs of these survivor children, as well as the necessity of an empathic therapeutic holding environment that can sustain the emerging family attachments under stress. The psychological impact of cross‐cultural adoption and traumatic early beginnings reverberates across time but with empathic parental care and treatment recovery can be significant.