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Despite civil and criminal sanctions, elder abuse is a prevalent, underreported, and underprosecuted event in the United States. Traditional reporting legislation and common law remedies have had minimal effect on the incidence and prevalence of elder abuse. The epidemic nature of elder abuse is projected to increase exponentially as the elderly population grows disproportionately over the next several decades. The fragmented system of detecting, reporting, and prosecuting this abuse across a wide range of medical and legal settings creates a poor structure to effectively allow a potentially abused patient to have his/her abuse circumstance communicated to the relevant parties to protect the patient, have his/her situation reported and investigated, and, if necessary, have the perpetrator brought to justice. Emergency rooms and other facilities where elders present for care should be staffed by clinically trained persons who have familiarity interacting with patients and providers across settings of care, and who are trained to detect and report abuse. Nursing case managers fill this role well because they are able to coordinate efforts among acute and long-term care facilities while also being able to supply patients with legal and clinical information about elder abuse. In addition they may support prosecution efforts through their clinical observations and expertise. Hence, clinical case managers are able to coordinate efforts lacking in the current system to effectively evaluate, report, protect, and arrange for relevant services for the patient. Through clinical and special training in elder abuse, nursing case managers can provide support to prosecution efforts against the perpetrators of this most egregious crime. 相似文献
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The goal of medical residency is to provide the best clinical education for future practice, while increasing quality and safety in current and future healthcare. This goal is not being met. Traditional residency programs often continue to utilize individually oriented, shame-and-blame approaches that do not recognize the systems nature of outcomes, care, and patient safety. Appropriate substantive methods, content, and training tools are also lacking, while residents continue to labor in a poor working environment. All these factors create a system that serves no one-not the resident, the patient, or the system in which both interact. Residency reforms are proposed to address these imperative concerns. 相似文献
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Bryan Caplan 《Public Choice》2006,128(3-4):367-381
Beliefs about normative economics appear to be primarily determined by sociotropic rather than egocentric variables. (Sears & Funk, 1990; Citrin & Green, 1990) Using the Survey of Americans and Economists on the Economy, the current paper finds that the same holds for positiveeconomic beliefs in most – but not all – cases. This hinges on whether a question is “causal” or “non-causal”: Causal beliefs depend on sociotropic variables, especially education and ideology; non-causal beliefs, in contrast, depend on egocentric variables, with income growth playing the leading role. This is consistent with a cognitive model where actors answer easier questions using personal experience, and harder ones with ``off-the-shelf" theories. 相似文献