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Improving Diagnosis in Health Care


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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.







Hitler's American Model


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How American race law provided a blueprint for Nazi Germany Nazism triumphed in Germany during the high era of Jim Crow laws in the United States. Did the American regime of racial oppression in any way inspire the Nazis? The unsettling answer is yes. In Hitler's American Model, James Whitman presents a detailed investigation of the American impact on the notorious Nuremberg Laws, the centerpiece anti-Jewish legislation of the Nazi regime. Contrary to those who have insisted that there was no meaningful connection between American and German racial repression, Whitman demonstrates that the Nazis took a real, sustained, significant, and revealing interest in American race policies. As Whitman shows, the Nuremberg Laws were crafted in an atmosphere of considerable attention to the precedents American race laws had to offer. German praise for American practices, already found in Hitler's Mein Kampf, was continuous throughout the early 1930s, and the most radical Nazi lawyers were eager advocates of the use of American models. But while Jim Crow segregation was one aspect of American law that appealed to Nazi radicals, it was not the most consequential one. Rather, both American citizenship and antimiscegenation laws proved directly relevant to the two principal Nuremberg Laws—the Citizenship Law and the Blood Law. Whitman looks at the ultimate, ugly irony that when Nazis rejected American practices, it was sometimes not because they found them too enlightened, but too harsh. Indelibly linking American race laws to the shaping of Nazi policies in Germany, Hitler's American Model upends understandings of America's influence on racist practices in the wider world.




Ulysses


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