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Biomedical subjects

R J Baron

Publications and source records attributed to R J Baron.

9 recordsLinked to original sources
PubMed2000

A "best practices" strategy to improve quality in Medicaid managed care plans.

Medicaid managed care is delivered through organizations operating in very heterogeneous environments that confront similar barriers to success. Because Medicaid managed care is implemented differently in each state, health plans have been isolated from each other and have not had an opportunity to learn how others may have surmounted commonly encountered barriers. After interviewing Medicaid health plan medical directors, we developed a learning collaborative model based on shared categories of problems they would need to address before they could implement a successful improvement strategy in an important clinical area, birth outcome improvement. Under the Best Clinical and Administrative Practices initiative, we have brought together 12 Medicaid health plans to work together on strategies and specific objectives for overcoming obstacles to improvement. Evaluations by participants have been positive, and they appear to be making a number of specific organizational changes based on learning from the collaboratives. We will be employing this organizational development model to a series of clinically and administratively important topics over the next few years.

Benchmarking↗
PubMed1990

Medical hermeneutics: where is the "text" we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of 'texts' in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work. The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.

Philosophy, Medical↗
PubMed1989

Giving answers or raising questions?: the problematic role of institutional ethics committees.

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver.

Cultural Diversity↗
PubMed1987

Laterally luxating patella in a goat.

A laterally luxating patella causing progressively worsening hind limb lameness was discovered in an 18-month-old cross-bred goat. The luxation was believed to be congenital in origin. Surgical correction was accomplished via subchondral trochlear sulcoplasty, capsular imbrication, and lateral relieving desmotomy. Surgical correction of an unusual orthopedic problem in goats can be accomplished by use of routine canine orthopedic techniques.

Animals↗
PubMed1985

An introduction to medical phenomenology: I can't hear you while I'm listening.

A great gulf exists between the way we think about disease as physicians and the way we experience it as people. Much of this separation derives directly from our basic assumptions about what illness is. Our medical world view is rooted in an anatomicopathologic view of disease that precludes a rigorous understanding of the experience of illness. What we need to remedy this problem is not just the admonition to remember that our patients are people, but a radical restructuring of what we take disease to be. The philosophic discipline of phenomenology is used to present a vision of disease that begins with an understanding of illness as it is lived. "Nonmedical" descriptions of illness show how we can reorient our thinking to encompass both our traditional paradigm and one that takes human experience as seriously as it takes anatomy.

Attitude of Health Personnel↗
PubMed1981

Bridging clinical distance: an empathic rediscovery of the known.

In this essay, I argue that traditional medical views of illness systematically exclude intuitive knowledge from their description of disease and thus result in a functionally impressive but humanly ungrounded medicine. Physicians trained in a technologized anatomico-pathologic view of disease find themselves cut off from much of what they knew about illness when they began their training. Not only do they lack a rigorous or formal way to confront the non-technical aspects of medical practice, but many have even lost sight of the motives for medicine. I argue here for an intuitively based humanly grounded ontology of illness. Such an ontology begins in an understanding of the experience of the sick person rather than in a "objective" description of pathology. It is only through a science of illness-as-lived that one may achieve a truly humanistic medicine.

Disease↗
PubMed1976

Brain architecture and mechanisms that underlie language: an information-processing analysis.

A neural network model for naming visual objects and their attributes, and understanding certain simple types of sentences has been presented. The model is based on neural processes rather than linguistic or symbolic constructs. The following are the major structural features of the model: 1. Memory stores are associative networks that perform an analysis of their inputs in real time. This analysis converts the input pattern into a "recognition pattern" that depends on the specific stored information and its location in the store. 2. The naming store is an analyzer network that converts the sensory encoding of a sentence into a "sentence pattern". The sentence pattern is obtained by averaging the recognition signals from several memory locations in the naming store. Because of the organization of words in the naming store, sentence patterns are an encoding of the structure of the sentences. 3. The sentence store is an associative memory store that recognizes sentence patterns and associates with each one an "instruction sequence" or "program" that specifies how the system should respond to the sentence. It is the enabling of access to this "program" that constitutes "understanding." Sentences are understood in real time, without the explicit grammatical analysis that is usual in sentence-understanding systems. Understanding a sentence involves two functionally distinct processes: (1) associating with its sentence pattern an instruction sequence that specifices what to do in order to generate an appropriate response to the sentence matching that pattern: for example, to look in the visual field for an object, determine its location, and so on, and (2) analysis of the tokens in the sentence that indicate specific attributes or entities to look for or determine.

Association↗