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There is constant pressure on hospitals to improve health care delivery and increase cost effectiveness. New initiatives are the order of the day in the dramatically different health care systems of the United States and Great Britain. Often, as we know all too well, these efforts are not successful. In The Challenge to Change, Rebecca Kolins Givan analyzes the successes and failures of efforts to improve hospitals and explains what factors make it likely that the implementation of reforms will be rewarded by positive transformation in a particular institution's day-to-day operation. Givan's in-depth qualitative case studies of both top-down initiatives and changes first suggested by staff on the front lines of care point clearly to the importance of all hospital workers in effecting change and even influencing national policy.Givan illuminates the critical role of workers, managers, and unions in enabling or constraining changes in policies and procedures and ensuring their implementation. Givan spotlights an Anglo-American model of hospital care and work organization, even while these countries retain their differences in access and payment. Entrenched professional roles, hierarchical workplace organization, and the sometimes-detached view of policymakers all shape the prospects for change in hospitals. Givan provides important examples of how the dedication and imagination of the people who work in hospitals can make all the difference when it comes to providing quality health care even in a challenging economic environment.

Health care reform --- Culture and politics of health care work. --- E-books --- Medicolegal issues

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Critics of narcology-as addiction medicine is called in Russia-decry it as being "backward," hopelessly behind contemporary global medical practices in relation to addiction and substance abuse, and assume that its practitioners lack both professionalism and expertise. On the basis of his research in a range of clinical institutions managing substance abuse in St. Petersburg, Eugene Raikhel increasingly came to understand that these assumptions and critiques obscured more than they revealed. Governing Habits is an ethnography of extraordinary sensitivity and awareness that shows how therapeutic practice and expertise is expressed in the highly specific, yet rapidly transforming milieu of hospitals, clinics, and rehabilitation centers in post-Soviet Russia. Rather than interpreting narcology as a Soviet survival or a local clinical world on the wane in the face of globalizing evidence-based medicine, Raikhel examines the transformation of the medical management of alcoholism in Russia over the past twenty years.Raikhel's book is more than a story about the treatment of alcoholism. It is also a gripping analysis of the many cultural, institutional, political, and social transformations taking place in the post-Soviet world, particularly in Putin's Russia. Governing Habits will appeal to a wide range of readers, from medical anthropologists, clinicians, to scholars of post-Soviet Russia, to students of institutions and organizational change, to those interested in therapies and treatments of substance abuse, addiction, and alcoholism.

Alcoholics --- Alcoholism --- Post-communism --- Postcommunism --- World politics --- Communism --- Addiction to alcohol --- Alcohol abuse --- Alcohol intoxication --- Dipsomania --- Drinking problem --- Drunkenness --- Inebriety --- Intemperance --- Intoxication --- Jellinek's disease --- Liquor problem --- Substance abuse --- Temperance --- Controlled drinking --- Drinking of alcoholic beverages --- Drinkers, Problem --- Drunkards --- Drunks --- Inebriates --- Problem drinkers --- Addicts --- Institutional care --- Treatment --- Hospitals --- Health aspects --- Patients --- Intoxication, Alcohol

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"I am an AIDS doctor. When I began that work in 1992, we knew what caused AIDS, how it spread, and how to avoid getting it, but we didn't know how to treat it or how to prevent our patients' seemingly inevitable progression toward death. The stigma that surrounded AIDS patients from the very beginning of the epidemic in the early 1980's continued to be harsh and isolating. People looked askance at me: What was it like to work in that kind of environment with those kinds of people? My patients are 'those kinds of people.' They are an array and a combination of brave, depraved, strong, entitled, admirable, self-centered, amazing, strange, funny, daring, gifted, exasperating, wonderful, and sad. And more. At my clinic most of the patients are indigent and few have had an education beyond high school, if that. Many are gay men and many of the patients use or have used drugs. They all have HIV, and in the early days far too many of them died. Every day they brought us the stories of their lives. We listened to them and we took care of them as best we could."-from the Introduction In 1992, Dr. Susan C. Ball began her medical career taking care of patients with HIV in the Center for Special Studies, a designated AIDS care center at a large academic medical center in New York City. Her unsentimental but moving memoir of her experiences bridges two distinct periods in the history of the epidemic: the terrifying early years in which a diagnosis was a death sentence and ignorance too often eclipsed compassion, and the introduction of antiviral therapies that transformed AIDS into a chronic, though potentially manageable, disease. Voices in the Band also provides a new perspective on how we understand disease and its treatment within the context of teamwork among medical personnel, government agencies and other sources of support, and patients. Deftly bringing back both the fear and confusion that surrounded the disease in the early 1990's and the guarded hope that emerged at the end of the decade, Dr. Ball effectively portrays the grief and isolation felt by both the patients and those who cared for them using a sharp eye for detail and sensitivity to each patient's story. She also recounts the friendships, humor, and camaraderie that she and her colleagues shared working together to provide the best care possible, despite repeated frustrations and setbacks. As Dr. Ball and the team at CSS struggled to care for an underserved population even after game-changing medication was available, it became clear to them that medicine alone could not ensure a transition from illness to health when patients were suffering from terrible circumstances as well as a terrible disease.

AIDS (Disease) --- Acquired immune deficiency syndrome --- Acquired immunodeficiency syndrome --- Acquired immunological deficiency syndrome --- HIV infections --- Immunological deficiency syndromes --- Virus-induced immunosuppression --- Patients --- History.

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Andy Lazris, MD, is a practicing primary care physician who experiences the effects of Medicare policy on a daily basis. As a result, he believes that the way we care for our elderly has taken a wrong turn and that Medicare is complicit in creating the very problems it seeks to solve. Aging is not a disease to be cured; it is a life stage to be lived. Lazris argues that aggressive treatments cannot change that fact but only get in the way and decrease quality of life. Unfortunately, Medicare's payment structure and rules deprive the elderly of the chance to pursue less aggressive care, which often yields the most humane and effective results. Medicare encourages and will pay more readily for hospitalization than for palliative and home care. It encourages and pays for high-tech assaults on disease rather than for the primary care that can make a real difference in the lives of the elderly.Lazris offers straightforward solutions to ensure Medicare's solvency through sensible cost-effective plans that do not restrict patient choice or negate the doctor-patient relationship. Using both data and personal stories, he shows how Medicare needs to change in structure and purpose as the population ages, the physician pool becomes more specialized, and new medical technology becomes available. Curing Medicare demonstrates which medical interventions (medicines, tests, procedures) work and which can be harmful in many common conditions in the elderly; the harms and benefits of hospitalization; the current culture of long-term care; and how Medicare often promotes care that is ineffective, expensive, and contrary to what many elderly patients and their families really want.

Human medicine --- Geriatrics --- Older people --- Medicare. --- Medical care