Makanan Sehat Bayi

Makanan Sehat Bayi - Makanan sehat untuk bayi tentunya berbeda dengan orang dewasa. Makanan yang sehat bagi orang dewasa belum tentu cocok sebagai makanan bayi karena bayi mempunyai perut yang masih kecil serta masih belum terlalu kuat. Tiap makanan yang masuk ke perut bayi haruslah diatur dengan baik. Ada hal-hal yang perlu untuk dipertimbangkan saat Ibu menyiapkan serta mengatur makanan sehat

Gangguan Kesehatan saat Puasa Ramadhan

GangguanKesehatan saat Puasa biasanya terjadi karena ketidaksiapan tubuh dengan pola
hidup yang berbeda ketika bulan Ramadhan. Namun sebenarnya puasa adalah salah
satu ibadah yang menyehatkan badan. Hal ini bisa dibuktikan dengan berkurangnya
jumlah pasien di klinik pengobatan atau rumah sakit. Sedangkan Gangguan
Kesehatan saat Puasa juga bisa terjadi pada orang-orang tertentu dikarenakan

Bayi Sehat

Bayi Sehat
- Memiliki bayi sehat tentu adalah dambaan setiap Ibu, tidak hanya saat
dia sudah lahir, naumn juga saat Ia masih di dlama kandungan.
Memastikan bayi dalam kandungan dalam keadaan sehat adalah hal yang
ingin dilakukan oleh setiap Ibu hamil. Bayi yang biasanya suka menendang
dalam rahim Ibu memang dapat menyebabkan rasa tidak nyaman
pada ibu hamil. Akan tetapi, gerakan bayi

Guest Post: Incompetent Management Breeds Demoralized Physicians

Health Care Renewal presents a guest post by Dr Howard Brody, John P McGovern Centennial Chair of Family Medicine, Director of the Institute for Medical Humanities at University of Texas - Medical Branch at Galveston, and blogger at Hooked: Ethics, Medicine and Pharma. 

Danielle Ofri, a prominent internist/author at Bellevue in New York, started a recent op-ed piece, “Last week I was ready to quit medicine."

She described an encounter most physicians can relate to—a 15-minute appointment slot, a new patient who spoke only Bengali, a long and complicated problem list, a bag containing 18 different medicines, two forms that had to be filled out by the doctor on this day’s visit, and a computer that froze while she was trying to keep up with the electronic charting. She described how, 45 minutes into the supposedly 15-minute visit, she had a phone in one ear with the Bengali translator and tech support on hold in the other ear.

Ofri’s plaint caught my attention because I had recently put up a guest post on Health Care Renewal about another highly skilled, caring physician who was seriously considering quitting practice. This led me to write a column for some of our local newspapers about demoralized doctors

In the space allowed in an op-ed column, you can’t go into great depth in analyzing a complicated situation. So here’s what I would have wanted to say.

We can list all the management failures that this encounter represents. I won’t even start with the electronic record as that’s such a frequent theme in this blog. Who scheduled such a patient for a 15-minute visit? Where is the pharmacist who could have done a better job of going through all the lady’s medicines? Where is the staffer who could have filled out the forms for Dr. Ofri to sign? This is just to scratch the surface.

There are two things worrisome about this long list of management failures. If the goal of the health care system is actually to take good care of patients, then it seems obvious that Dr. Ofri, who wanted to try to provide high-quality care, had roadblock after roadblock thrown in her way.

Cynics will protest that this system obviously has no interest in quality patient care and seeks only to maximize revenue. If that’s so, is it really true that a board-certified MD is the most efficient labor source for keyboarding data into a computer, filling out paper forms, and doing all the other busy-work tasks that Dr. Ofri had to juggle? Can anyone really believe that this management structure supports either quality care orefficient resource use?

If the management of U.S. hospitals was severely understaffed or underpaid, then we could perhaps forgive such lapses. But we know that while the growth of physicians in the U.S. has been slow, the number of administrators has grown by leaps and bounds [The number of health care managers increased by 726% from 1983-2000 while physician numbers increased by 39%, look here - Ed]  . And we know that at least at the high end, these managers are paid munificent sums, and are lauded for their supposed genius (look here for example). 

So we appear to have a system that is slowly (in some cases rapidly) driving the best doctors out of practice, and yet somehow imagines that everything is going all right and there’s no problem—or if there’s a problem, it’s those whining doctors.

All us medical educators know that when we ask the first-year class how may of them have been told by practicing physicians that they’re making a big mistake coming to medical school, the majority will raise their hands. Yet the managers of America’s health systems apparently believe that they can go on demoralizing good practitioners and nothing bad will happen.

This may sound as if I am saying that health care managers are all evil people, but that’s an unfair characterization. These folks are simply trying to do what our society tells them. As I explained some time ago, most of our popular and political discourse has been captured by a belief system that can be variously called neoliberalism, market fundamentalism, or economism. The ideology can be summarized as a quasi-religious faith in the so-called “free market,” steadfast opposition to government regulation of the market, and opposition to just about any form of taxes (for more on the nature of economism, look here.)

Among other things, this ideology teaches us that everything important in our society can be accurately captured in objective measures of “productivity” and “efficiency.”  [This is akin to the "shareholder value" theory of management (look here), or "financialization." - Ed]  Once one has mastered the basic concepts taught in MBA school, there’s no need to learn anything about health care and what makes it a unique activity; there’s no basic difference between providing health care and flipping burgers at McDonalds or making widgets. [We have called this generic management. - Ed.]. And so we get the crazy style of management well documented on this blog, not because of personal nastiness or ill will, but due to the ideological Kool-Aid everyone has been drinking for several decades now.

Today’s physicians seem to be like the proverbial frog being boiled in the pot of water because the heat was turned up so gradually the frog never figured out it needed to jump. [That is, they are suffering from "learned helplessness." - Ed] Dr. Ofri herself seems to represent a typical frog. Why? Perhaps it’s the style of the blog or op-ed writer to start off with a downer and then try to end on an upbeat note. Or perhaps it’s the natural physician’s tendency to stay away from policy questions. I’m not sure.

After starting us off with this hard-hitting description of a dysfunctional system, Dr. Ofri ends by opining that things are going to be better in the future because more women are entering medicine and because today’s medical students are more tech savvy. She gives herself credit for managing to forge a bond with the patient because they sat together and faced this adversity. She cites an upbeat study, “when asked what was the most satisfying aspect of medical practice, the number one answer was relationships with patients. This is what keeps us going on even the most trying of days.”

Dr. Ofri gets full credit for remembering the importance of relationships, and feels that she bonded more firmly with her patient because they went through all this together. How about a word, though, about the people behind the curtain, who are responsible for all that she and her patient had to go through, and who don’t seem to have a clue how bad it is and what it all means? 

Dr Howard Brody

Daily Blog #37: Web 2.0 Forensics Part 2

Hello Reader,
             Sunday Funday is always fun for me for two reasons. One it gets me two blog posts out of one so I get more time to get work done and two I like getting a general feeling of what level of understanding exists on certain artifacts. So while you get a prize, that I strive to make worth your effort, I get to see what I can continue to help you learn by writing additional blog posts to fill those gaps. With that said we are continuing the web 2.0 series today that I realized was needed from the IEF Sunday Funday challenge two weeks ago.

Json Data Structures

Json data structures are fairly easy to find, they are structure name pairs that are exchanged between the web server and the web client, for instance the Gmail server and the Chrome browser. In this example the Chrome browser would then parse the data to generate the view that you see.

Here is what a message summary from your Gmail inbox looks like:

Index data for gmail
["140303866b4ce541","140303866b4ce541","140303866b4ce541",1,0,["^all","^i","^o","^smartlabel_notification"]
,[]

Email from/subject/message preview and date
,"\u003cspan class\u003d\"yP\" email\u003d\"mail-noreply@google.com\" name\u003d\"Gmail Team\"\u003eGmail Team\u003c/span\u003e","\u0026raquo;\u0026nbsp;","Welcome to the new Gmail inbox","Hi David Meet the new inbox Inbox tabs put you back in control with simple organization so that you",0,"","","10:35 am","Tue, Jul 30, 2013 at 10:35 AM",1375198584460000,,[]
,,0,[]
,,[]
,,"3",[0]
,,"mail-noreply@google.com",,,,0,0]

Here is what a full message loaded and what the email header looks like:

 



  

  




  

   



  

    





    Gmail Team

    <mail-noreply@google.com>

    

 

 

10:35 AM (36 minutes ago)

img class="f T-KT-JX" src="images/cleardot.gif" alt="">

to me 

This is followed by the  body of the message.In addition on each page you have a listing of all the labels, email counts, circles and more data that is preloaded to each page providing you with a large amount of data on your custodians activities but also providing for a large amount of duplicates.

Tomorrow we will go into the important fields and their meanings and I'll provide a regex for carving them out. Recovering webmail used to be simple, just find a javascript library known to the service and carve out the html before and after it, now with JSON/Ajax services like Gmail we get fragments of emails and possibly entire messages but we either have to manually carve them or use a tool like IEF to do it for us.

I start with IEF and let find the fully formed messages and then go back myself to find partials knowing the users email address.

See you tomorrow! Leave comments or questions below if your seeing data differently. I'm going to install fiddler on my system tonight to show how the data looks as its being transmitted.