R Paul

En Irlande, les enfants nés avec des handicaps sévères, susceptibles de recevoir des soins de longue durée, sont pris en charge soit en milieu hospitalier soit par des services de soins à domicile, dans leur environnement familial. L’organisation caritative Jack and Jill Foundation (JJF) est, dans les faits, le principal prestataire de soins à domicile. Les services de soins à domicile statutaires dispensés par les équipes communautaires de soins primaires de longue durée (primary community and continuing care teams) complètent souvent ce service de soin à domicile non-statutaire. L’objectif de l’étude exploratoire présentée ici est double: il s’agit, d’une part, de comparer les coûts (tant directs qu’indirects) associés aux soins en milieu hospitalier et aux soins à domicile dispensés par JJF; d’autre part, il s’agit de comparer les niveaux de satisfaction des familles dont les enfants sont destinataires de soins de longue durée en milieu hospitalier et à domicile, dispensés par JJF, d’une part, et par des services de soins à domicile statutaires, d’autre part. La comparaison des coûts directs du modèle hospitalier et de celui du soin à domicile proposé par JJF fait apparaître un coût considérablement plus élevé du modèle hospitalier, tant du point de vue des coûts pour les services de santé (156 282€ versus 16 267€) que pour les familles (22 261€ versus 2620€). Les coûts de productivité indirects des deux modèles sont beaucoup plus proches, c’est-à-dire 27 728€ pour le modèle hospitalier et 22 941€ pour des soins à domicile dispensés par JJF. Le taux de satisfaction des familles est plus élevé à l’égard des prestations de JJF, avec une évaluation moyenne de 4,89 sur 5 versus 3,28 en ce qui concerne le modèle hospitalisé et 2,86 pour des services de soins à domicile statutaires. Ces résultats corroborent les conclusions de recherches antérieures, montrant également que le rapport coût-efficacité du modèle des soins à domicile est selon toute probabilité supérieur, avec un moindre coût supporté par le prestataire des soins et par les familles. S’ajoute à cela, une préférence clairement exprimée par les familles pour les prestations de soins à domicile.

Patient counseling is a cornerstone of ethical pharmacy practice and high quality pharmaceutical care. Counseling promotes patient compliance with prescription regimens and prevents dangerous drug interactions and medication errors. Counseling also promotes informed consent and protects pharmacists against legal risks. However, economic, social, and technological changes in pharmacy practice often force community pharmacists to choose between their professional obligations to counsel patients and business objectives. State and federal legislatures have enacted laws that require pharmacists to counsel patients, but these laws have had mixed results. This essay argues that community pharmacy's patient counseling conundrum can be solved through additional moral education and moral persuasion, not through additional legal mandates.

In lieu of an abstract, here is a brief excerpt of the content:American Journal of Philology 123.3 (2002) 513-516 [Access article in PDF] Deborah Tarn Steiner. Images in Mind: Statues in Archaic and Classical Greek Literature and Thought. Princeton: Princeton University Press, 2001. xviii + 360 pp. 28 black-and-white figures. Cloth, $39.50. The production of sculpture in metal, stone, and other materials was a craft that virtually disappeared from the Greek world for several centuries after the end of the Bronze Age. Small, solid cast bronze figurines reappeared in the ninth century B.C.E., but it was not until the middle seventh century that the first large-scale stone statues of women and men were created. From that point on, freestanding and architectural sculpture played a central role in Greek society and its artistic expression. While the stylistic evolution of Greek sculpture has been traced many times, in this provocative and ambitious book, Deborah Steiner sets out to examine, from a literary standpoint, "how archaic and classical Greek poets, philosophers, dramatists, and historians introduce statues as cognitive and hermeneutic devices in their texts" (xi). The investigation leads her to analyze what the statues "looked like, how they functioned," and "what they were credited with doing." The resulting book "aims to tell two stories, one about objects, the other about texts, and to show how each proves crucial to the other." The examination is somewhat lopsided, since the intellectual use of the visual material is given far greater emphasis than the statues themselves.The book is divided into five lengthy chapters and an epilogue. The first chapter, "Replacement and Replication," focuses on the physical resemblance of statues to people but not their inner natures. Chapter 2, "Inside and Out," examines, instead, the ways that a statue's exterior can relate more or less exactly to its inner truth. Chapter 3, "The Quick and the Dead," suggests that statues, by their very inertia, closely resemble the dead and therefore mediate in our imagination between the two states. Statues as erotic (or anti-erotic) art objects form the subject of chapter 4, "For Love of a Statue." The fifth and final chapter, "The Image in the Text," returns to the literary relation of sculpture to the production of memory: the similarity between victory odes and victors' statues, funerary epigrams and monuments, and the creation and regulation (on both the social and political levels) of honorary statuary and decrees. The retrospective epilogue is followed by twenty-eight black-and-white illustrations: Most of them depict well-known pieces of sculpture, but there are also several photographs of vase paintings and one of a drachma.In all the chapters, Steiner continually draws attention to the multivalent aspects of statues. The Greeks developed and applied a large and nuanced vocabulary to describe different types of image that embody differences only [End Page 513] poorly translated by our term, "statue": agalma, eidolon, eikon, kolossos, xoanon, and sema. Most of these have provoked extended discussion among modern scholars. The functions that statues played are even more diverse: they could serve as replacements for the absent or deceased individual, as votive offerings, as cult images, as commemorative monuments, as apotropaic devices, as protective symbols, as minatory agents, and occasionally as deadly entities (some statues could madden their viewer and even kill those who abused them or their creators by toppling over). They were also focusing devices that could evoke a wide range of emotional responses, from pity to lust. As exempla they served to instruct, and some could speak with their own voices, sometimes comically (e.g., the herms in Attic comedy) or poignantly through the words inscribed on their bases (e.g., the famous lines of Phrasikleia, the dead maiden who will never be a bride). The repeated use of the first person by funerary figures is particularly evocative. The inscriptions on other figures (like the very early Mantiklos Apollo statuette) make it clear that images could serve as bargaining chips with the gods for past services rendered or debts owed for the future.Other statues defy simple categorization—the Athena Parthenos, for example...