Ethical and policy implications of hospitalist systems
摘要:
Hospitalist systems raise ethical and policy concerns regarding informing patients about the hospitalist system itself, communication between primary care physicians and hospitalists, continuity of care, and conflicts of interest. Patients may worry that hospitalist systems are intended to achieve cost savings and that the role of the primary care physician as coordinator of care may be undermined. These concerns may be particularly salient for certain subgroups of patients. Hospitalists and health-care organizations that set up hospitalist systems should take steps to reduce the foreseeable risks that discontinuity of care might cause. Practice standards should be set for communication between primary care physicians and hospitalists and for involvement of primary physicians in inpatient care under certain circumstances. By setting such standards and monitoring performance, hospitalist systems can improve the quality of care and reassure patients.
Formal [3+2] Annulation Involving Allylic Bromides and Thioureas. Synthesis of 2-Iminothiazolidines through a Base-Catalyzed Intramolecular<i>anti</i>-Michael Addition
作者:Misael Ferreira、Marcus M. Sá
DOI:10.1002/adsc.201401026
日期:2015.3.9
A simple and efficient protocol was developed for the synthesis of 2‐iminothiazolidines through a base‐mediated [3+2] annulation involving substituted thioureas and allylic bromides bearing electron‐withdrawing groups. This domino process consists of nucleophilic displacement, followed by intramolecular anti‐Michael addition of the preformed allylic isothiourea under mild conditions to give the thiazolidine