scholarly journals The Prisoner’s Dilemma: An Adequate Concept for Ethical Analysis in Healthcare? A Systematic Search and Critical Review

2020 ◽  
Author(s):  
Wolf Rogowski ◽  
Oliver Lange
Keyword(s):  
Ethical Theory ◽  
Ethical Analysis ◽  
Institutional Changes ◽  
Empirical Methods ◽  
Economic Ethics ◽  
Ethical Frameworks ◽  
Ethical Conflicts ◽  
Study Type ◽  
Pareto Improving

Abstract Schools of economic ethics inspired by Buchanan propose viewing ethical conflicts as prisoners’ dilemmas (PDs) to facilitate solutions based on Pareto-improving institutional changes. Given that healthcare is determined by complex institutional arrangements, it has been claimed that this approach is also suitable for business ethics in healthcare. To scrutinize this claim, this research systematically searched for studies reporting PD structures in healthcare. PubMed, EconLit, and EconBiz were searched to find articles in German and English. Study type, characteristics of the game, and the proposed means to overcome the dilemma (if mentioned) were extracted and analyzed for aspects supporting or challenging the claim. Across 53 studies, 68 descriptions of various dilemmas in healthcare and public health were identified. Many authors successfully developed proposals for institutional change to overcome these dilemmas. However, many of these analyses exhibited limitations such as oversimplifications or inconsistencies. Also, the quality of evidence on both the characteristics of dilemmas and the effectiveness of proposed solutions was very poor. The subsamples of studies that explicitly cited the ethical approach were disjunct from those that applied empirical methods to analyze the dilemmas (frequently applying empirically richer frameworks than rational choice only). The large number of identified PDs indicates that economic ethics is relevant to healthcare. However, there is a need for further evidence to substantiate both the descriptive and prescriptive claims of this ethical theory. It should thus be seen as a complement that needs justification, rather than a substitute superior to other ethical frameworks.

STUDY OF THE IMPACT OF RAISING THE RETIREMENT AGE ON ECONOMIC GROWTH IN THE DIGITAL ECONOMY IN RUSSIA AND EUROPE

2020 ◽  
Author(s):  
Svetlana Apenko ◽  
◽  
Olga Kiriliuk ◽  
Elena Legchilina ◽  
Tatiana Tsalko ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Growth ◽  
Economic Policy ◽  
Labor Relations ◽  
Pension Reform ◽  
Digital Economy ◽  
Institutional Changes ◽  
Retirement Age ◽  
The Impact

The article presents the results of a study of the impact of pension reform in Russia on economic growth and quality of life in a digital economy, taking into account the experience of raising the retirement age in Europe. The aim of the study was to identify and analyze the impact of raising the retirement age on economic growth in the context of the development of digitalization in Russia and a comparative analysis with European countries. Results: the studies conducted allowed us to develop a system of indicators characterizing the impact of raising the retirement age on economic growth and the quality of life of the population in the context of digitalization. The authors found that raising the retirement age leads to a change in labor relations in Russia and Europe. The application of the proposed indicators can be used in the formation of a balanced state socio-economic policy in the field of institutional changes in the field of labor relations and raising the retirement age. The study was carried out under a grant from the RFBR № 19-010-00362 А.

Assessing Medical Evidence

2018 ◽  
Author(s):  
Jacob Stegenga
Keyword(s):  
Quality Assessment ◽  
Randomized Trials ◽  
Empirical Studies ◽  
Allocation Concealment ◽  
Assessment Tools ◽  
Medical Evidence ◽  
Empirical Methods ◽  
First Order ◽  
First Order Methods

Medical scientists employ ‘quality assessment tools’ to assess evidence from medical research, especially from randomized trials. These tools are designed to take into account methodological details of studies, including randomization, subject allocation concealment, and other features of studies deemed relevant to minimizing bias. There are dozens of such tools available. They differ widely from each other, and empirical studies show that they have low inter-rater reliability and low inter-tool reliability. This is an instance of a more general problem called here the underdetermination of evidential significance. Disagreements about the quality of evidence can be due to different—but in principle equally good—weightings of the methodological features that constitute quality assessment tools. Thus, the malleability of empirical research in medicine is deep: in addition to the malleability of first-order empirical methods, such as randomized trials, there is malleability in the tools used to evaluate first-order methods.

scholarly journals Importância da assistência de enfermagem no cuidado ao paciente transplantado renal

2018 ◽  
Vol 12 (12) ◽  
pp. 3436 ◽  
Author(s):  
Rafaella Vezzoli da Silva Marques ◽  
Vera Lucia Freitas
Keyword(s):  
Renal Transplant ◽  
Nursing Care ◽  
Renal Transplant Patient ◽  
Transplant Patient ◽  
Kidney Diseases ◽  
Calidad De Vida ◽  
Virtual Libraries ◽  
Study Type ◽  
Nursing Diagnoses

RESUMOObjetivo: descrever a importância da assistência de Enfermagem ao paciente transplantado renal. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa, na base de dados LILACS e bibliotecas virtuais SciELO e BVS, incluindo artigos completos, em português, inglês ou espanhol. Estabeleceu-se, um período de 15 anos para a inclusão dos estudos, e os resultados apresentam-se em figuras. Resultados: encontraram-se 1114 artigos, dos quais, após a leitura dos títulos e dos resumos e a aplicação dos critérios de inclusão e exclusão, foram selecionados dez, sendo dois na SciELO, três na BVS e quatro na LILACS. Verifica-se que os artigos abordam, de forma significativa, a relação dos diagnósticos de Enfermagem na elaboração de intervenções adequadas ao paciente. Conclusão: conclui-se que a Enfermagem possui um papel fundamental no sucesso, na recuperação e na melhoria da qualidade de vida do paciente transplantado renal. Descritores: Assistência ao Paciente; Cuidados de Enfermagem; Nefropatias; Pacientes; Sobrevida; Transplante de Rim.ABSTRACT Objective: to describe the importance of nursing care to the renal transplant patient. Method: this is a bibliographical study, type integrative, in the LILACS database and virtual libraries SciELO and VHL, including complete articles, in Portuguese, English or Spanish. A period of 15 years for the inclusion of the studies was established, and the results are presented in figures. Results: 1114 articles were found, of which, after reading titles and abstracts and applying the inclusion and exclusion criteria, ten were selected, two in SciELO, three in VHL and four in LILACS. It is verified that the articles approach, in a significant way, the relation of Nursing diagnoses in the elaboration of adequate interventions to the patient. Conclusion: it is concluded that Nursing plays a fundamental role in the success, recovery and improvement of the quality of life of the renal transplant patient. Descriptors: Patient Care; Nursing Care; Kidney Diseases; Patients; Survival; Kidney Transplantation.RESUMEN Objetivo: describir la importancia de la asistencia de enfermería al paciente trasplantado renal. Método: se trata de un estudio bibliográfico, revisión integrada de tipo, la base de datos LILACS y SciELO bibliotecas virtuales y BVS, incluyendo los artículos completos en portugués, inglés o español. Se estableció, un período de 15 años para la inclusión de los estudios, y los resultados se presentan en figuras. Resultados: se encontraron 1114 artículos, de los cuales, después de la lectura de los títulos y de los resúmenes y la aplicación de los criterios de inclusión y exclusión, fueron seleccionados diez, siendo dos en la SciELO, tres en la BVS y cuatro en la LILACS. Se verifica que los artículos abordan de forma significativa la relación de los diagnósticos de Enfermería en la elaboración de intervenciones adecuadas al paciente. Conclusión: se concluye que la Enfermería tiene un papel fundamental en el éxito, la recuperación y la mejora de la calidad de vida del paciente trasplantado renal. Descriptores: Atención al Paciente; Atención de Enfermería;  Enfermedades Renales; Pacientes; Supervivencia; Trasplante de Riñón.

scholarly journals Registros de enfermagem e suas implicações para a qualidade do cuidado

2019 ◽  
Vol 9 (26) ◽  
pp. 3
Author(s):  
Beatriz Da Silva Sousa ◽  
Ana Clara Maciel Barroso
Keyword(s):  
Medical Records ◽  
Electronic Records ◽  
Structured Interviews ◽  
Health Records ◽  
Study Case ◽  
Artery Disease ◽  
Study Type ◽  
Nursing Professionals

Avaliar o registro dos enfermeiros nos prontuários do paciente eletrônico e convencional, com vista à melhoria da qualidade do cuidado. Estudo descritivo, tipo estudo de caso. Foram realizadas entrevistas semiestruturadas com 8 enfermeiros da enfermaria de coronariopatias e a análise dos registros nos dois tipos de prontuários do paciente. Nos 25 prontuários revistos, constatou-se o número de 51 registros, sendo 37 do prontuário eletrônico e 14 do prontuário convencional, média de 31 dias de internação. Atrelou-se a não realização ao número insuficiente de profissionais de enfermagem no setor em comparação à complexidade dos pacientes atendidos. Destaca-se como obstáculo o quantitativo de pessoal da equipe de enfermagem e sua carga de trabalho. Consequentemente, há necessidade de ajustes quantitativo e qualitativo no processo de trabalho relacionados a execução desta e das demais tarefas para que possam ser adequadamente conduzidas.Descritores: Cuidados de Enfermagem, Registros Eletrônicos de Saúde, Carga de trabalho. Nursing records and their implications for the quality of careAbstract: To evaluate nurses' records in the electronic and conventional patient charts, with a view to improving the quality of care. Descriptive study, case study type. Semi-structured interviews were carried out with 8 nurses from the coronary artery disease ward and the analysis of the records in the two types of patient records. In the 25 revised records, the number of 51 records was verified, being 37 of the electronic records and 14 of the conventional medical records, average of 31 days of hospitalization. There was a lack of achievement of the insufficient number of nursing professionals in the sector compared to the complexity of the patients attended. The number of nursing staff and their workload stands out as an obstacle. Consequently, there is a need for quantitative and qualitative adjustments in the work process related to the execution of this and other tasks so that they can be properly conducted.Descriptors: Nursing Care, Eletronic Health Records, Workload. Registros de enfermería y sus implicaciones para la calidad de la atenciónResumen: Evaluar el registro de los enfermeros en los prontuarios del paciente electrónico y convencional, con objetivo la mejora de la calidad del cuidado. Estudio descriptivo, tipo estudio de caso. Se realizaron entrevistas semiestructuradas con 8 enfermeros de la enfermería de coronariopatias y el análisis de los registros en los dos tipos de prontuarios del paciente. En los 25 prontuarios revisados, se constató el número de 51 registros, siendo 37 del prontuario electrónico y 14 del prontuario convencional, promedio de 31 días de internación. La no realización se debe al número insuficiente de profesionales de enfermería en el sector en comparación a la complejidad de los pacientes atendidos. Se destaca como obstáculo el cuantitativo de personal del equipo de enfermería y su carga de trabajo. En consecuencia, hay necesidad de ajustes cuantitativos y cualitativos en el proceso de trabajo relacionados con la ejecución de ésta y de las demás tareas para que puedan ser adecuadamente conducidas.Descriptores: Atención de Enfermería, Registros Electrónicos de Salud, Carga de Trabajo.

scholarly journals Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: “If You Can’t Stand the Heat, Get Out of the Kitchen”

2020 ◽  
Vol 17 (12) ◽  
pp. 4442
Author(s):  
Moonok Kim ◽  
Younjae Oh ◽  
Byunghye Kong
Keyword(s):  
South Korea ◽  
Ethics Education ◽  
Phenomenological Study ◽  
Empirical Studies ◽  
Ethical Conflict ◽  
Face To Face ◽  
Quality Of Patient Care ◽  
Ethical Conflicts ◽  
Geriatric Nurses

Ethical conflicts among nurses can undermine nurses’ psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.

The Political Economy of Trust

2019 ◽  
pp. 627-648
Author(s):  
Christian Bjørnskov
Keyword(s):  
Political Economy ◽  
Public Choice ◽  
Empirical Evidence ◽  
Government Policy ◽  
Social Trust ◽  
The Political ◽  
Institutional Changes ◽  
Reverse Causality ◽  
Quality Of Institutions

This chapter provides a selective survey of the literature on social trust in public choice and political economy. It outlines the empirical evidence and discusses theoretical channels through which social trust can affect the quality of institutions and policies, and the conditions under which such mechanisms are likely to work. It also addresses the discussion of reverse causality, that is, whether good institutions or policies actively create trust. It then discusses whether trust can be created or destroyed by activist government policy or accidental institutional changes. Its main focus is on the set of theories and evidence of the association between social trust and institutions of governance.

More philosophical work needed in One Health on ethical frameworks and theory

2020 ◽  
Vol 46 (10) ◽  
pp. 705-706
Author(s):  
Jane Johnson ◽  
Chris Degeling
Keyword(s):  
Ethical Theory ◽  
One Health ◽  
Competing Values ◽  
Deliberative Process ◽  
Philosophical Work ◽  
Ethical Frameworks

We thank Zohar Lederman and Benjamin Capps for engaging with our paper on One Health (OH) and ethical frameworks, however we want to take issue with them on three points. First, they appear to misunderstand the distinction we appeal to between ethical theory and ethical frameworks, and so misinterpret what we are trying to achieve in our paper. Second, in spite of what they seem to imply, we agree that an OH approach can obscure differences in values, and that to progress the field there needs to be recognition of competing values and their implications for OH. Finally, we are puzzled by their interest in pursuing a deliberative process, as this seems at odds with other positions they take in their paper, and also opens up many questions that need to be addressed.

A Care Ethical Theory of Right Action

2020 ◽  
Author(s):  
Steven Steyl
Keyword(s):  
Ethical Theory ◽  
Care Ethics ◽  
Moral Evaluation ◽  
Right Action ◽  
Ethical Frameworks

Abstract One of the most striking and underexplored points of difference between care ethics and other normative theories is its reluctance to offer a theory of right action. Unlike other normative ethical frameworks, care ethicists typically either neglect right action or explicitly refuse to provide a theory thereof. This paper disputes that stance. It begins with an examination of right action in care ethics, offering reasons for care ethicists not to oppose the development of a care ethical theory thereof. It then considers some potential formulations of a first premise of a theory of right action, both demonstrating the diversity of possible first premises and arguing for a monistic subset of these. It subsequently presents some potential second premises, arguing that a care ethical theory of right action ought to adopt a eudaimonistic approach to care. The paper thereby makes several inroads into a care ethical account of moral evaluation.

Prevención de úlceras por presión en pacientes geriátricos

2018 ◽  
Vol 2 (1) ◽  
pp. 85-98
Author(s):  
Leonardo Mera Villamar. ◽  
Vicente Mendoza Vera ◽  
Adis Anicia Luna Báez ◽  
Anaisa Álvarez Luna
Keyword(s):  
Geriatric Patients ◽  
Pressure Ulcers ◽  
Geriatric Syndromes ◽  
Empirical Methods ◽  
Know How ◽  
Calidad De Vida ◽  
Documentary Analysis ◽  
Qualitative Descriptive ◽  
Las Mujeres

Las úlceras por presión (UPP), forman parte de los grandes síndromes geriátricos, son un problema de la práctica médica cotidiana, que afecta a toda la población, aunque se presentan con mayor frecuencia, en ancianos con diferentes discapacidades, o en etapa terminal. El objetivo es prevenir las causas de úlceras por presión en sus diferentes formas de aparición en pacientes geriátricos, para poder mejorar su calidad de vida. La metodología utilizada es cualitativa, descriptiva; que permitió conocer cómo se manifiesta este problema en términos frecuencia, características, condiciones, incidencia y prevalencia. Se aplicaron métodos teóricos y empíricos como análisis documental, encuestas y entrevista para verificar las insuficiencias en el manejo y cuidado de las lesiones por esta enfermedad, que tiene una predominancia en pacientes que consta en un rango de edad entre los 61 a 70 años, con un porcentaje de 41,3% en usuarias de género femenino, en un porcentaje de 63,6% siendo estos los casos de usuarios que han sufrido traumatismo, fracturas, se encuentran encamados en un 27,5 % o ensillados en un 26,5%. La forma de prevenir las ulceras por presión es de vital importancia ya que se podrá demostrar las causas, diferentes estadios, evolución de la enfermedad; proporcionar formación y educación a los cuidadores, desarrollar una continuidad de servicios sociales y de salud que sean asequibles, accesibles, de gran calidad y respetuosos con la edad, y que tengan en cuenta las necesidades y los derechos de las mujeres y los hombres a medida que envejecen.Palabras claves: prevención, pacientes, geriátricos, ulceras por presiónABSTRACTPressure ulcers (UPP), are part of the biggest geriatric syndromes, they’re a problem of everyday medical practice, this affect to all population, although they occur more frequently, in elderly with different disabilities, or terminal stage. The aim is to determine the causes of pressure ulcers in their different forms of appearance in geriatric patients, in order to improve their quality of life. The methodology used is qualitative, descriptive, and it allowed to know how this problem manifests in terms of frequency, characteristics, conditions, incidence and prevalence. Theoretical and empirical methods were applied such as documentary analysis, surveys and interviews to verify the insufficiencies in the management and care of the lesions due to this disease, it has a predominance in patients ranging from 61 to 70 years old, with a percentage of 41.3% in female users, in a percentage of 63.6%, these being the cases of users who have suffered trauma, fractures, are bedridden in 27.5% or saddled in a 26.5% %. The way to prevent pressure ulcers is of vital importance since it will be possible to demonstrate the causes, different stages, evolution of the disease; provide education to keepers, develop a continuity of social and health services that are possible, accessible, of high quality and respectful with age, and the women and men consider their need according as the years go by.Keywords: prevention, patients, geriatric, ulcers, pressure 

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