Bedside healthcare rationing dilemmas: a survey from Portugal

2015 ◽  
Vol 8 (4) ◽  
pp. 233-246 ◽  
Author(s):  
Micaela Pinho ◽  
Ana Borges
Keyword(s):  
Economic Crisis ◽  
Social Preferences ◽  
Personal Characteristics ◽  
Political Agenda ◽  
Online Questionnaire ◽  
Health States ◽  
Healthcare Resources ◽  
Content Type ◽  
Rationing Policy ◽  
Healthcare Rationing

Purpose – The purpose of this paper is to seek to elicit, in a context of economic crisis, the social preferences for the microallocation of scarce healthcare resources. Design/methodology/approach – Data were collected from an online questionnaire which includes a hypothetical rationing choice scenario with four patients differentiated by their personal characteristics and health states competing for treatments and a set of statements that embodies: distributive criteria for prioritizing patients; the authorship of these types of decisions; and the likelihood of these decisions to be taken. Descriptive statistics, factor analysis and non-parametric test were used for describing and validating the data. Findings – Findings suggest that respondents: support a pluralism of distributive principles in prioritizing patients with an incident in utilitarianism and the reducing of inequalities in health, translated in the fair-inning and in emotional arguments of fragility; trust in the health professional to make prioritization decisions; and are conscious that rationing decisions will be real in the short term. Practical implications – The pursuit of efficiency and the equalizing of a lifetime health seem to be the criteria that should guide any rationing policy at the micro level. Originality/value – This study addresses simultaneously several ethical principles inherent to microallocation healthcare resources in a suitable context in which Portugal is facing an economic crisis and where, consequently, rationing healthcare policies gain prominence on the political agenda.

scholarly journals Bedside healthcare rationing dilemmas: a survey from Croatia

2018 ◽  
Vol 11 (3) ◽  
pp. 153-164
Author(s):  
Micaela Pinho ◽  
Ana Pinto Borges ◽  
Duje Petricevic
Keyword(s):  
Descriptive Analysis ◽  
Life Time ◽  
Online Questionnaire ◽  
Policy Makers ◽  
Content Type ◽  
Rationing Policy ◽  
Rationing Decision ◽  
Healthcare Rationing ◽  
Allocation Decisions ◽  
Fair Innings

Purpose The purpose of this paper is to explore Croatian views about issues regarding bedside rationing decisions. Design/methodology/approach An online questionnaire was used to collect data from a sample of 243 Croatian citizens. In a context of hypothetical scenarios involving priority setting decisions taking by physicians, the present study elicits Croatian respondents’ views concerning: the ethical principles that should guide patients prioritization; the parties that should make prioritization decisions; and the likelihood of healthcare rationing becoming a reality. Descriptive analysis, factor analysis and parametric and non-parametric tests were performed. Findings Findings suggest that Croatian respondents: support multiple substantive rationing criteria, with an incident in favoring the worst-off, reducing inequalities in health, translated in the fair-innings argument and efficiency achievement; appoint health professionals as rationing decision makers; and do not seem to believe in the possibility of patient selection becoming a reality. Practical implications Favoring the worst-off, equalizing life time health and the pursuit of efficiency seem to be the criteria most preferred by Croatian respondents to guide rationing policy at the micro level. Originality/value This study is the first attempt to elicit Croatian opinions concerning several rationing criteria inherent in healthcare micro allocation decisions. Healthcare rationing is a serious challenge to Croatian policy makers and so it would be useful for the public’s perceptions and beliefs to be considered.

scholarly journals Personality and Behavioral Predictors of Cyclist Involvement in Crash-Related Conditions

2019 ◽  
Vol 16 (24) ◽  
pp. 4881 ◽  
Author(s):  
Yubing Zheng ◽  
Yang Ma ◽  
Nan Li ◽  
Jianchuan Cheng
Keyword(s):  
Personality Traits ◽  
Road Safety ◽  
Sensation Seeking ◽  
Structural Equation ◽  
Personal Characteristics ◽  
Equation Modeling ◽  
Online Questionnaire ◽  
Road Crashes ◽  
Crash Rates ◽  
Model Combining

In recent years, the increasing rate of road crashes involving cyclists with a disproportionate overrepresentation in injury statistics has become a major concern in road safety and public health. However, much remains unknown about factors contributing to cyclists’ high crash rates, especially those related to personal characteristics. This study aims to explore the influence of cyclist personality traits and cycling behaviors on their road safety outcomes using a mediated model combining these constructs. A total of 628 cyclists completed an online questionnaire consisting of questions related to cycling anger, impulsiveness, normlessness, sensation seeking, risky cycling behaviors, and involvement in crash-related conditions in the past year. After the psychometric properties of the employed scales were examined, the relationships among the tested constructs were investigated using structural equation modeling. The results showed that cyclists’ crash risks were directly predicted by risky cycling behaviors and cycling anger, and the effects of cycling anger, impulsiveness, as well as normlessness on crash risks, were mediated by cycling behaviors. The current findings provide insight into the importance of personality traits in impacting cycling safety and could facilitate the development of evidence-based prevention and promotion strategies targeting cyclists in China.

scholarly journals Hidden bedside rationing in the Netherlands: a cross-sectional survey among physicians in internal medicine

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ursula W. de Ruijter ◽  
Hester F. Lingsma ◽  
Willem A. Bax ◽  
Johan Legemaate
Keyword(s):  
Internal Medicine ◽  
The Netherlands ◽  
Patient Choice ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Physician Characteristics ◽  
Distribution Of Resources ◽  
Healthcare Rationing ◽  
Do So

Abstract Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice. Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics. Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n = 203). Most participants (n = 129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n = 153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR = 17 95%CI 6.1–48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR = 3.2, 95%CI 2.1–4.7), while salaried physicians were less likely to do so than physicians in private practice (OR = 0.5, 95%CI 0.4–0.8). Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.

scholarly journals A sociology for other animals: analysis, advocacy, intervention

2016 ◽  
Vol 36 (3/4) ◽  
pp. 242-257 ◽  
Author(s):  
Erika Cudworth
Keyword(s):  
Animal Studies ◽  
Actor Network Theory ◽  
Political Agenda ◽  
Political Strategy ◽  
Advocacy Groups ◽  
Content Type ◽  
Secondary Sources ◽  
Central Argument ◽  
Practical Implications

Purpose – The purpose of this paper is to map the field of sociological animal studies through some examples of critical and mainstream approaches and considers their relation to advocacy. It makes the argument that while all these initiatives have made important contributions to the project of “animalising sociology” and suggest a need for change in species relations, the link between analysis and political strategy is uncertain. Design/methodology/approach – The paper develops its argument by using secondary sources, reviewing sociological positions and offering illustrations of possible interventions. Findings – Sociological interventions in the field of animal studies have been informed by critical perspectives, such as feminism and Marxism, or taken less critical routes deploying actor-network theory and symbolic interactionism. Whilst those working in critical traditions may appear to have a more certain political agenda, an analysis of “how things are” does not always lead to a clear position on “what is to be done” in terms of social movement agendas or policy intervention. In addition, concepts deployed in advocacy such as “liberation”, “quality of life” or “care” are problematic when applied beyond the human. Despite this, there are possibilities for coalition and solidarity around certain claims for change. Research limitations/implications – If the central argument of the paper were taken seriously by general sociologists, then sociology may be more open to “animal studies”. In implications for exisitng sociological animal studies scholarship is to trouble some of the certainties around advocacy. Practical implications – If the central argument of the paper were taken seriously by advocacy groups, then the hiatus between “welfarism” and “liberation” might be overcome. Originality/value – There have been recent attempts to map the field of scholarship in animal studies, but surprisingly little consideration of how different emergent positions inform questions of advocacy and the possibilities for political intervention.

Agripreneurship development: a strategy for revamping Nigeria’s economy from recession

2017 ◽  
Vol 8 (4) ◽  
pp. 474-483 ◽  
Author(s):  
Innocent Otache
Keyword(s):  
Economic Crisis ◽  
Design Methodology ◽  
Agricultural Sector ◽  
Content Type ◽  
Current Economic Crisis ◽  
Leadership Failure ◽  
Oil Sector ◽  
The Government ◽  
Creativity And Innovation ◽  
Practical Implications

Purpose The purpose of this paper is to explore agripreneurship development as a strategy for economic growth and development. Design/methodology/approach Though a few related literature were reviewed, this paper relies heavily on the author’s viewpoint regarding how Nigeria can grow and develop its economy through agripreneurship development. Findings The present economic challenges that Nigeria is facing are blamed on overdependence on the oil sector, bad governance, corruption, leadership failure, policy inconsistency, overdependence on imported goods and ostensible neglect of the agricultural sector. Also, policymakers, economic analysts and the government have advocated strongly for diversification of the economy. Besides, there is a consensus among scholars, economic analysts and policymakers that “agriculture is the answer.” Research limitations/implications This paper addresses specifically one sector of the economy – the agricultural sector. On the other hand, economic crisis needs to be addressed holistically by resolving specific issues that confront different sectors of the economy. Practical implications This paper has some insightful policy and practical implications for the Nigerian Government and Nigerians. The government and Nigerians need to take practical steps to grow and develop the economy. On the part of the government, apart from the need to transform the agricultural sector by allocating enough funds to it, the government should establish well-equipped agripreneurship development centers and organize periodically agripreneurship development programmes for the main purpose of training and developing both current and potential agripreneurs who will be able to apply today’s agricultural techniques and practices which involve a great deal of creativity and innovation for a successful agribusiness. The federal government should integrate agripreneurship education into Nigeria’s education system. Similarly, the Nigerian people, particularly the youths or graduates should be encouraged to choose agribusiness as a career. Originality/value While previous papers have offered different solutions to the current economic crisis that Nigeria is experiencing, ranging from economic to structural reforms, this paper differs significantly from others by recommending specifically agripreneurship development as a strategy for revamping Nigeria’s economy from its current recession. Moreover, there is a dearth of literature on agripreneurship and agripreneurship development. This paper therefore fills the literature gap.

scholarly journals Student engagement with sustainability: understanding the value–action gap

2014 ◽  
Vol 15 (4) ◽  
pp. 404-417 ◽  
Author(s):  
Gareth Chaplin ◽  
Paul Wyton
Keyword(s):  
Design Methodology ◽  
Strong Association ◽  
Structured Interviews ◽  
Online Questionnaire ◽  
Sustainable Living ◽  
Content Type ◽  
Lack Of Information ◽  
Significant Barrier ◽  
The Uk ◽  
Insight Into

Purpose – The purpose of this paper is to present the findings of research that aimed to determine what university students living in Unite accommodation in the UK understand about the concept of sustainable living. It considers what barriers they perceive to be standing in the way of following sustainable living practices. In particular, the research aimed to explore any value–action gap for the student population with a view to informing future actions to help close any gap. Design/methodology/approach – The study was completed through an online questionnaire survey of students living in halls of residence operated by provider The Unite Group Plc. The survey informed semi-structured interviews and focus groups that explored the issues raised in greater detail. Findings – It was found that students living in Unite properties believed sustainable living to be important, yet levels of understanding were very low and there appeared to be a wide value–action gap. Reasons for this are varied; however, an unexpected theme emerged around the association of effort and importance. There was a very strong association between sustainable living and recycling, which, therefore, saw the lack of adequate recycling facilities as a significant barrier to sustainable living. There were also issues around a lack of information, cost and respondents’ flatmates as further barriers. However, the most significant barrier was the displacement of responsibility for sustainable living to other people or organisations. Originality/value – Gaining an insight into the complexity of attitude and behaviour of students with the sustainability agenda will enable understanding that can be applied to activities that promote sustainability.

The role of agency in project initiation decisions

2014 ◽  
Vol 7 (3) ◽  
pp. 518-535 ◽  
Author(s):  
Mark Mullaly
Keyword(s):  
Decision Making ◽  
Decision Rules ◽  
Personal Characteristics ◽  
Decision Makers ◽  
Organizational Dynamics ◽  
Substantive Theory ◽  
Content Type ◽  
The Subject ◽  
Board Level

Purpose – The purpose of this paper is to explore the role of decision rules and agency in supporting project initiation decisions, and the influences of agency on decision-making effectiveness. Design/methodology/approach – The study this paper is based upon used grounded theory methodology, and sought to understand the influences of individual decision makers on project initiation decisions within organizations. Data collection involved 28 participants who were involved in project initiation decisions within their organizations, who discussed the process of project initiation in their organization and their role within that process. Findings – The study demonstrates that the overall effectiveness of project initiation decisions is a product of agency, process effectiveness or rule effectiveness. The employment of agency can have a direct influence on decision-making effectiveness, it can compensate for organizational inadequacies of a process or political nature, and it can be constrained in the evidence of formal and effective organizational practices. Research limitations/implications – While agency was recognized by all participants, there are clearly circumstances where actors perceive the ability to exercise agency to be externally constrained. The study is exploratory, contributing to the development of substantive theory. Theory testing as well as a more in-depth investigation of the underlying drivers of agency would be valuable. Practical implications – The study provides executives and individuals supporting the initiation of projects with insights on how to effectively influence the effectiveness of project initiation decisions, and the degree to which personal characteristics influence organizational dynamics. Originality/value – Most discussions of agency has been framed the subject as an executive- or board-level phenomenon. The current study demonstrates that agency is in fact being perceived and operationalized at all levels. Those demonstrating agency in the majority of instances in this study do so in exercising stewardship behaviours. This has important implications for how agency is perceived by executives, and by how agency is exercised by actors at all levels of the organization.

scholarly journals Knowledge sharing in open source software communities: motivations and management

2015 ◽  
Vol 19 (4) ◽  
pp. 791-813 ◽  
Author(s):  
Zilia Iskoujina ◽  
Joanne Roberts
Keyword(s):  
Knowledge Sharing ◽  
Open Source ◽  
Open Source Software ◽  
Online Communities ◽  
Descriptive Analysis ◽  
Online Questionnaire ◽  
Content Type ◽  
The Individual ◽  
The Impact

Purpose – This paper aims to add to the understanding of knowledge sharing in online communities through an investigation of the relationship between individual participant’s motivations and management in open source software (OSS) communities. Drawing on a review of literature concerning knowledge sharing in organisations, the factors that motivate participants to share their knowledge in OSS communities, and the management of such communities, it is hypothesised that the quality of management influences the extent to which the motivations of members actually result in knowledge sharing. Design/methodology/approach – To test the hypothesis, quantitative data were collected through an online questionnaire survey of OSS web developers with the aim of gathering respondents’ opinions concerning knowledge sharing, motivations to share knowledge and satisfaction with the management of OSS projects. Factor analysis, descriptive analysis, correlation analysis and regression analysis were used to explore the survey data. Findings – The analysis of the data reveals that the individual participant’s satisfaction with the management of an OSS project is an important factor influencing the extent of their personal contribution to a community. Originality/value – Little attention has been devoted to understanding the impact of management in OSS communities. Focused on OSS developers specialising in web development, the findings of this paper offer an important original contribution to understanding the connections between individual members’ satisfaction with management and their motivations to contribute to an OSS project. The findings reveal that motivations to share knowledge in online communities are influenced by the quality of management. Consequently, the findings suggest that appropriate management can enhance knowledge sharing in OSS projects and online communities, and organisations more generally.

scholarly journals White Syndrome-Affected Corals Have a Distinct Microbiome at Disease Lesion Fronts

2016 ◽  
Vol 83 (2) ◽  
Author(s):  
F. Joseph Pollock ◽  
Naohisa Wada ◽  
Gergely Torda ◽  
Bette L. Willis ◽  
David G. Bourne
Keyword(s):  
Disease Ecology ◽  
Tissue Loss ◽  
Coral Tissue ◽  
Health States ◽  
Host Coral ◽  
Tissue Samples ◽  
Content Type ◽  
White Syndrome ◽  
Community Profiling

ABSTRACT Coral tissue loss diseases, collectively known as white syndromes (WSs), induce significant mortality on reefs throughout the Indo-Pacific, yet definitive confirmation of WS etiologies remains elusive. In this study, we integrated ecological disease monitoring, bacterial community profiling, in situ visualization of microbe-host interactions, and cellular responses of the host coral through an 18-month repeated-sampling regime. We assert that the observed pathogenesis of WS lesions on acroporid corals at Lizard Island (Great Barrier Reef) is not the result of apoptosis or infection by Vibrio bacteria, ciliates, fungi, cyanobacteria, or helminths. Histological analyses detected helminths, ciliates, fungi, and cyanobacteria in fewer than 25% of WS samples, and helminths and fungi were also observed in 12% of visually healthy samples. The abundances of Vibrio-affiliated sequences (assessed using 16S rRNA amplicon sequencing) did not differ significantly between health states and never exceeded 3.3% of reads in any individual sample. In situ visualization detected Vibrio bacteria only in summer WS lesion samples and revealed no signs of these bacteria in winter disease samples (or any healthy tissue samples), despite continued disease progression year round. However, a 4-fold increase in Rhodobacteraceae-affiliated bacterial sequences at WS lesion fronts suggests that this group of bacteria could play a role in WS pathogenesis and/or serve as a diagnostic criterion for disease differentiation. While the causative agent(s) underlying WSs remains elusive, the microbial and cellular processes identified in this study will help to identify and differentiate visually similar but potentially distinct WS etiologies. IMPORTANCE Over the past decade, a virulent group of coral diseases known as white syndromes have impacted coral reefs throughout the Indian and Pacific Oceans. This article provides a detailed case study of white syndromes to combine disease ecology, high-throughput microbial community profiling, and cellular-scale host-microbe visualization over seasonal time scales. We provide novel insights into the etiology of this devastating disease and reveal new diagnostic criteria that could be used to differentiate visually similar but etiologically distinct forms of white syndrome.

Debates over Irish unification will gain traction

2021 ◽  
Keyword(s):  
Northern Ireland ◽  
Status Quo ◽  
Political Agenda ◽  
Successful Implementation ◽  
Northern Irish ◽  
Content Type ◽  
The United Kingdom ◽  
The Status ◽  
Scottish Independence ◽  
The Uk

Significance The differing perspectives of unionists and nationalists on the creation of Northern Ireland as a political entity within the United Kingdom, together with Brexit and tensions over the Northern Ireland Protocol (NIP), have brought the contentious issue of Irish reunification onto the political agenda in Northern Ireland and the Irish Republic. Impacts Scottish independence would likely increase momentum for a referendum on Irish unity. Successful implementation of the NIP, giving firms access to EU and UK markets, may support arguments for maintaining the status quo. If the UK government abandons the NIP, the adverse trade impact on Northern Irish firms could increase support for unification.

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