scholarly journals Pre-diabetes in the elderly and the see-saw model of paternalism

2020 ◽  
pp. medethics-2020-106573
Author(s):  
Patrick Burch ◽  
Soren Holm
Keyword(s):  
Elderly Patients ◽  
Lifestyle Modification ◽  
The Elderly ◽  
Routine Practice ◽  
Very Elderly ◽  
Limited Life ◽  
The Usa ◽  
The Individual ◽  
The Uk ◽  
The Impact

Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. While ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a ‘see-saw’ model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes.

scholarly journals Pacemaker therapy in the elderly and very elderly: comorbidity-burden vs age, as prognostic factors for excess of length of in-hospital stay, complications and mortality

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Marschall ◽  
H Del Castillo Carnevali ◽  
F Goncalves Sanchez ◽  
M Torres Lopez ◽  
F A Delgado Calva ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Elderly Patients ◽  
Hospital Stay ◽  
The Elderly ◽  
Very Elderly ◽  
Pacemaker Therapy ◽  
Clinical Scenarios ◽  
Comorbidity Burden ◽  
The Impact ◽  
Complications And Mortality

Abstract Background The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. Recent studies suggest that comorbidity burden may have an equal, if not greater, effect on length of in-hospital stay (LOS), complications and mortality, as age in a variety of clinical scenarios. Objective The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate the impact of comorbidities, as compared to age, on excess of length of in-hospital stay and mortality. Methods This is a retrospective observational study of a single centre. Patients that underwent (both elective and non-elective) PM implantation between June 2016 and December 2018 in our centre, were included for chart review. Elderly patients were defined as those with age 80–89 years, whereas very elderly patients were defined as those with ≥90 years of age. Excess in LOS was defined as an in-hospital stay >3 days. Results A total of 507 patients were included in the study with a mean age of 80.6 (±8.5) years. 255 elderly and 60 very elderly patients were included. Median follow-up time was 24 months. Baseline clinical characteristics are presented in Table 1. The mortality rate for elderly patients was 18.8% for the elderly and 36.7% for the very elderly (p=0.002). The presence of ≥2 comorbidities (defined in Table 1) resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 7.1 (4.4–11.4), p<0.001); HR: 1.01 (0.9–1.1), p=0.56, respectively). Neither age, nor comorbidity burden predicted the appearance of device related complications. Both comorbidites and age predicted mortality. However, the association was stronger for the presence of comorbidites, than for age (HR: 1.9 (1.1–3.1), p=0.002 vs HR: 1.1 (1.1–1.2), p<0.001, respectively). Elderly patients with low comorbidity burden (<2 comorbidities) showed no significant differences with regards to LOS and mortality when compared to younger patients (2 (2–4) vs 3 (2–5) days, p=0.529 and 18.3% vs 17.4%, p=0.702; respectively). Conclusions Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 17064: Frailty Predicts Mortality and Hospital Readmission Amongst Elderly Heart Failure (HF) Patients Discharged From Hospital or the Emergency Department (ED)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Penelope Rampersad ◽  
Susan E Bronskill ◽  
Alice Chong ◽  
Peter C Austin ◽  
Jack V Tu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Vital Signs ◽  
The Elderly ◽  
Population Based ◽  
Community Dwelling ◽  
Very Elderly ◽  
Predictors Of Mortality ◽  
Chart Abstraction ◽  
The Individual ◽  
The Impact

Introduction: Frailty is commonly encountered in elderly patients with HF. However, the impact of both frailty and HF on outcomes in the population has not been delineated. There is a need for operationalizable definitions of frailty to explore variations in care among the elderly. Objective: To assess common indicators of frailty as predictors of mortality and rehospitalisation within 1 year in a population-based study of very elderly HF patients. Methods: Community-dwelling HF patients aged >75 yrs discharged from hospital or ED in Ontario, Canada, were studied using the Enhanced Feedback for Effective Cardiac Treatment and Emergency HF Mortality Risk Grade databases. Surrogates of frailty, including dementia, falls, incontinence, immobility, caregiver dependence, and abnormal weight loss, were identified from chart abstraction and linked hospitalization records. Survival analyses were performed using multiple Cox regression, for frail vs non-frail status and for each frailty component. Results: 9964 patients were identified (age 84±5 yrs). After adjustment for age, sex, vital signs, laboratory variables, and comorbidities, presence of any frailty indicator was associated with mortality: adjusted hazard ratio [HR] 1.18 (95%CI; 1.06-1.32, p=0.003). Frailty increased the risk of readmission and the association was more pronounced than for mortality (see Figure ): adjusted HR 1.29 (95%CI; 1.18-1.41, p<.001). Among the individual frailty components, significant predictors of mortality were: dementia (HR 1.49, 95%CI; 1.34-1.64, p<.001) and care provider dependency (HR 1.17, 95%CI; 1.01-1.36, p=0.038). In contrast, other frailty components increased the risk of readmission, specifically: falls (HR 1.17, 95%CI; 1.06-1.29, p=0.003) and incontinence (HR 1.64, 95%CI; 1.18-2.29, p=0.004). Conclusion: Frailty indicators derived from clinical and administrative data sources are associated with death and readmission in a very elderly HF cohort.

scholarly journals Experiences of people affected by cancer during the outbreak of the COVID-19 pandemic: an exploratory qualitative analysis of public online forums

2021 ◽  
Author(s):  
Sara Colomer-Lahiguera ◽  
Karin Ribi ◽  
Hayley J. Dunnack ◽  
Mary E. Cooley ◽  
Marilyn J. Hammer ◽  
...  
Keyword(s):  
Self Report ◽  
Qualitative Description ◽  
Online Forums ◽  
Behavioral Challenges ◽  
Response Options ◽  
Cancer Symptoms ◽  
The Usa ◽  
The Individual ◽  
The Uk ◽  
The Impact

Abstract Purpose Studies focusing on patients with and survivors of cancer during the COVID-19 pandemic highlight unique psychological and behavioral challenges. These findings were obtained in surveys using self-report questionnaires with pre-specified response options that may not capture the broad range of experiences of individuals affected by cancer, including people with cancer and informal caregivers, in this unprecedented situation. Online forums produce a large amount of valuable first-hand user-generated content that can be used to better understand their day-to-day lives. This study, based on the analysis of narratives in cancer online forums, aims to describe and categorize the experiences of people affected by cancer during the outbreak of the COVID-19 pandemic. Method An inductive, descriptive, thematic approach was applied to publicly available cancer forums from Germany, the USA, the UK, and Ireland posted between mid-March and mid-April 2020. Results An analysis of the content of 230 main posts revealed three major themes: (1) concerns related to the impact of COVID-19 on cancer care, the risks and fears of getting infected, logistic issues, and economic impact; (2) adaptation challenges faced at the individual and societal level; and (3) the need for advice including information about COVID-19 and the (self-)management of cancer symptoms and treatment. Conclusion Our qualitative description of the experiences of people affected by cancer during the COVID-19 pandemic outbreak can help to improve communication, education, and the development of supportive care strategies. Furthermore, the themes and subthemes identified could potentially inform item development for future self-report questionnaires.

scholarly journals Crisis Management in Higher Education in the Time of Covid-19: The Case of Actor Training

2021 ◽  
Vol 11 (3) ◽  
pp. 132
Author(s):  
Anna McNamara
Keyword(s):  
Higher Education ◽  
Crisis Management ◽  
High Frequency ◽  
High Reliability ◽  
Actor Training ◽  
Management Actions ◽  
The Usa ◽  
The Uk ◽  
The Impact ◽  
High Frequency Words

The impact of Covid-19 placed Higher Education leadership in a state of crisis management, where decision making had to be swift and impactful. This research draws on ethea of mindfulness, actor training techniques, referencing high-reliability organisations (HRO). Interviews conducted by the author with three leaders of actor training conservatoires in Higher Education institutions in Australia, the UK and the USA reflect on crisis management actions taken in response to the impact of Covid-19 on their sector, from which high-frequency words are identified and grouped thematically. Reflecting on these high-frequency words and the thematic grouping, a model of mindful leadership is proposed as a positive tool that may enable those in leadership to recognise and respond efficiently to wider structural frailties within Higher Education, with reference to the capacity of leaders to operate with increased mindfulness, enabling a more resilient organisation that unlocks the locus of control.

scholarly journals Three models for the regulation of polygenic scores in reproduction

2021 ◽  
pp. medethics-2020-106588
Author(s):  
Sarah Munday ◽  
Julian Savulescu
Keyword(s):  
Human Genetics ◽  
Ethical Issues ◽  
Well Being ◽  
Embryo Selection ◽  
Risk Scores ◽  
Regulatory Regime ◽  
Polygenic Scores ◽  
The Usa ◽  
The Uk ◽  
The Impact

The past few years have brought significant breakthroughs in understanding human genetics. This knowledge has been used to develop ‘polygenic scores’ (or ‘polygenic risk scores’) which provide probabilistic information about the development of polygenic conditions such as diabetes or schizophrenia. They are already being used in reproduction to select for embryos at lower risk of developing disease. Currently, the use of polygenic scores for embryo selection is subject to existing regulations concerning embryo testing and selection. Existing regulatory approaches include ‘disease-based' models which limit embryo selection to avoiding disease characteristics (employed in various formats in Australia, the UK, Italy, Switzerland and France, among others), and 'laissez-faire' or 'libertarian' models, under which embryo testing and selection remain unregulated (as in the USA). We introduce a novel 'Welfarist Model' which limits embryo selection according to the impact of the predicted trait on well-being. We compare the strengths and weaknesses of each model as a way of regulating polygenic scores. Polygenic scores create the potential for existing embryo selection technologies to be used to select for a wider range of predicted genetically influenced characteristics including continuous traits. Indeed, polygenic scores exist to predict future intelligence, and there have been suggestions that they will be used to make predictions within the normal range in the USA in embryo selection. We examine how these three models would apply to the prediction of non-disease traits such as intelligence. The genetics of intelligence remains controversial both scientifically and ethically. This paper does not attempt to resolve these issues. However, as with many biomedical advances, an effective regulatory regime must be in place as soon as the technology is available. If there is no regulation in place, then the market effectively decides ethical issues.

Product Liability

2020 ◽  
Author(s):  
Fairgrieve Duncan ◽  
Richard Goldberg
Keyword(s):  
Strict Liability ◽  
Product Liability ◽  
Case Law ◽  
The European Union ◽  
Financial Loss ◽  
Liability Law ◽  
The Usa ◽  
The Law ◽  
The Uk ◽  
The Impact

Product Liability is a recognised authority in the field and covers the product liability laws through which manufacturers, retailers, and others may be held liable to compensate persons who are injured, or who incur financial loss, when the products which they manufacture or sell are defective or not fit for their purpose. Product defects may originate in the production process, be one of design, or be grounded in a failure to issue an adequate warning or directions for safe use and practitioners advising business clients or claimants will find this book provides all the necessary information for practitioners to manage a product liability claim. This new edition has been fully updated to take account of 10 years of development in case law and regulation, and the increasing impact of cross-border and transnational sale of goods. The Court of Justice of the European Union handed down major rulings concerning the Product Liability Directive which affect the application of the Directive and national arrangements and Fairgrieve and Goldberg examines this in detail. For any legal practitioner operating in areas which require knowledge of European product liability law, an understanding of the impact of recent developments is essential and this work is an essential resource for practitioners working on product liability, sale of goods, personal injury and negligence. The work provides comprehensive coverage of the law of negligence as it applies to product liability, of the strict liability provisions of the Consumer Protection Act 1987, and of the EU's Product Liability Directive on which the Act is based. Although the majority of cases involve pharmaceuticals and medical devices, in recent English cases the allegedly defective products have been as diverse as a child's buggy, an All Terrain Vehicle, and even a coffee cup. Many cases are brought as group actions, and the book examines the rights of those who are injured by defective products. As well as considering the perspective of the law as it has developed in the UK, this edition contains detailed discussion of case law from other jurisdictions including the USA, Australia, New Zealand, Canada, France and Germany. The coverage in the work is complemented by a full analysis of issues which arise in transnational litigation involving problems of jurisdiction and the choice of laws.

scholarly journals Impact of Ownership Structure on Bank Profitability in Nigeria

2008 ◽  
Vol 4 (3) ◽  
pp. 170-183
Author(s):  
Uhomoibhi Aburime Toni
Keyword(s):  
Emerging Markets ◽  
Ownership Structure ◽  
Developed Countries ◽  
Bank Profitability ◽  
Limited Applicability ◽  
The Usa ◽  
The Individual ◽  
The Uk ◽  
Finance Theory ◽  
Political Economic

Ownership structure is considered an important factor that affects a firm’s health. If ownership structure affects a firm’s health, it is possible then to use the ownership structure to predict firm profitability. Against this backdrop, this paper analyzes the relationship between ownership structure and bank profitability in Nigeria. There are two motivations for this paper. Firstly, midway into the banks consolidation exercise in Nigeria, the CBN identified the need for a determination of the most appropriate composition of bank capitalization that would enhance the individual and systemic profitability and efficiency of banks in Nigeria post-consolidation. Hence, it decided to minimize state governments’ investment in banks during the exercise and also issued a December 2007 ultimatum to all tiers of governments that have stakes in banks to dilute their investments to a maximum of 10 per cent. Unfortunately, the CBN did not state any econometrically-based rationale giving credence to its directives. Secondly, the effect of ownership structure and concentration on a firm’s performance is an important issue in the literature of finance theory. However, no researcher has studied this important aspect of finance theory in the Nigerian context. It is worth noting that most research on ownership structure and firm performance has been dominated by studies conducted in developed countries. However, there is an increasing awareness that theories originating from developed countries such as the USA and the UK may have limited applicability to emerging markets. Emerging markets have different characteristics such as different political, economic and institutional conditions, which limit the application of developed markets’ empirical models.

scholarly journals Social Frontiers: Estimating the Spatial Boundaries Between Residential Groups and Their Impacts on Crime

2021 ◽  
pp. 285-304
Author(s):  
Ivana Křížková ◽  
Meng Le Zhang ◽  
Dan Olner ◽  
Gwilym Pryce
Keyword(s):  
Cultural Distance ◽  
Free Market ◽  
Poisson Model ◽  
Distance Measures ◽  
The Usa ◽  
Short Run ◽  
History Of ◽  
Conditional Autoregressive ◽  
The Uk ◽  
The Impact

AbstractInthischapter, we highlight the importance of social frontiers—sharp spatial divisions in the residential make-up of adjacent communities—as a potentially important form of segregation. The handful of studies estimating the impacts of social frontiers have been based in the USA and the UK, both of which are free-market democracies with a long history of immigration, ethnic mix and segregation. There are currently no studies of social frontiers in former socialist countries, for example, or in countries where immigration and ethnic mix are only a recent phenomenon or non-existent. This chapter aims to address this research gap by estimating the impacts of social frontiers on crime rates in a post-socialistcountry, Czechia. We demonstrate how a Bayesianspatial conditional autoregressive estimation can be used to detect social frontiers in this setting, and we use a fixed effect quasi-Poisson model to investigate the impact on crime. Our results suggest that in new immigration destinations, social frontiers may not be associated with higher rates of crime, at least in the short run. Moreover, our use of cultural distance measures helps to promote a more nuanced approach to studying the impact of segregation and highlights the role of cultural diversity in understanding the link between immigrant segregation and crime. We reflect on how this approach could contribute to the study of segregation and inequality in the Chinese context.

scholarly journals Exploring Ethnicity in Hospital Patients with COVID-19 in South London

The Physician ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Anna Zatorska ◽  
Niladri Konar ◽  
Pratyasha Saha ◽  
Alice Moseley ◽  
Jessica Denman ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Population Distribution ◽  
Local Population ◽  
Case Series ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Hospital Patients ◽  
The Usa ◽  
The Uk ◽  
The Impact

Ethnicity was found to be an independent risk factor in COVID-19 outcomes in the UK and the USA during the pandemic surge. London, being in the epicentre and having one of the most ethnically diverse population in the UK, was likely to have experienced a much higher intensity of this phenomenon. Black Asian and Minority ethnic groups were more likely to be admitted, more likely to require admission to intensive care, and more likely to die from COVID-19. We undertook an analysis of a case series to explore the impact of ethnicity in hospitalised patients with confirmed COVID-19 during the 3 months of the pandemic. Our results demonstrated that although the proportion of Asian and Black patients were representative of the local population distribution, they were much younger. The prevalence of comorbidities was similar but logistic regression analysis showed that male sex (OR 1.4, 95% CI 1.1-1.9; p=0.02), age (OR 1.03, 95% CI 1.02 - 1.04, p<0.001), those in the ‘Other’ [Odds ratio 1.7 (1.1-2.6) p = 0.01] and ‘Asian’[Odds ratio 1.8 (1.1-2.7) p=0.01], category were at higher risk of death in this cohort. Our results, therefore, are consistent with the overall data from the UK and USA indicating that ethnicity remains a significant additional risk and hence our clinical services must ensure that adequate provision is made to cater to this risk and research must be designed to understand the causes.   

scholarly journals Earnings quality and the cost of equity capital: evidence on the impact of legal background

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ahmed Hassan Ahmed ◽  
Yasean Tahat ◽  
Yasser Eliwa ◽  
Bruce Burton
Keyword(s):  
Earnings Quality ◽  
Institutional Ownership ◽  
Equity Capital ◽  
Cost Of Equity Capital ◽  
Cost Of Equity ◽  
Content Type ◽  
The Usa ◽  
The Uk ◽  
The Cost ◽  
The Impact

Purpose Earnings quality is of great concern to corporate stakeholders, including capital providers in international markets with widely varying regulatory pedigrees and ownership patterns. This paper aims to examine the association between the cost of equity capital and earnings quality, contextualised via tests that incorporate the potential for moderating effects around institutional settings. The analysis focuses on and compares evidence relating to (common law) UK/US firms and (civil law) German firms over the period 2005–2018 and seeks to identify whether, given institutional dissimilarities, significant differences exist between the two settings. Design/methodology/approach First, the authors undertake a review of the extant literature on the link between earnings quality and the cost of capital. Second, using a sample of 948 listed companies from the USA, the UK and Germany over the period 2005 to 2018, the authors estimate four implied cost of equity capital proxies. The relationship between companies’ cost of equity capital and their earnings quality is then investigated. Findings Consistent with theoretical reasoning and prior empirical analyses, the authors find a statistically negative association between earnings quality, evidenced by information relating to accruals and the cost of equity capital. However, when they extend the analysis by investigating the combined effect of institutional ownership and earnings quality on financing cost, the impact – while negative overall – is found to vary across legal backdrops. Research limitations/implications This paper uses institutional ownership as a mediating variable in the association between earnings quality and the cost of equity capital, but this is not intended to suggest that other measures may be of relevance here and additional research might usefully expand the analysis to incorporate other forms of ownership including state and foreign bases. Second, and suggestive of another avenue for developing the work presented in the study, the authors have used accrual measures of earnings quality. Practical implications The results are shown to provide potentially important insights for policymakers, creditors and investors about the consequences of earnings quality variability. The results should be of interest to firms seeking to reduce their financing costs and retain financial viability in the wake of the impact of the Covid-19 pandemic. Originality/value The reported findings extends the single-country results of Eliwa et al. (2016) for the UK firms and Francis et al. (2005) for the USA, whereby both reported that the cost of equity capital is negatively associated with earnings quality attributes. Second, in a further increment to the extant literature (particularly Francis et al., 2005 and Eliwa et al., 2016), the authors find the effect of institutional ownership to be influential, with a significantly positive impact on the association between earnings quality and the cost of equity capital, suggesting in turn that institutional ownership can improve firms’ ability to secure cheaper funding by virtue of robust monitoring. While this result holds for the whole sample (the USA, the UK and Germany), country-level analysis shows that the result holds only for the common law countries (the UK and the USA) and not for Germany, consistent with the notion that extant legal systems are a determining factor in this context. This novel finding points to a role for institutional investors in watching and improving the quality of financial reports that are valued by the market in its price formation activity.

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