scholarly journals Who gets a lung transplant? Assessing the psychosocial decision-making process for transplant listing

2016 ◽  
Vol 2016 (3) ◽  
Author(s):  
Amber N Lewandowski ◽  
Jared Lyon Skillings
Keyword(s):  
Decision Making ◽  
Moral Distress ◽  
Solid Organ Transplantation ◽  
The United States ◽  
Waiting List ◽  
Decision Making Process ◽  
Solid Organ ◽  
Regulatory Bodies ◽  
The Impact ◽  
Donor Organs

In the United States, there is a significant shortage of available donor organs. This requires transplant professionals to hold simultaneous, yet divergent roles as (1) advocates for patients who are in need of a lifesaving transplant, and (2) responsible stewards in the allocation of scarce donor organs. In order to balance these roles, most transplant teams utilize a committee based decision-making process to select suitable candidates for the transplant waiting list. These committees use medical and psychosocial criteria to guide their decision to list a patient. Transplant regulatory bodies have established medical standards for identifying appropriate medical candidates for transplantation. However, transplant regulatory bodies have not developed policies to standardize psychosocial criteria for listing patients. This affords transplant centers the autonomy to develop their own psychosocial criteria for determining which patients will be placed on the transplant waiting list. This lack of a standardized policy has resulted in inconsistent psychosocial practices amongst transplant centers nationwide. Since there has been no formal review of the inconsistency in psychosocial policy and practice, this paper seeks to explore the non-standardized psychosocial approach to organ transplant listing. The authors review factors that are relevant to the standardization of the psychosocial decision-making process, including shared decision-making, clinician judgment, bias in decision-making and moral distress in transplant staff. We conclude with a discussion about the impact of these issues on psychosocial practices in solid organ transplantation. 

scholarly journals 1094. Infective Endocarditis During Index Hospitalization for Solid Organ Transplantation in the United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S576
Author(s):  
Emily Eichenberger ◽  
Michael M Dagher ◽  
Vance G Fowler ◽  
Jerome Federspiel
Keyword(s):  
Infective Endocarditis ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
The United States ◽  
Solid Organ ◽  
Adjusted Relative Risk ◽  
Transplant Recipients ◽  
Research Support ◽  
The Impact ◽  
Research Grant

Abstract Background The prevalence and impact of infective endocarditis (IE) on organ transplant recipients is unknown. We used a large cohort of transplant recipients to assess the impact of IE on outcomes during index transplant hospitalization. Methods We used data from the 2013-2017 Nationwide Readmissions Database (NRD). Hospitalizations associated with solid organ transplantation procedures (heart, liver, kidney, lung, intestines, pancreas) were included. Outcomes included 60-day rates of mortality, ECMO deployment, thromboembolic events, length of stay, and inpatient costs. For data obtained October 2015 and later, rates of graft rejection and graft failure were also measured. Regression models, weighted to account for the NRD sample design, were used to model associations between outcomes and transplant procedure, adjusting for patient age, sex, facility characteristics, comorbid conditions, and organs transplanted. Results A total of 75,069 hospitalizations for organ transplantation, corresponding to a national estimate of 160,368, were included. A diagnosis of IE was associated with 416 (weighted estimate = 898). IE cases were less likely to be female (22.2% vs. 37.9%, p< 0.001), and had higher rates of underlying pulmonary disease. The most common organ transplanted in the hospitalization during which IE was diagnosed (allowing for multiple organs) was heart (84.5%) followed by kidney (8.9%) and liver (7.9%), (p< 0.001). IE was associated with higher mortality [adjusted relative risk (aRR): 1.70, 95% confidence interval (CI) (1.09, 2.66)], prolonged ventilation (aRR 1.32 [1.06, 1.65], 4.6 additional inpatient days (CI: 1.5, 7.6) and $28,300 more inpatient cost (CI: $12,000, $44,700) (Table). 60-Day Outcomes, Stratified by IE During Index Transplant Hospitalization Conclusion IE complicating hospitalization for organ transplantation is associated with higher rates of morbidity and mortality. IE during index transplant hospitalization occurs most frequently in heart transplant recipients. Understanding the high rate of IE in heart recipients in the early post-transplant period requires further study. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Actavis (Grant/Research Support)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Research Grant or Support)Affinium (Consultant)Allergan (Grant/Research Support)Ampliphi Biosciences (Consultant)Basilea (Consultant, Research Grant or Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Research Grant or Support)Contrafect (Consultant, Research Grant or Support)Cubist (Grant/Research Support)Debiopharm (Consultant)Destiny (Consultant)Durata (Consultant)Forest (Grant/Research Support)Genentech (Consultant, Research Grant or Support)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Research Grant or Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)Medimmune (Consultant, Research Grant or Support)Merck (Consultant, Research Grant or Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Research Grant or Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Research Grant or Support)Tetraphase (Consultant)Theravance (Consultant, Research Grant or Support)Trius (Consultant)xBiotech (Consultant)

Systemic Conservatism in North American Organizations

1990 ◽  
Vol 11 (3) ◽  
pp. 413-433
Author(s):  
Barbara Wake Carroll
Keyword(s):  
Decision Making ◽  
Cultural Values ◽  
The United States ◽  
Decision Making Process ◽  
Organizational Decision Making ◽  
Rational Models ◽  
And Performance ◽  
Conservative Values ◽  
And Function ◽  
The Impact

Rational theories of organizational decision-making have shown that organiza tional outcomes and performance reflect a mixture of behavioural, structural and contextual factors, such as the goals of managers, the size and function of the organization, and the condition of the external environment. Critiques of this model suggest that non-rational factors such as national or systemic cultural values also affect the decision-making process. This article treats Canada and the United States as similar systems that differ in the degree to which their cultures embody conservative values. The author hypothesizes that the expenditure pat terns of organizations in the two countries will reflect this variation in systemic conservatism, and tests this expectation against data from a longitudinal sample of firms from three industries in each of the two countries. The analysis suggests that the impact and relative importance of the factors included in rational models of decision-making differ in Canada and the U.S. in ways that are consistent with the systemic conservatism hypothesis.

Solid-Organ Transplantation and the Affordable Care Act: Accessibility and Outcomes

2018 ◽  
Vol 84 (12) ◽  
pp. 1894-1899 ◽  
Author(s):  
Jaimin R. Trivedi ◽  
Mickey Ising ◽  
Matthew P. Fox ◽  
Robert M. Cannon ◽  
Victor H. Van Berkel ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Waiting List ◽  
Solid Organ ◽  
Point Increase ◽  
The Affordable Care Act ◽  
Cent Point ◽  
One Year ◽  
The Impact

The objective of the study is to evaluate the impact of the Affordable Care Act (ACA) on accessibility to solid organ transplant and outcomes. Data source registry: United Network of Organ Sharing database. Patients aged ≥18 years listed for kidney, liver, heart, and lung transplant between years 2010 and 2016 were classified by insurance and status of Medicaid adoption under ACA to evaluate insurance distribution. Between 2010 and 2016, states that adopted Medicaid had 2 to 4 per cent point increase in the proportion of patients listed with Medicaid across all organs. One-year waiting list survival of Medicaid patients was better in the ACA era. States that expanded Medicaid under the ACA had a significant increase in the proportion of patients listed with Medicaid and better one-year waiting list survival.

scholarly journals COVID‐19 in solid organ transplantation: an analysis of the impact on transplant activity and wait lists

2020 ◽  
Vol 34 (1) ◽  
pp. 209-212
Author(s):  
Maria Irene Bellini ◽  
Francesco Tortorici ◽  
Marco Capogni
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
The Impact

scholarly journals The Impact of Social Media Use on Consumers’ Restaurant Consumption Experiences: A Qualitative Study

2021 ◽  
Vol 13 (12) ◽  
pp. 6581
Author(s):  
Jooyoung Hwang ◽  
Anita Eves ◽  
Jason L. Stienmetz
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Selection Process ◽  
Decision Making Process ◽  
Structured Interviews ◽  
High Standards ◽  
Tourism And Hospitality Industry ◽  
Tourism And Hospitality ◽  
Search For Information ◽  
The Impact

Travellers have high standards and regard restaurants as important travel attributes. In the tourism and hospitality industry, the use of developed tools (e.g., smartphones and location-based tablets) has been popularised as a way for travellers to easily search for information and to book venues. Qualitative research using semi-structured interviews based on the face-to-face approach was adopted for this study to examine how consumers’ restaurant selection processes are performed with the utilisation of social media on smartphones. Then, thematic analysis was adopted. The findings of this research show that the adoption of social media on smartphones is positively related with consumers’ gratification. More specifically, when consumers regard that process, content and social gratification are satisfied, their intention to adopt social media is fulfilled. It is suggested by this study that consumers’ restaurant decision-making process needs to be understood, as each stage of the decision-making process is not independent; all the stages of the restaurant selection process are organically connected and influence one another.

scholarly journals Pharmacy premises licensing policy formulation: experience from Ghana

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Augustina Koduah ◽  
Reginald Sekyi-Brown ◽  
Joseph Kodjo Nsiah Nyoagbe ◽  
Daniel Amaning Danquah ◽  
Irene Kretchy
Keyword(s):  
Decision Making ◽  
Pharmacy Practice ◽  
Policy Formulation ◽  
Policy And Practice ◽  
Select Committee ◽  
Limited Participation ◽  
Pharmacy Council ◽  
Decision Making Processes ◽  
Regulatory Bodies ◽  
The Impact

Abstract Background Licences to operate pharmacy premises are issued by statutory regulatory bodies. The Health Institutions and Facilities Act (Act 829) and Health Professions Regulatory Bodies Act (Act 857) regulate pharmacy premises and the business of supplying restricted medicines by retail, respectively, and this could create a potential regulatory overlap for pharmacy practice in Ghana. We theorise that the potential overlap of regulation duties stems from how law-makers framed issues and narratives during the formulation of these Acts. Objective To describe the policy actors involved, framing of narratives and decision-making processes relating to pharmacy premises licensing policy formulation. Methods A qualitative study was conducted and data gathered through interviewing eight key informants and reviewing Hansards, reports, bills, memoranda and Acts 829 and 857. Data were analysed to map decision-making venues, processes, actors and narratives. Results The Ministry of Health drafted the bills in July 2010 with the consensus of internal stakeholders. These were interrogated by the Parliament Select Committee on Health (with legislative power) during separate periods, and decisions made in Parliament to alter propositions of pharmacy premises regulations. Parliamentarians framed pharmacies as health facilities and reassigned their regulation from the Pharmacy Council to a new agency. The Pharmacy Council and the Pharmaceutical Society of Ghana could not participate in the decision-making processes in Parliament to oppose these alterations. The laws’ contents rested with parliamentarians as they made decisions in venues restricted to others. Legislative procedure limited participation, although non-legislative actors had some level of influence on the initial content. Conclusion Implementation of these laws would have implications for policy and practice and therefore understanding how the laws were framed and formulated is important for further reforms. We recommend additional research to investigate the impact of the implementation of these Acts on pharmacy practice and business in Ghana and the findings can serve as bargaining information for reforms.

Focal Concerns and Police Decision Making in Sexual Assault Cases: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 152483802199128
Author(s):  
David S. Lapsey ◽  
Bradley A. Campbell ◽  
Bryant T. Plumlee
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Sexual Assault ◽  
Meta Analysis ◽  
The United States ◽  
Empirical Literature ◽  
Campbell Collaboration ◽  
Focal Concerns ◽  
Police Decision Making ◽  
The Impact

Sexual assault and case attrition at the arrest stage are serious problems in the United States. Focal concerns have increasingly been used to explain police decision making in sexual assault cases. Because of the popularity of the focal concerns perspective and potential to inform evidence-based training, a systematic review and meta-analysis are needed to condense the literature. In this study, we assess the overall strength of the relationship between focal concerns variables and police decisions to arrest in cases of sexual assault. Our assessment of the effects of focal concerns variables on arrest decision making in sexual assault cases followed the systematic review protocols provided by the Campbell Collaboration of Systematic Reviews. Specifically, we used the Campbell Collaboration recommendations to search empirical literature and used meta-analysis to evaluate the size, direction, and strength of the impact of focal concerns variables on arrest decisions. Our search strategy detected 14 eligible studies and 79 effect sizes. The meta-analysis found several robust and statistically significant correlates of arrest. In fact, each focal concerns concept produced at least one robust arrest correlate. Overall, focal concerns offers a strong approach for explaining police decisions in sexual assault cases. Although practical concerns and resource constraints produced the strongest arrest correlates, results show the importance of additional case characteristics in officers’ decision to arrest.

scholarly journals Cognitive mapping as an approach to facilitate organ donation among African Americans

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110294
Author(s):  
Jayme E Locke ◽  
Rhiannon D Reed ◽  
Richard M Shewchuk ◽  
Katherine L Stegner ◽  
Haiyan Qu
Keyword(s):  
Decision Making ◽  
African Americans ◽  
Organ Donation ◽  
Cognitive Mapping ◽  
The United States ◽  
Two Dimensions ◽  
Nominal Group ◽  
Solid Organ ◽  
Related Information ◽  
Empirical Framework

Making up 13.4% of the United States population, African Americans (AAs) account for 28.7% of candidates who are currently waiting for an organ donation. AAs are disproportionately affected by end-organ disease, particularly kidney disease, therefore, the need for transplantation among this population is high, and the high need is also observed for other solid organ transplantation. To this end, we worked with the AA community to derive an empirical framework of organ donation strategies that may facilitate AA decision-making. We used a cognitive mapping approach involving two distinct phases of primary data collection and a sequence of data analytic procedures to elicit and systematically organize strategies for facilitating organ donation. AA adults ( n = 89) sorted 27 strategies identified from nominal group technique meetings in phase 1 based on their perceived similarities. Sorting data were aggregated and analyzed using Multidimensional scaling and hierarchical cluster analyses. Among 89 AA participants, 68.2% were female, 65.5% obtained > high school education, 69.5% reported annual household income ≤ $50,000. The average age was 47.4 years (SD = 14.5). Derived empirical framework consisted of five distinct clusters: fundamental knowledge, psychosocial support, community awareness, community engagement, and system accountability; and two dimensions: Approach, Donor-related Information. The derived empirical framework reflects an organization scheme that may facilitate AA decision-making about organ donation and suggests that targeted dissemination of donor-related information at both the individual-donor and community levels may be critical for increasing donation rates among AAs.

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