Dialysate Sodium—One Size Unlikely to Fit All

The role of medical director of a hemodialysis unit has become increasingly complex. Among the many roles it encompasses, the delivery of safe and effective dialysis treatments requires constant review, synthesis, and interpretation of the medical literature. Despite decades of experience with hemodialysis, the evidence base for dialysate prescription is relatively limited, with the choice of dialysate sodium being a prime example. The ask of this exercise was to imagine ourselves as the medical director of a new hemodialysis unit and to consider factors influencing the choice of dialysate sodium. While fiscal considerations are indeed important, one hopes that these align with the delivery of clinical care to improve patient well-being. Therefore, my approach was to focus on exploring the clinical responsibilities of a medical director in the choice of dialysate sodium. As such, after reviewing the evidence to date, my ‘default’ dialysate sodium prescription would be 140 mmol/L, but I would retain the option of individualizing treatment for certain patients until further evidence becomes available.

International perspectives

This chapter will examine deinstitutionalisation in Italy, the United States, and post-apartheid South Africa. In examining the different drivers and outcomes of policies in these areas, similar themes to the UK experience emerge. These include: the role of scandals in the pressure for change, the role of fiscal considerations in the development of policy, an initial period of optimism and the impact of scandals. In Italy, the work of the psychiatrist, Franco Basaglia was seen as a possible blueprint for wider reforms. Basaglia’s work became very influential amongst radicals and the anti-psychiatry movement. The USA was at the forefront of the deinstitutionalisation policy. The links between the closure of psychiatric facilities and the expansion of the use of imprisonment have been most closely examined in this context. Finally, the chapter examines the total policy failure that led to the deaths of one hundred and forty-four patients in Gauteng Province, South Africa in 2014

Constituting Agricultural and Food Security Policy in Malawi: Exploring the Factors that Have Driven Policy Processes in the Farm Inputs Subsidy Programme

Political economy analyses of agricultural and food security policies in Malawi have emphasized the role played by domestic politics and, more specifically, the centralization of power in the executive. This paper builds on this perspective by exploring the view that such policies are in fact negotiated outcomes of interactions at the state–donor interface. Using interview data gathered from expert key informants and a review of publicly available data, the paper explores how certain policy drivers have interacted to shape agricultural and food security policies in Malawi. The results reveal that policy processes in the recent past have been driven and mediated by fiscal considerations, sociopolitical pressures, and pragmatism, which accounts for the unique and complex peculiarities of the Malawi context.

Accounting and Fiscal Considerations upon Performance Guarantees - Particular Case of Construction Works

The performance guarantee represents the contractor's liability to ensure the beneficiary on the fulfillment of the quality conditions for the contracted works, as well as of their execution within the agreed contractual term. In the context of a growth trend in the industrial construction market since 2018, we considered it appropriate to study the impact of the performance guarantees on the financial balance of the contractors operating on this market. Through this research we aim to analyze the methods of guaranteeing the construction works, to assess the financial, accounting and fiscal issues of a construction company as a general contractor, to identify potential risks and to find solutions to avoid them.

Principle-guided Policy Experimentation in China: From Rural Tax and Fee Reform to Hu and Wen's Abolition of Agricultural Tax

The abolition of Agricultural Tax in 2005 was a major policy of the early Hu–Wen administration. But how and why did it happen? Drawing on abundant media reports, archive documents and internal speeches by key policymakers, as well as on the author's interviews, this article argues that this reform was pushed through (the “how”) by “principle-guided policy experimentation” with origins in the period of Jiang Zemin's leadership. Not only does this show policy continuities from the Jiang–Zhu era into the Hu–Wen period, it also reveals a different process of policy experimentation from that identified by Sebastian Heilmann in the economic policy arena. Under principle-guided policy experimentation, Chinese central decision makers first reached consensus on the principle of the Rural Tax and Fee Reform (RTFR) drawing on policy learning from prior bottom-up local experimentation, and then formulated and implemented an experimental programme from the top-down, funding it in order to encourage local governments to participate. The evidence suggests that international, political (rural instability), economic and fiscal considerations came to explain leaders’ decisions (the “why”) on tax reform as much as their individual preferences.

Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting

Objective: With increasing demands to provide a cost efficient nursing service, changes to nursing skill mix are being implemented globally. Team nursing as a model of care is seen as a way to address both patient care and safety issues. The aim of this study was to explore job satisfaction (JS) and stress outcomes of nursing staff when introducing team nursing as model of care within the Australian healthcare environment.Methods: An experimental study was utilised. Nursing staff (n = 63) were surveyed, using the Person Centred Nursing Index (PCNI) tool, prior to the implementation of a team nursing model of care and then again six months post implementation of the model (n = 64). Data was analysed to determine if there was a statistically significant difference in the average theme between pre and post surveys.Results: Nursing stress (NS) was reduced and JS was increased post implementation of the new model of care. JS and organisational traits, JS and work stress (WS), were positively related and increased post implementation. WS and nursing care (NC), organisational traits and NC were positively related but showed no statistically significant change after the implementation. This study demonstrated that in introducing a new model of care, levels of stress staff increased yet unexpectedly JS also improved.Conclusions: Decisions to adopt team nursing as the model of care should be based on a broad range of considerations not simply on fiscal considerations and should include staff readiness, staff mix and supportive measures to introduce a changed model of care.

Case Study of a Sustained Educator Partnership between the U.S. and Norway

This chapter describes an ongoing international partnership that involves the exchange of Norwegian secondary school teachers and U.S. college students with an overarching goal of promoting cultural understanding. The author implemented a descriptive, action research case study to document the background and history of the partnership, describe the key partners and their roles, outline the academic activities, discuss logistical and fiscal considerations, and address issues of sustainability and plans for the future. The author aims to provide a comprehensive narrative of the development and implementation of the partnership from its inception to provide a basis for improving and advancing the partnership in the future. The author also discusses lessons that may inform similar international collaborations.

Biobanking—Budgets and the Role of Pathology Biobanks in Precision Medicine

Biobanks have become an important component of the routine practice of pathology. At the 2016 meeting of the Association of Pathology Chairs, a series of presentations covered several important aspects of biobanking. An often overlooked aspect of biobanking is the fiscal considerations. A biobank budget must address the costs of consenting, procuring, processing, and preserving high-quality biospecimens. Multiple revenue streams will frequently be necessary to create a sustainable biobank; partnering with other key stakeholders has been shown to be successful at academic institutions which may serve as a model. Biobanking needs to be a deeply science-driven and innovating process so that specimens help transform patient-centered clinical and basic research (ie, fulfill the promise of precision medicine). Pathology’s role must be at the center of the biobanking process. This ensures that optimal research samples are collected while guaranteeing that clinical diagnostics are never impaired. Biobanks will continue to grow as important components in the mission of pathology, especially in the era of precision medicine.