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Value judgement

Amy Blake, Bryan T Carroll
OBJECTIVE: This paper analyses how game theory can provide a framework for understanding the strategic decision-making that occurs in everyday scenarios in medical training and practice, and ultimately serves as a tool for improving the work environment and patient care. Game theory has been applied to a variety of fields outside of its native economics, but has not been thoroughly studied in the context of health care provision. METHODS: The paper discusses four of the most common 'games' and applies each to a scenario in medicine to provide new insight on the incentives and drivers for certain types of behaviour and a deeper understanding of why certain results are valued more strongly than others...
November 2016: Medical Education
Dominic Wilkinson
Decisions about allocation of limited healthcare resources are frequently controversial. These decisions are usually based on careful analysis of medical, scientific and health economic evidence. Yet, decisions are also necessarily based on value judgements. There may be differing views among health professionals about how to allocate resources or how to evaluate existing evidence. In specific cases, professionals may have strong personal views (contrary to professional or societal norms) that treatment should or should not be provided...
October 12, 2016: Journal of Medical Ethics
Jey Han Lau, Alexander Clark, Shalom Lappin
The question of whether humans represent grammatical knowledge as a binary condition on membership in a set of well-formed sentences, or as a probabilistic property has been the subject of debate among linguists, psychologists, and cognitive scientists for many decades. Acceptability judgments present a serious problem for both classical binary and probabilistic theories of grammaticality. These judgements are gradient in nature, and so cannot be directly accommodated in a binary formal grammar. However, it is also not possible to simply reduce acceptability to probability...
October 12, 2016: Cognitive Science
Hasnat Ahmad, Bruce V Taylor, Ingrid van der Mei, Sam Colman, Beth A O'Leary, Monique Breslin, Andrew J Palmer
BACKGROUND: The measurement of health state utility values (HSUVs) for a representative sample of Australian people with multiple sclerosis (MS) has not previously been performed. OBJECTIVES: Our main aim was to quantify the HSUVs for different levels of disease severities in Australian people with MS. METHOD: HSUVs were calculated by employing a 'judgement-based' method that essentially creates EQ-5D-3L profiles based on WHOQOL-100 responses and then applying utility weights to each level in each dimension...
October 3, 2016: Multiple Sclerosis: Clinical and Laboratory Research
Andrew J E Harding, Colin Pritchard
It is well-established that for a considerable period the United Kingdom has spent proportionally less of its gross domestic product (GDP) on health-related services than almost any other comparable country. Average European spending on health (as a % of GDP) in the period 1980 to 2013 has been 19% higher than the United Kingdom, indicating that comparable countries give far greater fiscal priority to its health services, irrespective of its actual fiscal value or configuration. While the UK National Health Service (NHS) is a comparatively lean healthcare system, it is often regarded to be at a 'crisis' point on account of low levels of funding...
July 10, 2016: International Journal of Health Policy and Management
C Raina MacIntyre, Robert Menzies, Elizabeth Kpozehouen, Michael Chapman, Joanne Travaglia, Michael Woodward, Lisa Jackson Pulver, Christopher J Poulos, David Gronow, Timothy Adair
On the 20th June, 2014 the National Health and Medical Research Council's Centre for Research Excellence in Population Health "Immunisation in under Studied and Special Risk Populations", in collaboration with the Public Health Association of Australia, hosted a workshop "Equity in disease prevention: vaccines for the older adults". The workshop featured international and national speakers on ageing and vaccinology. The workshop was attended by health service providers, stakeholders in immunisation, ageing, primary care, researchers, government and non-government organisations, community representatives, and advocacy groups...
September 26, 2016: Vaccine
P Lambe, E Kay, D Bristow
AIM: In 2013 the UKCAT included a non-cognitive situational judgement test in addition to the four cognitive subtests commonly used by UK dental schools to select students. However, little is known about the situational judgement test's psychometric properties and relationship to other selection tools. This study's aim was explore these issues to inform decisions about the inclusion of the UKCAT SJT in the dental student selection process. METHOD: The sample comprised a cohort of applicants to a Bachelor of Dental Surgery programme, at a UK dental school, which does not use achievement in the UKCAT SJT in its selection process...
September 26, 2016: European Journal of Dental Education: Official Journal of the Association for Dental Education in Europe
Åsa Rejnö, Gunilla Silfverberg, Britt-Marie Ternestedt
BACKGROUND: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as 'incompetent' decision makers regarding their own care. OBJECTIVE: The aim of the study was to deepen the understanding of stroke team members' reasoning about truth-telling in end-of-life care due to acute stroke...
September 22, 2016: Nursing Ethics
Matthew Robson, Miqdad Asaria, Richard Cookson, Aki Tsuchiya, Shehzad Ali
Health inequality aversion parameters can be used to represent alternative value judgements about policy concern for reducing health inequality versus improving total health. In this study, we use data from an online survey of the general public in England (n = 244) to elicit health inequality aversion parameters for both Atkinson and Kolm social welfare functions. We find median inequality aversion parameters of 10.95 for Atkinson and 0.15 for Kolm. These values suggest substantial concern for health inequality among the English general public which, at current levels of quality adjusted life expectancy, implies weighting health gains to the poorest fifth of people in society six to seven times as highly as health gains to the richest fifth...
September 20, 2016: Health Economics
Andreas G Franke, Sophie Lehmberg, Michael Soyka
BACKGROUND: Pharmacological neuroenhancement (PN) is a topic of increasing importance. Its prevalence rates range from 1 % to more than 20 %. Students are a group that shows exceptionally high prevalence rates. However, little is known about teachers' knowledge, management, attitudes and ethical judgements regarding PN. METHODS: A web-based survey containing 40 closed questions was developed. All teachers working at all private and public schools in Mecklenburg-Vorpommern, a state in northeastern Germany, were invited to participate after their respective school offices were contacted by telephone, email and mail...
2016: Substance Abuse Treatment, Prevention, and Policy
Shingisai Chando, Christian Young, Jonathan C Craig, Hasantha Gunasekera, Allison Tong
UNLABELLED: This study aims to describe parental experiences and perspectives of caring for a child with otitis media. We conducted a systematic review of qualitative studies on parental perspectives on caring for a child with otitis media. We searched electronic databases to July 2015. Seventeen studies involving 284 participants from six countries were included. We identified seven themes: diminishing competency (guilt over failure to identify symptoms, helpless and despairing, fear of complications, disempowered and dismissed); disrupting life schedules (disturbing sleep, interfering with work, burden on family); social isolation (stigma and judgement, sick consciousness); threatening normal development (delaying growth milestones, impairing interpersonal skills, impeding education); taking ownership (recognising symptoms, diagnostic closure, working the system, protecting against physical trauma, contingency planning); valuing support (needing respite, depending on community, clinician validation); and cherishing health (relief with treatment success, inspiring resilience)...
October 2016: European Journal of Pediatrics
Emily C Stratta, David M Riding, Paul Baker
OBJECTIVES: This study sought to understand whether UK Foundation doctors perceived the phenomena of ethical erosion and empathy decline during their initial period of clinical practice, and if so, why this occurred. METHODS: This qualitative study used semi-structured interviews with nine doctors in their first year of clinical practice at Royal Bolton Hospital, UK. Participants were invited to discuss the definition of empathy, how individuals acquire and maintain empathic ability, perceptions of ethical erosion in the self and others, and how clinical experiences have influenced their empathic ability...
2016: International Journal of Medical Education
Marianna Capecci, Lucia Pepa, Federica Verdini, Maria Gabriella Ceravolo
INTRODUCTION: The freezing of gait (FOG) is a common and highly distressing motor symptom in patients with Parkinson's Disease (PD). Effective management of FOG is difficult given its episodic nature, heterogeneous manifestation and limited responsiveness to drug treatment. METHODS: In order to verify the acceptance of a smartphone-based architecture and its reliability at detecting FOG in real-time, we studied 20 patients suffering from PD-related FOG. They were asked to perform video-recorded Timed Up and Go (TUG) test with and without dual-tasks while wearing the smartphone...
August 21, 2016: Gait & Posture
Hasan Raza Mohammad, Jeremy Boardman, Laura Howell, Roger J Mills, Hedley C A Emsley
BACKGROUND: Urgent referral for suspected central nervous system (CNS) cancer is recommended, but little analysis of the referral criteria diagnostic performance has been conducted. New 2015 NICE guidance recommends direct brain imaging for patients with symptoms with positive predictive values (PPV) of 3 %, but further guidance is needed. METHODS: A 12-month retrospective evaluation of 393 patients referred under previous 2005 NICE 2-week rule criteria was conducted...
2016: BMC Neurology
Carolyn Oliver, Grant Charles
Strengths-based solution-focused approaches are gaining ground in statutory child protection work, but few studies have asked front line practitioners how they navigate the complex worker-client relationships such approaches require. This paper describes one component of a mixed-methods study in a large Canadian statutory child protection agency in which 225 workers described how they applied the ideas of strengths-based practice in their daily work. Interviews with twenty-four practitioners were analysed using an interpretive description approach...
June 2016: British Journal of Social Work
Clinton J Doering, Eugenia Feldman, Tali Bdolah-Abram, Reuben E Merideth, Ron Ofri
PURPOSE OF THE STUDY: The purpose of the study was to determine if Tono-Pen tonometers use simple average and coefficient of variation (CV) algorithms to calculate intraocular pressure (IOP). MATERIAL AND METHODS: IOPs were measured as part of routine ocular examination in 152 client-owned dogs. Using 11 Tono-Pen's, a total of 778 averaged readings were collected. Individual IOP readings, and average IOP and CV displayed by the instrument, were recorded. Average IOP and CV were then manually calculated from individual readings and compared with those displayed by the instrument...
August 22, 2016: Journal of Glaucoma
Jigna Balsara, Penny Fletcher
AIM: In paediatrics drugs are prescribed as mg/kg doses to facilitate accurate dosing. Anecdotally, some drugs are prescribed in such a way that the volume to be given is difficult to measure which may lead to inaccuracies and potential for error. Locally, errors have been reported where there has been a misunderstanding of the required dose, especially when decimal points are involved. This audit aimed to evaluate doses prescribed for in-patient children and evaluate whether they can be measured using the printed markings of one oral syringe...
September 2016: Archives of Disease in Childhood
Daiichi Morii, Takayuki Yokozawa, Naoki Ichinose, Toshimi Oda
The blood culture contamination rate is often used to validate specimen-collection procedures. CUMITECH has set its optimal target to be 2% to 3%. However, the term "contamination rate" has been defined in many ways, limiting its generalizability. The definitions used in earlier studies can be divided into two categories; definitions based on clinical judgements, and those based on preset rules. According to each principle, the equation must be composed of a defined numerator and denominator. The problem with clinical definitions is that the decision is inevitably subjective, and the process is too cumbersome...
May 2016: Kansenshōgaku Zasshi. the Journal of the Japanese Association for Infectious Diseases
Yvonne Grace Peters, Arthur Bird, Greg R M Bellairs, Glenda Mary Davison
BACKGROUND: Previous studies have documented a marked variation in transfusion practice for total hip replacement (THR) surgery. OBJECTIVE: To audit red cell product utilisation for THR at two Western Cape tertiary referral hospitals (HY and HG). METHODS: The folders of 207 consecutive patients undergoing elective THR surgery from January 2013 to December 2013 were reviewed. Information relating to age, sex, clinical observations, indications for surgery, pre- and postoperative haemoglobin (Hb) values, comorbidities, length of hospital stay and transfusion history was recorded...
August 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Kartina A Choong, Mohamed Y Rady
The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological (brainstem) death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices...
August 4, 2016: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
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