Archambault, P.M.; Turgeon, A.F.; Witteman, H.O.; Lauzier, F.; Moore, L.; Lamontagne, F.; Horsley, T.; Gagnon, M.P.; Droit, A.; Weiss, M.; Tremblay, S.; Lachaine, J.; Sage, N. Le; Emond, M.; Berthelot, S.; Plaisance, A.; Lapointe, J.; Razek, T.; Belt, T.H. van de; Brand, K; Berube, M.; Clement, J.; Iii, F.J. Grajales; Eysenbach, G.; Kuziemsky, C.; Friedman, D.; Lang, E.; Muscedere, J.; Rizoli, S.; Roberts, D.J.; Scales, D.C.; Sinuff, T.; Stelfox, H.T.; Gagnon, I.; Chabot, C.; Grenier, R.; Legare, F.
BACKGROUND: Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the
Chhatre, Sumedha; Gallo, Joseph J; Wittink, Marsha; Schwartz, J Sanford; Jayadevappa, Ravishankar
To elicit patient stakeholders' experience and perspectives about patient-centred care. Qualitative. A large urban healthcare system. Four patient stakeholders who are prostate cancer survivors. Experience and perspectives of patient stakeholders regarding patient-centred care and treatment decisions. Our patient stakeholders represented a diverse socio-demographic group. The patient stakeholders identified engagement and dialogue with physicians as crucial elements of patient-centred care model. The degree of patient-centred care was observed to be dependent on the situations. High severity conditions warranted a higher level of patient involvement, compared to mild conditions. They agreed that patient-centred care should not mean that patients can demand inappropriate treatments. An important attribute of patient-centred outcomes research model is the involvement of stakeholders. However, we have limited knowledge about the experience of patient stakeholders in patient-centred outcomes research. Our study indicates that patient stakeholders offer a unique perspective as researchers and policy-makers aim to precisely define patient-centred research and care.
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The Standing Committee of European Doctors (CPME has been actively promoting patient safety for a long time, well before the issue was given a firm place on the European and international agendas. Among its efforts to help raise the profile of patient safety, CPME organised a conference on the 4th and 5th April 2005 together with a group of EU health stakeholders that covered the whole spectrum of healthcare delivery.
The European Conference ‘Patient Safety – Making it happen!’ took place in Luxembourg under the auspices of the Luxembourg EU presidency and EU Commissioner Kyprianou and resulted in the “Luxembourg Declaration on Patient Safety”.
This Declaration contains recommendations to the EU, national authorities and healthcare organizations. It underlines the added value of the EU and recommends joining forces with the WHO Alliance for Patient Safety.
A culture of transparency, trust and safety is being sought for through the suggested use of e-health, flows of health information, patient involvement and reporting systems. CPME saw perseverance and commitment pay off as patient safety is now seen as a priority by all health stakeholders and EU institutional bodies (European Commission, presidencies and Council. However all parties realise full well that the Luxembourg Declaration on Patient Safety is only the first step. All efforts are now focussed on follow up and implementation.
Hinrichs, Saba; Dickerson, Terry; Clarkson, John
This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.
Concannon, Thomas W; Meissner, Paul; Grunbaum, Jo Anne; McElwee, Newell; Guise, Jeanne-Marie; Santa, John; Conway, Patrick H; Daudelin, Denise; Morrato, Elaine H; Leslie, Laurel K
Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.
Cukor, Daniel; Cohen, Lewis M; Cope, Elizabeth L; Ghahramani, Nasrollah; Hedayati, S Susan; Hynes, Denise M; Shah, Vallabh O; Tentori, Francesca; Unruh, Mark; Bobelu, Jeanette; Cohen, Scott; Dember, Laura M; Faber, Thomas; Fischer, Michael J; Gallardo, Rani; Germain, Michael J; Ghahate, Donica; Grote, Nancy; Hartwell, Lori; Heagerty, Patrick; Kimmel, Paul L; Kutner, Nancy; Lawson, Susan; Marr, Lisa; Nelson, Robert G; Porter, Anna C; Sandy, Phillip; Struminger, Bruce B; Subramanian, Lalita; Weisbord, Steve; Young, Bessie; Mehrotra, Rajnish
Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases. Copyright © 2016 by the American Society of Nephrology.
Forsythe, Laura P; Ellis, Lauren E; Edmundson, Lauren; Sabharwal, Raj; Rein, Alison; Konopka, Kristen; Frank, Lori
Patients and healthcare stakeholders are increasingly becoming engaged in the planning and conduct of biomedical research. However, limited research characterizes this process or its impact. We aimed to characterize patient and stakeholder engagement in the 50 Pilot Projects funded by the Patient-Centered Outcomes Research Institute (PCORI), and identify early contributions and lessons learned. A self-report instrument was completed by researchers between 6 and 12 months following project initiation. Forty-seven principal investigators or their designees (94 % response rate) participated in the study. MAIN MEASURES Self-report of types of stakeholders engaged, stages and levels of engagement, facilitators and barriers to engagement, lessons learned, and contributions from engagement were measured. Most (83 %) reported engaging more than one stakeholder in their project. Among those, the most commonly reported groups were patients (90 %), clinicians (87 %), health system representatives (44 %), caregivers (41 %), and advocacy organizations (41 %). Stakeholders were commonly involved in topic solicitation, question development, study design, and data collection. Many projects engaged stakeholders in data analysis, results interpretation, and dissemination. Commonly reported contributions included changes to project methods, outcomes or goals; improvement of measurement tools; and interpretation of qualitative data. Investigators often identified communication and shared leadership strategies as "critically important" facilitators (53 and 44 % respectively); lack of stakeholder time was the most commonly reported challenge (46 %). Most challenges were only partially resolved. Early lessons learned included the importance of continuous and genuine partnerships, strategic selection of stakeholders, and accommodation of stakeholders' practical needs. PCORI Pilot Projects investigators report engaging a variety of stakeholders across many stages of research, with specific
Bekker, Charlotte L; Gardarsdottir, Helga; Egberts, Toine C G; Bouvy, Marcel L; van den Bemt, Bart J F
Background Medication waste has undesirable economic and environmental consequences. This waste is partly unavoidable, but might be reduced by redispensing medicines unused by patients. However, there is little knowledge of stakeholders' views on the redispensing. Objective To identify the stakeholders' views on the redispensing of medicines unused by patients. Setting Dutch healthcare system. Method Semi-structured interviews were conducted with 19 Dutch stakeholders from September 2014 until April 2015. The interview guide included two themes: medication waste and redispensing of unused medicines. The latter included qualitative-, legal- and financial aspects and stakeholder involvement, with specific attention to the patient. Interview transcripts were subjected to thematic content analysis. Main outcome measure Requirements related to the redispensing of unused medicines. Results All stakeholders considered the redispensing of medicines desirable if the implementation is feasible and the requirements for the safe redispensing are met. All of them pointed out that the product quality of redispensed medicines should be guaranteed and that it should be clear who is responsible for the quality of redispensed medicines. The stakeholders stated that transparent communication to patients is essential to guarantee trust in the redispensing system and that patients should be willing to use redispensed medicines. Moreover, the redispensing system's benefits should outweigh the costs and a minimal economic value of medicines suitable for redispensing should be determined. Conclusion Redispensing unused medicines could decrease medication waste if several requirements are met. For successful implementation of a redispensing system, all relevant stakeholders should be involved and cooperate as a joint-force.
Shelef, Deborah Q; Rand, Cynthia; Streisand, Randi; Horn, Ivor B; Yadav, Kabir; Stewart, Lisa; Fousheé, Naja; Waters, Damian; Teach, Stephen J
Stakeholder engagement has the potential to develop research interventions that are responsive to patient and provider preferences. This approach contrasts with traditional models of clinical research in which researchers determine the study's design. This article describes the effect of stakeholder engagement on the design of a randomized trial of an intervention designed to improve child asthma outcomes by reducing parental stress. The study team developed and implemented a stakeholder engagement process that provided iterative feedback regarding the study design, patient-centered outcomes, and intervention. Stakeholder engagement incorporated the perspectives of parents of children with asthma; local providers of community-based medical, legal, and social services; and national experts in asthma research methodology and implementation. Through a year-long process of multidimensional stakeholder engagement, the research team successfully refined and implemented a patient-centered study protocol. Key stakeholder contributions included selection of patient-centered outcome measures, refinement of intervention content and format, and language framing the study in a culturally appropriate manner. Stakeholder engagement was a useful framework for developing an intervention that was acceptable and relevant to our target population. This approach might have unique benefits in underserved populations, leading to sustainable improvement in health outcomes and reduced disparities. Copyright Â© 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.
Purpose: Patient-centered communication is critical to quality cancer care. Effective communication can help patients and family members cope with cancer, make informed decisions, and effectively manage their care; suboptimal communication can contribute to care breakdowns and undermine clinician-patient relationships. The study purpose was to explore stakeholders' views on the feasibility and acceptability of collecting self-reported patient and family perceptions of communication experiences while receiving cancer care. The results were intended to inform the design, development, and implementation of a structured and generalizable patient-level reporting system. Methods: This was a formative, qualitative study that used semistructured interviews with cancer patients, family members, clinicians, and leaders of health care organizations. The constant comparative method was used to identify major themes in the interview transcripts. Results: A total of 106 stakeholders were interviewed. Thematic saturation was achieved. All stakeholders recognized the importance of communication and endorsed efforts to improve communication during cancer care. Patients, clinicians, and leaders expressed concerns about the potential consequences of reports of suboptimal communication experiences, such as damage to the clinician-patient relationship, and the need for effective improvement strategies. Patients and family members would report good communication experiences in order to encourage such practices. Practical and logistic issues were identified. Conclusion: Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices. This qualitative study provides a foundation for the design and pilot testing of such a patient reporting system. PMID:23943884
Bleijenbergh, I.L.; van Engen, Marloes
Purpose Interventions to support gender equality in organisations are often unsuccessful. Stakeholders disagree about the causes and problem definition of gender equality or pay lip service to the principle of gender equality, but fail to implement gender equality in practice. The purpose of this
Bleijenbergh, I.L.; Engen, M.L. van; Engen, M. van
- Purpose – Interventions to support gender equality in organisations are often unsuccessful. Stakeholders disagree about the causes and problem definition of gender equality or pay lip service to the principle of gender equality, but fail to implement gender equality in practice. The purpose of
McCarthy, Simon; Tapsell, Sue M.; McDonagh, Rosalind; Vita, Lanfranchi; Kim, Anema; Uta, Wehn de Montalvo
This document presents the report on the initial requirements analysis for citizen observatories of water that are designed, developed and implemented during the WeSenseIt project. The observatories will be tested in three distinct case study locations: Doncaster (UK), Delfland (NL) and Alto Adriatico (Italy). The report focuses on the initial requirements analysis of stakeholders in terms of their preferences for the technological components of the citizen observatory for the design and use ...
Treiman, Katherine; McCormack, Lauren; Olmsted, Murrey; Roach, Nancy; Reeve, Bryce B; Martens, Christa E; Moultrie, Rebecca R; Sanoff, Hanna
Patient-centered communication (PCC) is an essential component of patient-centered care and contributes to patient satisfaction, health-related quality of life, and other important patient outcomes. The aim of this study was to develop and test survey questions to assess patients' experiences with PCC in cancer care. We used a conceptual model developed by the National Cancer Institute as our framework. The survey questions align with the six core functions of PCC defined in the model: Exchanging Information, Managing Uncertainty, Enabling Patient Self-Management, Fostering Healing Relationships, Making Decisions, and Responding to Emotions. The study focused on colorectal cancer patients. We conducted two rounds of cognitive interviewing to evaluate patients' ability to understand and provide valid answers to the PCC questions. Interviews were conducted in Maryland and North Carolina in 2014. We involved a patient advocacy group, Fight Colorectal Cancer, and a multidisciplinary panel of stakeholders throughout the measurement development process to ensure that the survey questions capture aspects of PCC that are important to patients and meet the needs of potential end users, including researchers, healthcare organizations, and health professionals. Patient and other stakeholder input informed revisions of draft survey questions, including changes to survey instructions, frame of reference for questions, response scales, and language. This study demonstrated the feasibility and value of engaging patients and other stakeholders in a measurement development study. The Patient-Centered Outcomes Research Institute (PCORI) conceptual model of patient-centered outcomes research provides a useful guide for patient engagement in research. Research funders should call for meaningful roles for patients and other stakeholders in health research, including in the development of patient-centered outcomes.
Pound, Pandora; Denford, Sarah; Shucksmith, Janet; Tanton, Clare; Johnson, Anne M; Owen, Jenny; Hutten, Rebecca; Mohan, Leanne; Bonell, Chris; Abraham, Charles; Campbell, Rona
Sex and relationship education (SRE) is regarded as vital to improving young people's sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation. This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations. Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide. Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a 'life skills' approach and not focus on abstinence. Young people advocated a 'sex-positive' approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence. We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes
Kwan, Bethany M; Jortberg, Bonnie; Warman, Meredith K; Kane, Ilima; Wearner, Robyn; Koren, Romona; Carrigan, Thomas; Martinez, Vincent; Nease, Donald E
Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices. To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR). Twenty-seven diabetes care stakeholders, including patients and providers from a local network of federally qualified health centres participated. Stakeholders met in-person and by conference call over the course of 8 months. Subject matter experts provided education on the diabetes SMS evidence. Facilitators engaged the group in discussions about barriers to self-management and opportunities for improving delivery of SMS. BCT participants identified lack of social support, personal resources, trust, knowledge and confidence as barriers to diabetes self-management. Intervention opportunities emphasized peer support, use of multidisciplinary care teams and centralized systems for sharing information about community and practice resources. BCT informed new services and a PCOR study proposal. Patients and family engaged in diabetes care research value peer support, group visits, and multidisciplinary care teams as key features of SMS models. SMS should be tailored to an individual patient's health literacy. BCT can be used to engage multiple stakeholders in translation of evidence into practice and to inform PCOR. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Concannon, Thomas W; Fuster, Melissa; Saunders, Tully; Patel, Kamal; Wong, John B; Leslie, Laurel K; Lau, Joseph
We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs. Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports. To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.
Smith, Katherine C; Brundage, Michael D; Tolbert, Elliott; Little, Emily A; Bantug, Elissa T; Snyder, Claire F
Patient-reported outcomes (PROs) can promote patient-centered care, but previous research has documented interpretation challenges among clinicians and patients. We engaged stakeholders to improve formats for presenting individual-level PRO data (for patient monitoring) and group-level PRO data (for reporting comparative clinical studies). In an iterative process, investigators partnered with stakeholder workgroups of clinicians and patients to address previously identified interpretation challenges. Candidate approaches were then tested in semi-structured, one-on-one interviews with cancer patients and clinicians. Interpretation issues addressed included conveying score meaning (i.e., what is good/bad) and directional inconsistency (whether higher scores are better/worse). An additional issue for individual-level PROs was highlighting potentially concerning scores and, for group-level PROs, identifying important between-group differences (clinical, statistical). One-on-one interviews in a purposive sample of clinicians (n = 40) and patients (n = 39) provided insights regarding approaches to address issues identified. For example, adding descriptive labels to the Y-axis (none, mild, moderate, severe) helps address directional inconsistency and aids interpretation of score meaning. Red circles around concerning data points or a threshold line indicating worse-than-normal scores indicate possibly concerning scores for individual-level PRO data. For group-level PRO data, patients and some clinicians are confused by confidence limits and clinical versus statistical significance, but almost all clinicians want p values displayed. Variations in interpretation accuracy demonstrate the importance of presenting PRO data in ways that promote understanding and use. In an iterative stakeholder-driven process, we developed improved PRO data presentation formats, which will be evaluated in further research across a large population of patients and clinicians.
Full text: Spanish experience holds a relatively important position in the field of the decommissioning of nuclear and radioactive facilities. Decommissioning projects of uranium concentrate mill facilities are near completion; some old uranium mine sites have already been restored; several projects for the dismantling of various small research nuclear reactors and a few pilot plants are at various phases of the dismantling process, with some already completed. The most notable Spanish project in this field is undoubtedly the decommissioning of the Vandellos 1 nuclear power plant that is currently ready to enter a safe enclosure, or dormancy, period. The management of radioactive wastes in Spain is undertaken by 'Empresa Nacional de Residuos Radioactivos, S.A.' (ENRESA), the Spanish national radioactive waste company, constituted in 1984. ENRESA operates as a management company, whose role is to develop radioactive waste management programmes in accordance with the policy and strategy approved by the Spanish Government. Its responsibilities include the decommissioning and dismantling of nuclear installations. Decommissioning and dismantling nuclear installations is an increasingly important topic for governments, regulators, industries and civil society. There are many aspects that have to be carefully considered, planned and organised in many cases well in advance of when they really need to be implemented. The goal of this paper is describe proven approaches relevant to organizing and managing large decommissioning projects, in particular in the case of Vandellos-1 NPP decommissioning. (author)
Moyano Santiago, Miguel Angel; Rivera Lirio, Juana María
Health plans of the Spanish autonomous communities can incorporate sustainable development criteria in its development. There have been no analysis or proposals about development and indicators. The goal is to add a contribution to help build better health plans aimed at sustainable development and help to manage economic, social and environmental impacts of health systems criteria. We used a variation of the RAND/UCLA or modified Delphi technique method. The process consisted of a bibliographical and context matters and issues related to health and social responsibility analysis based on ISO 26000: 2010. A survey by deliberately to a selection of 70 expert members of the identified stakeholders was carried out and a discussion group was held to determine the consensus on the issues addressed in the survey sample. The research was conducted in 2015. From the literature review 33 health issues included in ISO 26000:2010 were obtained. 7 survey proved relevant high consensus, 8 relevance and average consensus and 18 with less relevance and high level of dissent. The expert group excluded 4 of the 18 subjects with less consensus. 29 issues included 33 at work, divided into 7 subjects contained in the guide ISO 26000 of social responsibility, were relevant stakeholders regarding possible inclusion in health plans. Considering the direct relationship published by ISO (International Organization for Standardization) among the issues ISO 26000 and the economic, social and environmental indicators in GRI (Global Reporting Initiative) in its G4 version, a panel with monitoring indicators related to relevant issues were elaborated.
Béland, Daniel; Rocco, Philip; Waddan, Alex
We conducted a comparative study of how state-level political stakeholders affected the implementation of 3 major reforms within the Patient Protection and Affordable Care Act (ACA). Our goal was to analyze the effects of policy legacy, institutional fragmentation, and public sentiments on state obstruction of the reform. We gathered quantitative and qualitative evidence to generate cross-case comparisons of state implementation of 3 reform streams within the ACA: health insurance exchanges, Medicaid expansion, and regulatory reform. Our sources included secondary literature, analysis of official decisions, and background interviews with experts and public officials. We found that state-level opponents of the ACA were most likely to be successful in challenging reforms with few preexisting policy legacies, high institutional fragmentation, and negative public sentiments. Reforms that built on existing state legislation, avoided state veto points or offered lucrative fiscal incentives, and elicited less negative public reaction were less likely to be contested. Our findings point to the importance of institutional design for the role of political stakeholders in implementing reforms to improve the cost, quality, and availability of medical treatments. Although other research has found that political polarization has shaped early ACA outcomes, comparative analysis suggests political stakeholders have had the highest effect on reforms that were particularly vulnerable. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.
Barkhordarian, Andre; Demerjian, Gary; Jan, Allison; Sama, Nateli; Nguyen, Mia; Du, Angela; Chiappelli, Francesco
Modern health care in the field of Medicine, Dentistry and Nursing is grounded in fundamental philosophy and epistemology of translational science. Recently in the U.S major national initiatives have been implemented in the hope of closing the gaps that sometimes exist between the two fundamental components of translational science, the translational research and translational effectiveness. Subsequent to these initiatives, many improvements have been made; however, important bioethical issues and limitations do still exist that need to be addressed. One such issue is the stakeholder engagement and its assessment and validation. Federal, state and local organizations such as PCORI and AHRQ concur that the key to a better understanding of the relationship between translational research and translational effectiveness is the assessment of the extent to which stakeholders are actively engaged in the translational process of healthcare. The stakeholder engagement analysis identifies who the stakeholders are, maps their contribution and involvement, evaluates their priorities and opinions, and accesses their current knowledge base. This analysis however requires conceptualization and validation from the bioethics standpoint. Here, we examine the bioethical dilemma of stakeholder engagement analysis in the context of the person-environment fit (PE-fit) theoretical model. This model is an approach to quantifying stakeholder engagement analysis for the design of patient-targeted interventions. In our previous studies of Alzheimer patients, we have developed, validated and used a simple instrument based on the PE-fit model that can be adapted and utilized in a much less studied pathology as a clinical model that has a wide range of symptoms and manifestations, the temporomandibular joint disorders (TMD). The temporomandibular joint (TMJ) is the jaw joint endowed with sensory and motor innervations that project from within the central nervous system and its dysfunction can
Khodyakov, Dmitry; Grant, Sean; Meeker, Daniella; Booth, Marika; Pacheco-Santivanez, Nathaly; Kim, Katherine K
Little evidence exists about effective and scalable methods for meaningful stakeholder engagement in research. We explored patient/caregiver experiences with a high-tech online engagement approach for patient-centered research prioritization, compared their experiences with those of professional stakeholders, and identified factors associated with favorable participant experiences. We conducted 8 online modified-Delphi (OMD) panels. Panelists participated in 2 rating rounds with a statistical feedback/online discussion round in between. Panels focused on weight management/obesity, heart failure, and Kawasaki disease. We recruited a convenience sample of adults with any of the 3 conditions (or parents/guardians of Kawasaki disease patients), clinicians, and researchers. Measures included self-reported willingness to use OMD again, the panelists' study participation and online discussion experiences, the system's perceived ease of use, and active engagement metrics. Out of 349 panelists, 292 (84%) completed the study. Of those, 46% were patients, 36% were clinicians, and 19% were researchers. In multivariate models, patients were not significantly more actively engaged (Odds ratio (OR) = 1.69, 95% confidence interval (CI), 0.94-3.05) but had more favorable study participation (β = 0.49; P ≤ .05) and online discussion (β = 0.18; P ≤ .05) experiences and were more willing to use OMD again (β = 0.36; P ≤ .05), compared to professional stakeholders. Positive perceptions of the OMD system's ease of use (β = 0.16; P ≤ .05) and favorable study participation (β = 0.26; P ≤ .05) and online discussion (β = 0.57; P ≤ .05) experiences were also associated with increased willingness to use OMD in the future. Active engagement was not associated with online experience indices or willingness to use OMD again. Online approaches to engaging large numbers of stakeholders are a promising and efficient adjunct
Dixon-Woods, M; Tarrant, C; Willars, J; Suokas, A
Implementation of quality improvement programmes may suffer if the stakeholders involved do not share a common understanding of the theory of change or do not accept it as legitimate. We aimed to identify how strategic stakeholders understood and responded to the first phase of the Health Foundation's Safer Patients Initiative, a programme aimed at making hospitals safer for patients in the UK. Semistructured telephone interviews were conducted with 60 strategic-level hospital stakeholders and with five stakeholders involved in commissioning, designing and introducing the initiative. Analysis was based on the constant comparative method. The aims of the initiative were seen as legitimate and sound by most hospital stakeholders, and the theory of change was generally understood and accepted, but seven hospital stakeholders were unable to describe it. Although participants had specific doubts, particularly relating to feasibility of implementation and scientific legitimacy of some elements of the initiative, overall there was a broadly shared vision and commitment to the principles and practices associated with the theory of change, and considerable enthusiasm and optimism. Contestations about the legitimacy and relevance of the initiative among front-line staff, local resistance to changes that went against established norms, and resource and structural issues were, however, seen as potentially threatening to implementation. It is possible to get strategic-level individuals, even when widely dispersed, to understand and agree upon a theory of change that can be used in their organisations. These individuals are also able to recognise the contexts of negotiation in which programmes of change are enacted.
Saunders, Tully; Mackie, Thomas I; Shah, Supriya; Gooding, Holly; de Ferranti, Sarah D; Leslie, Laurel K
Explore perspectives of adolescent and young adult (AYA) and parent stakeholders regarding their engagement in comparative effectiveness research (CER) evaluating cholesterol screening and treatment strategies for 17-21 year olds. All nine AYAs and parent stakeholders participating in a 20-member panel of AYAs, parents and professionals (i.e., clinicians, researchers, policy makers, payers), completed a quantitative survey and a semistructured interview at the completion of the core CER study. AYAs and parents stakeholders emphasized the role of power differentials regarding shared knowledge, relationships and trust, and logistics. To mitigate power differentials, stakeholders recommended more materials, clearer definition of roles and in-person meetings. Perceived positive outcomes included diversity of perspectives provided, better understanding their own health and decision-making and improving CER.
Atanasova, Elka; Pavlova, Milena; Moutafovа, Emanuela; Kostadinova, Todorka; Groot, Wim
The reforms of the Bulgarian healthcare sector have been widely discussed, both nationally and internationally. In spite of the reforms, problems with the efficiency, equity and quality in healthcare provision continue to exist in Bulgaria. Among others, the reforms included the implementation of formal patient charges for the use of healthcare services. These were established in the country in 2000. Formal patient charges are applied to all levels of medical services with the exception of emergency care. The aim of this paper is to describe and analyze the attitudes of Bulgarian healthcare stakeholders toward patient charges. The analysis is based on data collected in focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The paper concludes by recommendations for policies related to patient payments. The social sensitivity of these payments requires broad discussion before policy decisions are implemented. There is also a need of a well-thought communication strategy on the issue of patient payments by the Ministry of Health. Copyright © 2013 John Wiley & Sons, Ltd.
Chi, Donald L; Milgrom, Peter; Gillette, Jane
Purpose: The purpose of this study was to use qualitative methods to describe the key lessons learned during the stakeholder engagement stage of planning a randomized clinical trial comparing outcomes of silver diamine fluoride (SDF) as an alternative to pit-and-fissure sealants in a school-based delivery system. Methods: Eighteen caregivers and community-based stakeholders with involvement in the school-based sealant program Sealants for Smiles from the state of Montana, were recruited for this qualitative study. United States (U.S.) Patient-Centered Outcomes Research Institute (PCORI) methodology standards were used to develop two semi-structured interview guides consisting of 6 questions. One interview guide was used for telephone interviews with caregivers and the second was used for a stakeholder focus group. Content analytic methods were used to analyze the data. Results: All participants believed that a study comparing SDF and sealants was clinically relevant. Non-caregiver stakeholders agreed with the proposed primary outcome of the study (caries prevention) whereas caregivers also emphasized the importance of child-centered outcomes such as minimizing dental anxiety associated with dental care. Stakeholders described potential concerns associated with SDF such as staining and perceptions of safety and discussed ways to address these concerns through community engagement, appropriate framing of the study, proper consent procedures, and ongoing safety monitoring during the trial. Finally, stakeholders suggested dissemination strategies such as direct communication of findings through professional organizations and encouraging insurance plans to incentivize SDF use by reimbursing dental providers. Conclusions: Involving key stakeholders in early planning is essential in developing patient-centered research questions, outcomes measures, study protocols, and dissemination plans for oral health research involving a school-based delivery system. Copyright © 2018
Kwan, Bethany M; Sills, Marion R; Graham, Deborah; Hamer, Mika K; Fairclough, Diane L; Hammermeister, K E; Kaiser, Alicyn; de Jesus Diaz-Perez, Maria; Schilling, Lisa M
Patient-reported outcome (PRO) measures offer value for clinicians and researchers, although priorities and value propositions can conflict. PRO implementation in clinical practice may benefit from stakeholder engagement methods to align research and clinical practice stakeholder perspectives. The objective is to demonstrate the use of stakeholder engagement in PRO implementation. Engaged stakeholders represented researchers and clinical practice representatives from the SAFTINet practice-based research network (PBRN). A stakeholder engagement process involving iterative analysis, deliberation, and decision making guided implementation of a medication adherence PRO measure (the Medication Adherence Survey [MAS]) for patients with hypertension and/or hyperlipidemia. Over 9 months, 40 of 45 practices (89%) implemented the MAS, collecting 3,247 surveys (mean = 72, median = 30, range: 0 - 416). Facilitators included: an electronic health record (EHR) with readily modifiable templates; existing staff, tools and workflows in which the MAS could be integrated (e.g., health risk appraisals, hypertension-specific visits, care coordinators); and engaged leadership and quality improvement teams. Stakeholder engagement appeared useful for promoting PRO measure implementation in clinical practice, in a way that met the needs of both researchers and clinical practice stakeholders. Limitations of this approach and opportunities for improving the PRO data collection infrastructure in PBRNs are discussed. © Copyright 2016 by the American Board of Family Medicine.
Cleemput, Irina; Christiaens, Wendy; Kohn, Laurence; Léonard, Christian; Daue, François; Denis, Alain
In systems with public health insurance, coverage decisions should reflect social values. Deliberation among stakeholders could achieve this goal, but rarely involves patients and citizens directly. This study aimed at evaluating the acceptability, and the perceived benefits and risks, of public and patient involvement (PPI) in coverage decision making to Belgian stakeholders. A two-round Delphi survey was conducted among all stakeholder groups. The survey was constructed on the basis of interviews with 10 key stakeholders and a review of the literature on participation models. Consensus was defined as 65% or more of the respondents agreeing with a statement and less than 15% disagreeing. Eighty stakeholders participated in both rounds. They were defined as the Delphi panel. Belgian stakeholders are open toward PPI in coverage decision processes. Benefits are expected to exceed risks. The preferred model for involvement is to consult citizens or patients, within the existing decision-making structures and at specific milestones in the process. Consulting citizens and patients is a higher level of involvement than merely informing them and a lower level than letting them participate actively. Consultation involves asking nonbinding advice on (parts of) the decision problem. According to the Delphi panel, the benefits of PPI could be increasing awareness among members of the general public and patients about the challenges and costs of health care, and enriched decision processes with expertise by experience from patients. Potential risks include subjectivity, insufficient resources to participate and weigh on the process, difficulties in finding effective ways to express a collective opinion, the risk of manipulation, and lobbying or power games of other stakeholders. PPI in coverage decision-making processes is acceptable to Belgian stakeholders, be it in different ways for different types of decisions. Benefits are expected to outweigh risks. Copyright © 2015
Lavallee, Danielle C; Wicks, Paul; Alfonso Cristancho, Rafael; Mullins, C Daniel
Patient and stakeholder engagement enhances the meaningfulness of patient-centered outcomes research. Continuous engagement of diverse patients helps to achieve representativeness and to avoid tokenism, but is perceived as challenging due to resource and time constraints. The widespread availability of the internet, mobile phones, and electronic devices makes 'high-tech' solutions appealing, but such approaches may trade-off larger sample sizes for shallower engagement and/or skewed perspectives if most participants reflect users of technology. More traditional 'high-touch' solutions such as in-person interviews, focus groups, and town hall meetings can provide qualitative and sociological context and potentially more in-depth insights from small numbers of patients, but such approaches are also prone to selection bias as well. We compare and contrast high-tech and high-touch approaches to engaging stakeholders and suggest hybrid processes.
Shin, Marlena H; Rivard, Peter E; Shwartz, Michael; Borzecki, Ann; Yaksic, Enzo; Stolzmann, Kelly; Zubkoff, Lisa; Rosen, Amy K
Given that patient safety measures are increasingly used for public reporting and pay-for performance, it is important for stakeholders to understand how to use these measures for improvement. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are one particularly visible set of measures that are now used primarily for public reporting and pay-for-performance among both private sector and Veterans Health Administration (VA) hospitals. This trend generates a strong need for stakeholders to understand how to interpret and use the PSIs for quality improvement (QI). The goal of this study was to develop an educational program and tailor it to stakeholders' needs. In this paper, we share what we learned from this program development process. Our study population included key VA stakeholders involved in reviewing performance reports and prioritizing and initiating quality/safety initiatives. A pre-program formative evaluation through telephone interviews and web-based surveys assessed stakeholders' educational needs/interests. Findings from the formative evaluation led to development and implementation of a cyberseminar-based program, which we tailored to stakeholders' needs/interests. A post-program survey evaluated program participants' perceptions about the PSI educational program. Interview data confirmed that the concepts we had developed for the interviews could be used for the survey. Survey results informed us on what program delivery mode and content topics were of high interest. Six cyberseminars were developed-three of which focused on two content areas that were noted of greatest interest: learning how to use PSIs for monitoring trends and understanding how to interpret PSIs. We also used snapshots of VA PSI reports so that participants could directly apply learnings. Although initial interest in the program was high, actual attendance was low. However, post-program survey results indicated that perceptions about the
Stroetmann, Karl A
By taking a stakeholder perspective, the paper explores reasons why the political commitment to patient-centric integrated care, facilitated by eHealth applications, is so difficult to meet. In spite of hundreds of pilots, still today there is a dearth of evidence on how to indeed successfully organise such services. Outcomes from a variety of implementation projects supported by the European Union were analysed, focusing on benefits and costs for the diverse stakeholder groups involved or impacted. The re-engineering of the services may result in a considerable shift in these variables between groups. Rendering both positive clinical impacts and a positive (overall) socio-economic return is not sufficient to assure wide acceptance and long-term sustainability. However motivated stakeholders may be, few will operate against their economic interests. Successfully establishing modern eHealth facilitated services is not so much a technical, but a social, organisational, and business innovation. We need to better understand in detail the benefits and costs, or the new 'business models' that go with integrated care for each involved stakeholder group, and the likely impacts for each of them, with a focus on how to best assure a win-win situation for all. Health policy has to respond to this, and a promising approach would be to promote organisational integration with shared budgets and outcome targets.
Sadigh, Gelareh; Applegate, Kimberly E; Ng, Timothy W; Hendrix, Kamilah A; Tridandapani, Srini
Integrating digital facial photographs of pediatric patients as identifiers (ID) with medical imaging (integrated photographic IDs) may increase the detection of mislabeled studies. The purpose of this study was to determine how different stakeholders would receive this novel technology. Parents or guardians of patients in a children's hospital outpatient radiology department, radiology faculty and residents, and radiology technologists and nurses were asked to complete a survey. The perception about the anticipated use of integrated photographic ID in different clinical scenarios was investigated, and its predictors were determined using logistic regression analysis. Four hundred ninety-eight parents responded (response rate 83 %); 96 and 97 % supported the use of integrated photographic ID, if it improves the radiologist's imaging interpretation or decreases the rate of mislabeled errors, respectively. Thirty-eight percent were worried that photographic IDs would impact patients' privacy. Ninety-four percent believed that they should be asked for their consent prior to obtaining their child's photograph. Seventy-eight radiologists responded (response rate 39 %); 63 and 59 % believed that the use of integrated photographic ID would result in improvement in accurate interpretation of images and identification of mislabeled patient errors, respectively. Forty-nine percent of radiologists had concern that integrated photographic ID would increase interpretation time. Fifty technologists and nurses responded (response rate 59 %); 71 and 73 % supported the technology if it resulted in more acute interpretation of images and identification of mislabeled patients, respectively. A majority of stakeholders support integrated photographic ID in order to improve safety. A majority of parents believe that consent should be obtained.
Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Cerón, Alejandro; Labonte, Ronald
Medical tourism has attracted considerable interest within the Latin American and Caribbean (LAC) region. Governments in the region tout the economic potential of treating foreign patients while several new private hospitals primarily target international patients. This analysis explores the perspectives of a range of medical tourism sector stakeholders in two LAC countries, Guatemala and Barbados, which are beginning to develop their medical tourism sectors. These perspectives provide insights into how beliefs about international patients are shaping the expanding regional interest in medical tourism. Structured around the comparative case study methodology, semi-structured interviews were conducted with 50 medical tourism stakeholders in each of Guatemala and Barbados (n = 100). To capture a comprehensive range of perspectives, stakeholders were recruited to represent civil society (n = 5/country), health human resources (n = 15/country), public health care and tourism sectors (n = 15/country), and private health care and tourism sectors (n = 15/country). Interviews were transcribed verbatim, coded using a collaborative process of scheme development, and analyzed thematically following an iterative process of data review. Many Guatemalan stakeholders identified the Guatemalan-American diaspora as a significant source of existing international patients. Similarly, Barbadian participants identified their large recreational tourism sector as creating a ready source of foreign patients with existing ties to the country. While both Barbadian and Guatemalan medical tourism proponents share a common understanding that intra-regional patients are an existing supply of international patients that should be further developed, the dominant perception driving interest in medical tourism is the proximity of the American health care market. In the short term, this supplies a vision of a large number of Americans lacking adequate health insurance willing to
Ersek, Mary; Hickman, Susan E; Thomas, Anne C; Bernard, Brittany; Unroe, Kathleen T; Meeks, Suzanne
The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes. Published by Oxford University Press on behalf of The Gerontological Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Mouton Dorey, Corine; Baumann, Holger; Biller-Andorno, Nikola
There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient's rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy makers. We used a qualitative design to examine Swiss healthcare stakeholders' experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants (11 physicians, 7 policy-makers, 4 ethical committee members) between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory. All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries' patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients' rights and citizens' involvement on the other. The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both
Leto di Priolo, Susanna; Fehervary, Andras; Riggins, Phil; Redmond, Kathy
The relationship between the pharmaceutical industry and cancer patient groups has been the subject of much scrutiny and skepticism, and some high-profile negative media coverage has focused attention on some of the problematic aspects of the relationship. Both the pharmaceutical industry and cancer patient groups have made an effort in recent years to improve the transparency and openness of their relations, specifically with regard to the financial support offered by pharmaceutical companies to patient groups. The objectives of this survey were to benchmark perceptions held by different stakeholder groups about current relationships between cancer patient groups and pharmaceutical companies in Europe, and to explore opinions about ways in which partnerships between patient groups and pharmaceutical companies could evolve to the benefit of cancer patients. The survey was conducted using a structured questionnaire that contained a combination of matrix, scaled, and open-ended questions. The questionnaire was developed based on a literature search and the findings from ten in-depth interviews conducted with policy makers and advocates working at an EU level. Telephone interviews were carried out using a structured questionnaire with a convenience sample of 161 policy makers, cancer healthcare group representatives, and cancer patient group leaders from France, Germany, Hungary, Italy, Latvia, the Netherlands, Poland, Portugal, Romania, Spain, Sweden, and the UK. The interviews took place in the relevant language of the country. The current relationship between the pharmaceutical industry and cancer patient groups in Europe is generally viewed as positive, but it is also viewed as being unequal, not transparent enough, and not sufficiently patient-centric. There is broad agreement that cancer patient groups can help companies identify unmet needs and contribute to the development of innovative medicines; however, there is some concern about cancer patients
O’Donnell, Alison J.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert; Cronholm, Peter F.
Introduction Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. Methods The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Results Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Conclusion Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care. PMID:26916899
Chen, Qi; Shin, Marlena H; Chan, Jeffrey A; Sullivan, Jennifer L; Borzecki, Ann M; Shwartz, Michael; Rivard, Peter E; Hatoun, Jonathan; Rosen, Amy K
Health care systems are increasingly burdened by the large numbers of safety measures currently being reported. Within the Veterans Administration (VA), most safety reporting occurs within organizational silos, with little involvement by the frontline users of these measures. To provide a more integrated picture of patient safety, the study team partnered with multiple VA stakeholders and engaged potential frontline users at 2 hospitals to develop a Guiding Patient Safety (GPS) tool. The GPS is currently in its fourth generation; once approval is obtained from senior leadership, implementation will begin. Stakeholders were enthusiastic about the GPS's user-friendly format, comprehensive content, and potential utility for improving safety. These findings suggest that stakeholder engagement is a critical first step in the development of tools that will more likely be used by frontline users. Policy makers and researchers may consider adopting this innovative partnered-research model in developing future national initiatives to deliver meaningful programs to frontline users. © The Author(s) 2014.
Boonstra, A.; Bell, S.; Boddy, D.
Implementing an inter-organizational system (IOS) requires significant organizational as well as technical changes. These will affect stakeholders (upon whom promoters depend) with varying degrees of power and with varying degrees of interest in the system. Identifying stakeholders and understanding
Al-Haboubi, Mustafa; Newton, Paul; Gallagher, Jennifer E
A pilot scheme was established across London to train NHS primary dental care practitioners to provide endodontic treatment of moderate difficulty. It was co-led by the former London Deanery (Health Education England: North West London) and local NHS commissioners. This research aimed to explore key stakeholders' perceptions about the purpose of the initiative, its advantages, disadvantages and future implications. Nineteen semi-structured interviews were conducted with stakeholders (commissioners and providers of the educational initiative; commissioners and providers of care, including trainees, principal dentists and specialists) involved in establishing, running and participating in the initiative and wider endodontic service provision in London. Interviews were based on a topic guide informed by the literature, and a workshop involving the London trainees. Interviews were recorded, transcribed and analysed using framework methodology. The project was perceived as supporting four key areas: addressing services, improving quality/outcomes, delivering education and enhancing professional status. There was evidence that dentists were harnessing health policy in facilitating 'reprofessionalisation' of dentistry with the creation of dentists with enhanced skills (DwSIs). Learning outcomes from the pilot were related to the accreditation of the participants, service tariffs, reimbursement for endodontic treatment on the NHS, and the need for continuity within and between services across the dental system. Uncertainty about funding and the changes within the NHS were among the concerns expressed regarding the future of the initiative. The findings of this research suggest that extending the skills of primary care practitioners may contribute to the reprofessionalisation of dentistry, which has much to contribute to patient care and the development of an integrated and accessible dental care system of quality, with improved outcomes for patients. The implications for
Pezold, Michael L; Pusic, Andrea L; Cohen, Wess A; Hollenberg, James P; Butt, Zeeshan; Flum, David R; Temple, Larissa K
Identifying timely and important research questions using relevant patient-reported outcomes (PROs) in surgery remains paramount in the current medical climate. The inaugural Patient-Reported Outcomes in Surgery (PROS) Conference brought together stakeholders in PROs research in surgery with the aim of creating a research agenda to help determine future directions and advance cross-disciplinary collaboration. To create a research agenda to help determine future directions and advance cross-disciplinary collaboration on the use of PROs in surgery. An iterative web-based interface was used to create a conference-based, modified Delphi survey for registrants at the PROS Conference (January 29-30, 2015), including surgeons, PRO researchers, payers, and other stakeholders. In round 1, research items were generated from qualitative review of responses to open-ended prompts. In round 2, items were ranked using a 5-point Likert scale; attendees were also asked to submit any new items. In round 3, the top 30 items and newly submitted items were redistributed for final ranking using a 3-point Likert scale. The top 20 items by mean rating were selected for the research agenda. An expert-generated research agenda on PROs in surgery. Of the 143 people registered for the conference, 137 provided valid email addresses. There was a wide range of attendees, with the 3 most common groups being plastic surgeons (28 [19.6%]), general surgeons (19 [13.3%]), and researchers (25 [17.5%]). In round 1, participants submitted 459 items, which were reduced through qualitative review to 53 distinct items across 7 themes of PROs research. A research agenda was formulated after 2 successive rounds of ranking. The research agenda identified 3 themes important for future PROs research in surgery: (1) PROs in the decision-making process, (2) integrating PROs into the electronic health record, and (3) measuring quality in surgery with PROs. The PROS Conference research agenda was created using a
Flak, Leif Skiftenes; Rose, Jeremy
The e-government field, like most young fields, lacks a strong body of well-developed theory. One strategy for coping with theoretical immaturity is to import and adapt theories from other, more mature fields. This study reviews Stakeholder Theory (ST) and investigates its potential in relation...... to e-Government. Originally a management theory, stakeholder theory advocates addressing the concerns of all stakeholders in a firm, as opposed to concentration on the interests of senior managers and stockholders. Apart from the original profit focus, there is no serious conceptual mismatch between...... stakeholder theory and government’s objective of providing policy and services for citizens and organizations – society’s stakeholders. Potential problems with adapting a management theory to a government setting are discussed. The paper further discusses how information technology impacts a stakeholder model...
van der Putten, Ingeborg M; Evers, Silvia M A A; Deogaonkar, Rohan; Jit, Mark; Hutubessy, Raymond C W
Current health economic evaluation guidelines mainly concentrate on immediate health gains and cost savings for the individual involved in the intervention. However, it has been argued that these guidelines are too narrow to capture the full impact of vaccination in low and middle income countries. The inclusion of broader economic impact of vaccines (BEIV) has therefore been proposed. Some examples of these are productivity-related gains, macro-economic impact, and different externalities. Despite their potency, the extent to which such benefits can and should be incorporated into economic evaluations of vaccination is still unclear. This mixed methods study aims to assess the relevance of BEIV to different stakeholders involved in the vaccine introduction decision making process. In this mixed method study an internet based survey was sent to attendees of the New and Underutilized Vaccines Initiative meeting in Montreux, Switzerland in 2011. Additionally, semi-structured interviews of 15 minutes each were conducted during the meeting. Study participants included decision makers, experts and funders of vaccines and immunization programs in low and middle income countries. Descriptive analysis of the survey, along with identification of common themes and factors extracted from the interviews and open survey questions was undertaken. Evidence on macro-economic impact, burden of disease and ecological effects were perceived as being most valuable towards aiding decision making for vaccine introduction by the 26 survey respondents. The 14 interviewees highlighted the importance of burden of disease and different types of indirect effects. Furthermore, some new interpretations of BEIVs were discussed, such as the potential negative impact of wastage during immunization programs and the idea of using vaccines as a platform for delivering other types of health interventions. Interviewees also highlighted the importance of using a broader perspective in connection to
Appraisal Of Quality Of Life Of Diabetic Patients, Including Life Expectancy. ... of long-term complications, development of short-term complications, and physical symptoms and lifestyle changes resulting from the demands of the diabetic ... Key words: Type 2 Diabetes, quality of life, life expectancy, diabetic complications.
Fage-Butler, Antoinette Mary
Existing research reveals that patients’ perspectives are missing from mandatory patient information leaflets (PILs). At the same time, there is overwhelming consensus that they should be included in this genre, and a corresponding need for potential approaches to tackle this problem. This paper ...
Dikkers, Marije F; Westerman, Marjan J; Rubinstein, Sidney M; van Tulder, Maurits W; Anema, Johannes R
Treatment of neck pain with manual therapy demonstrated to be more effective and cost-effective than general practitioner (GP) care or physiotherapy in a high quality RCT in the Netherlands in 2002. However, referral to manual therapy for neck pain is still relatively low. This study aims to explore the barriers and facilitators affecting the implementation of manual therapy in neck pain management in primary care. An explorative study was conducted comprising semi-structured interviews with GPs (n = 13), physiotherapists (n = 10), manual therapists (n = 7) and their patients with neck pain (n = 27), and three focus groups with additional stakeholders (n = 10-12 per group). A thematic analysis approach was used. Different barriers and facilitators for referral were found for patients, GPs and physiotherapists on the individual level, but also in the interaction between stakeholders and their context. Individual perceptions such as knowledge and beliefs about manual therapy for neck pain either impeded or facilitated referral. Fear for complications associated with cervical manipulation was an important barrier for patients as well as GPs. For GPs and physiotherapists it was important whether they perceived it was part of their professional role to refer for manual therapy. Existing relations formed referral behavior, and the trust in a particular practitioner was a recurrent theme among GPs and physiotherapist as well as patients. The contextual factor availability of manual therapy played a role for all stakeholders. Barriers and facilitators were found especially in individual perceptions on manual therapy for neck pain (e.g. knowledge and beliefs), the interaction between stakeholders (e.g. collaboration and trust) and the organizational context. Implementation strategies that focus on these different aspects seem to be likely to optimize referral rates and the use of manual therapy in primary care management of neck pain.
Aslakson, Rebecca A; Schuster, Anne L R; Lynch, Thomas J; Weiss, Matthew J; Gregg, Lydia; Miller, Judith; Isenberg, Sarina R; Crossnohere, Norah L; Conca-Cheng, Alison M; Volandes, Angelo E; Smith, Thomas J; Bridges, John F P
Patient-centered outcomes research (PCOR) methods and social learning theory (SLT) require intensive interaction between researchers and stakeholders. Advance care planning (ACP) is valuable before major surgery, but a systematic review found no extant perioperative ACP tools. Consequently, PCOR methods and SLT can inform the development of an ACP educational video for patients and families preparing for major surgery. The objective is to develop and test acceptability of an ACP video storyline. The design is a stakeholder-guided development of the ACP video storyline. Design-thinking methods explored and prioritized stakeholder perspectives. Patients and family members evaluated storyboards containing the proposed storyline. The study was conducted at hospital outpatient surgical clinics, in-person stakeholder summit, and the 2014 Maryland State Fair. Measurements are done through stakeholder engagement and deidentified survey. Stakeholders evaluated and prioritized evidence from an environmental scan. A surgeon, family member, and palliative care physician team iteratively developed a script featuring 12 core themes and worked with a medical graphic designer to translate the script into storyboards. For 10 days, 359 attendees of the 2014 Maryland State Fair evaluated the storyboards and 87% noted that they would be "very comfortable" or "comfortable" seeing the storyboard before major surgery, 89% considered the storyboards "very helpful" or "helpful," and 89% would "definitely recommend" or "recommend" this story to others preparing for major surgery. Through an iterative process utilizing diverse PCOR engagement methods and informed by SLT, storyboards were developed for an ACP video. Field testing revealed the storyline to be highly meaningful for surgery patients and family members.
Rustagi, Alison S; Manjate, Rosa Marlene; Gloyd, Stephen; John-Stewart, Grace; Micek, Mark; Gimbel, Sarah; Sherr, Kenneth
Task shifting is a common strategy to deliver antiretroviral therapy (ART) in resource-limited settings and is safe and effective if implemented appropriately. Consensus among stakeholders is necessary to formulate clear national policies that maintain high-quality care. We sought to understand key stakeholders' opinions regarding task shifting of HIV care in Mozambique and to characterize which specific tasks stakeholders considered appropriate for specific cadres of health workers. National and provincial Ministry of Health leaders, representatives from donor and non-governmental organizations (NGOs), and clinicians providing HIV care were intentionally selected to represent diverse viewpoints. Using open- and closed-ended questions, interviewees were asked about their general support of task shifting, its potential advantages and disadvantages, and whether each of seven cadres of non-physician health workers should perform each of eight tasks related to ART provision. Responses were tallied overall and stratified by current job category. Interviews were conducted between November 2007 and June 2008. Of 62 stakeholders interviewed, 44% held leadership positions in the Ministry of Health, 44% were clinicians providing HIV care, and 13% were donors or employed by NGOs; 89% held a medical degree. Stakeholders were highly supportive of physician assistants performing simple ART-related tasks and unanimous in opposing community health workers providing any ART-related services. The most commonly cited motives to implement task shifting were to increase ART access, decrease physician workload, and decrease patient wait time, whereas chief concerns included reduced quality of care and poor training and supervision. Support for task shifting was higher among clinicians than policy and programme leaders for three specific task/cadre combinations: general mid-level nurses to initiate ART in adults (supported by 75% of clinicians vs. 41% of non-clinicians) and in pregnant
Khodyakov, Dmitry; Savitsky, Terrance D; Dalal, Siddhartha
Public and stakeholder engagement can improve the quality of both research and policy decision making. However, such engagement poses significant methodological challenges in terms of collecting and analysing input from large, diverse groups. To explain how online approaches can facilitate iterative stakeholder engagement, to describe how input from large and diverse stakeholder groups can be analysed and to propose a collaborative learning framework (CLF) to interpret stakeholder engagement results. We use 'A National Conversation on Reducing the Burden of Suicide in the United States' as a case study of online stakeholder engagement and employ a Bayesian data modelling approach to develop a CLF. Our data modelling results identified six distinct stakeholder clusters that varied in the degree of individual articulation and group agreement and exhibited one of the three learning styles: learning towards consensus, learning by contrast and groupthink. Learning by contrast was the most common, or dominant, learning style in this study. Study results were used to develop a CLF, which helps explore multitude of stakeholder perspectives; identifies clusters of participants with similar shifts in beliefs; offers an empirically derived indicator of engagement quality; and helps determine the dominant learning style. The ability to detect learning by contrast helps illustrate differences in stakeholder perspectives, which may help policymakers, including Patient-Centered Outcomes Research Institute, make better decisions by soliciting and incorporating input from patients, caregivers, health-care providers and researchers. Study results have important implications for soliciting and incorporating input from stakeholders with different interests and perspectives. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
Full Text Available n a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs at decision-making points in primary healthcare (PHC based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.
Esmail, Laura; Moore, Emily; Rein, Alison
Despite the growing demand for research that engages stakeholders, there is limited evidence in the literature to demonstrate its value - or return on investment. This gap indicates a general lack of evaluation of engagement activities. To adequately inform engagement activities, we need to further investigate the dividends of engaged research, and how to evaluate these effects. This paper synthesizes the literature on hypothesized impacts of engagement, shares what has been evaluated and identifies steps needed to reduce the gap between engagement's promises and the underlying evidence supporting its practice. This assessment provides explicit guidance for better alignment of engagement's promised benefits with evaluation efforts and identifies specific areas for development of evaluative measures and better reporting processes.
Svendsen, A. [CoreRelation Consulting Inc., Delta, BC (Canada)]|[Simon Fraser Univ., Burnaby, BC (Canada); Laberge, M. [Simon Fraser Univ., Burnaby, BC (Canada)
Management philosophies concerning stakeholder engagement were reviewed. This presentation provided guidelines for managers working from a sustainability value creation framework who wish to develop more effective ways to engage with stakeholders and high stakes issues that cross political, social and organizational boundaries. It was suggested that conflicts over resources, the demand for participation and the increasing power of Non-Governmental Organizations have all contributed to the increased need for stakeholder engagement. A review of different types of stakeholders was provided. Earlier strategies of managing stakeholders were examined, in which externalities such as environmental cost were not accounted for. By contrast, the emerging management philosophy presented here stressed a recognition that long term survival relied on the good health of external and internal environments. Core business strategies were discussed with reference to core values. It was suggested that a longer term focus, inclusiveness, and integration were beneficial to businesses as a whole. A case study of Clayoquot Sound was presented. The concept of social capital was examined. Individual and collective learning were evaluated. A model for engaging stakeholder networks was presented as well as a step by step procedural guide, which included the creation of a solid foundation; organizational alignment; strategy; the importance of asking questions; trust building; evaluation; and renewal. Challenges to stakeholder engagement included finding resources; ensuring consistency; patience; a tendency in business to measure success in short term payoffs; and maintaining a stakeholder perspective. It was concluded that the benefits of a sustainability value creation framework for businesses far outweighed any initial disadvantages. refs., tabs., figs.
including the shareholders of a company. Although it may be the ultimate goal for Corporate Social Responsibility to achieve this kind of maximization, broad stakeholder maximization is quite difficult to give a precise definition. There is no one-dimensional measure to add different stakeholder benefits...... by other stakeholders' interests. These constraints vary for dif-ferent stakeholder owners and new standards for Corporate Social Responsibility and more active political consumers will strengthen these constraints.......With reference to the discussion about shareholder versus stakeholder maximization it is argued that the normal type of maximization is in fact stakeholder-owner maxi-mization. This means maximization of the sum of the value of the shares and stake-holder benefits belonging to the dominating...
Inácio, P; Cavaco, A; Allan, E; Airaksinen, M
In the European Union (EU), legislation allows patients to directly report adverse drug reactions (ADRs) to competent authorities. Five years after its implementation, patient reporting is not equal in all countries. This study aimed to explore key stakeholders' perceptions of patient reporting in four EU countries. Qualitative study design. Twelve representatives from national pharmacovigilance centres and/or authorities as well as national pharmaceutical industry bodies in four EU countries participated in the study. Supranational organizations were also included. Data collection was via face-semi-structured interviews. Inductive content analysis was performed thereafter, applying principles of risk management as a theoretical framework. Four themes (attitudes and beliefs, system maturation factors, regulatory improvements, and cultural shifts) emerged, conceptually interconnected. Participants from countries introducing patient reporting recently expressed a negative attitude. Participants highlighted the need for additional resources, both human and financial, to address patient reporting and associated advantages. The findings identified perceived barriers and facilitators of patient reporting. The involvement of patients, use of information, and dissemination of patient reporting are far from optimal. A better integration of the work by EU regulatory authorities is recommended. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Brabers, A.; Esch, T.E.M. van; Groenewegen, P.P.; Hek, K.; Mullenders, P.; Dijk, L. van; Jong, J.D. de
Background: One perceived barrier to adherence to guidelines is the existence of patient preferences which may conflict with them. We examined whether patient preferences influence the prescription of antibiotics in general practice, and how this affects adherence to guidelines. We hypothesised that
Chernyshev, A L; Filimonov, R M; Karasev, A V; Neronov, V A; Maksimov, V A
Patients with viral hepatitis have disturbances of biliary tract motor function with the tendency to hypertonus of Oddi's sphincter, changes of physic-colloid properties of bile with increase in density of gall and hepatic bile, pH shift to acid side, microlites formation, disorders in biochemical composition of bile. More than 80% patients have biliar insufficiency. According to our data, with the purpose to correct of disturbances of hepatic exocrine function in patients with viral hepatitis and to prevent stone formation, it is reasonable to use together with antiviral therapy also intravenous injection of ozonated physiological solution and preparations of ursodeoxycholic acid.
Børresen, Betina; Clausen, Malene Martini; Hansen, Anders Elias
Cancer bearing dogs represent a unique clinical cancer model with a direct potential for accelerating translation into human patients. A research collaboration between the veterinary and human medical facilities at Copenhagen University and Rigshospitalet has taken offset in this. Canine cancer...
Haas, Jigal; Bentov, Yaakov
Metformin, a drug developed for the treatment of patients with type II diabetes, has become commonly prescribed medication for PCOS patients. Initially, metformin was prescribed for patients with impaired glucose tolerance at the pre conception period, however more recently its use was expanded to many of the PCOS patients and for the whole duration of pregnancy. Several studies examining the effects of Metformin during pregnancy reported a lower pregnancy loss, reduced gestational diabetes and no increased risk for birth defects, however, several more recent studies also raised concerns about its safe use. The therapeutic effect of metformin stems from its ability to inhibit the action of the first complex of the electron transport resulting in reduced ATP production. At the initial stages of embryo development, the only source of ATP is the mitochondrial electron transport chain. Lowering ATP production at the critical stage of early embryo development may impair oocyte maturation and embryo development as well as reprogram the metabolic characteristics of the offspring. Copyright © 2017 Elsevier Ltd. All rights reserved.
Lauesen, Linne Marie
The purpose of this chapter is to investigate the question of whether corporate social responsibility (CSR) can be used as a link of trust between business and society, and which role CSR plays in recovering distrust in businesses. It uses a mixed methods study of processes of moving businesses...... within the Danish water sector from a general trust-breakdown to trust recovery from 2003 to 2013. Trust recovery is found to depend on stakeholders’ mutual engagement with each other and their willingness to share knowledge and learn from each other’s professional and institutional cultures....... This chapter suggests a theoretical extension of Bogenschneider and Corbett’s (2010) Community Dissonance Theory to embrace multiple stakeholders each having their own complex and unique culture and communication modus based on their institutional, professional or individual comprehensive language universes...
Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor
Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to
Babiuch, W.M.; Farhar, B.C.
Stakeholder analysis allows analysts to identify how parties might be affected by government projects. This process involves identifying the likely impacts of a proposed action and stakeholder groups affected by that action. Additionally, the process involves assessing how these groups might be affected and suggesting measures to mitigate any adverse effects. Evidence suggests that the efficiency and effectiveness of government actions can be increased and adverse social impacts mitigated when officials understand how a proposed action might affect stakeholders. This report discusses how to conduct useful stakeholder analyses for government officials making decisions on energy-efficiency and renewable-energy technologies and their commercialization. It discusses methodological issues that may affect the validity and reliability of findings, including sampling, generalizability, validity, ``uncooperative`` stakeholder groups, using social indicators, and the effect of government regulations. The Appendix contains resource directories and a list of specialists in stakeholder analysis and involvement.
including the shareholders of a company. Although it may be the ultimate goal for Corporate Social Responsibility to achieve this kind of maximization, broad stakeholder maximization is quite difficult to give a precise definition. There is no one-dimensional measure to add different stakeholder benefits...
Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E
Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.
Johnston, Maximilian J; King, Dominic; Arora, Sonal; Cooper, Kerri; Panda, Neha Aparajita; Gosling, Rebecca; Singh, Kaushiki; Sanders, Bradley; Cox, Benita; Darzi, Ara
In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety. © 2014 John Wiley & Sons, Ltd.
Young, Bridget; Bagley, Heather
This commentary article describes three interactive workshops that explored how patients can contribute to decisions about what outcomes are measured in clinical trials across the world. Outcomes like quality of life, side-effects and pain are used in trials to measure whether a treatment is effective. Here, we outline how research groups are increasingly coming together to develop 'core outcomes sets' for particular conditions. Core outcome sets are lists of agreed outcomes. Their use will help in identifying which treatments are effective by enabling people to compare the findings of different clinical trials in the same condition. Currently, it is often very difficult to make these comparisons because different studies often measure different outcomes. Delegates attending the workshops included patients, clinicians and researchers. They discussed ways of making core outcome set development more meaningful and accessible for patients, and ensuring that they have a genuine say in the development process. This article summarises these discussions and concludes by identifying three distinctive challenges in securing patient input to core outcome set development: the process and objectives can seem far removed from the immediate concerns of patients, difficulties can arise in securing patient input on an international scale, and difficulties can also arise in bringing multiple stakeholder groups together to achieve consensus. While patient participation, involvement and engagement in core outcome set development can draw on lessons from other research areas, these distinctive challenges point to the need for distinctive solutions to enable meaningful patient input to core outcome set development. Background This article describes three workshops that explored how patients can contribute to decisions about what outcomes are measured in clinical trials. People need evidence about what treatments are best for particular health conditions. The strongest evidence comes
Gesell, Sabina B; Klein, Karen Potvin; Halladay, Jacqueline; Bettger, Janet Prvu; Freburger, Janet; Cummings, Doyle M; Lutz, Barbara J; Coleman, Sylvia; Bushnell, Cheryl; Rosamond, Wayne; Duncan, Pamela W
The Comprehensive Post-Acute Stroke Services (COMPASS) Study is one of the first large pragmatic randomized-controlled clinical trials using comparative effectiveness research methods, funded by the Patient-Centered Outcomes Research Institute. In the COMPASS Study, we compare the effectiveness of a patient-centered, transitional care intervention versus usual care for stroke patients discharged home from acute care. Outcomes include stroke patient post-discharge functional status and caregiver strain 90 days after discharge, and hospital readmissions. A central tenet of Patient-Centered Outcomes Research Institute-funded research is stakeholder engagement throughout the research process. However, evidence on how to successfully implement a pragmatic trial that changes systems of care in combination with robust stakeholder engagement is limited. This combination is not without challenges. We present our approach for broad-based stakeholder engagement in the context of a pragmatic trial with the participation of patients, caregivers, community stakeholders, including the North Carolina Stroke Care Collaborative hospital network, and policy makers. To maximize stakeholder engagement throughout the COMPASS Study, we employed a conceptual model with the following components: (1) Patient and Other Stakeholder Identification and Selection; (2) Patient and Other Stakeholder Involvement Across the Spectrum of Research Activities; (3) Dedicated Resources for Patient and Other Stakeholder Involvement; (4) Support for Patient and Other Stakeholder Engagement Through Organizational Processes; (5) Communication with Patients and Other Stakeholders; (6) Transparent Involvement Processes; (7) Tracking of Engagement; and (8) Evaluation of Engagement. In this paper, we describe how each component of the model is being implemented and how this approach addresses existing gaps in the literature on strategies for engaging stakeholders in meaningful and useful ways when conducting
The success of EPA's pesticide program is directly connected to our efforts to engage all stakeholders. In addition to meetings on pesticide-specific actions, we sponsor advisory committees that include diverse, independent stakeholders.
Haywood, Kirstie; Lyddiatt, Anne; Brace-McDonnell, Samantha J; Staniszewska, Sophie; Salek, Sam
Active patient engagement is increasingly viewed as essential to ensuring that patient-driven perspectives are considered throughout the research process. However, guidance for patient engagement (PE) in HRQoL research does not exist, the evidence-base for practice is limited, and we know relatively little about underpinning values that can impact on PE practice. This is the first study to explore the values that should underpin PE in contemporary HRQoL research to help inform future good practice guidance. A modified 'World Café' was hosted as a collaborative activity between patient partners, clinicians and researchers: self-nominated conference delegates participated in group discussions to explore values associated with the conduct and consequences of PE. Values were captured via post-it notes and by nominated note-takers. Data were thematically analysed: emergent themes were coded and agreement checked. Association between emergent themes, values and the Public Involvement Impact Assessment Framework were explored. Eighty participants, including 12 patient partners, participated in the 90-min event. Three core values were defined: (1) building relationships; (2) improving research quality and impact; and (3) developing best practice. Participants valued the importance of building genuine, collaborative and deliberative relationships-underpinned by honesty, respect, co-learning and equity-and the impact of effective PE on research quality and relevance. An explicit statement of values seeks to align all stakeholders on the purpose, practice and credibility of PE activities. An innovative, flexible and transparent research environment was valued as essential to developing a trustworthy evidence-base with which to underpin future guidance for good PE practice.
Madsen, Henning; Ulhøi, John Parm
relationships with various stakeholders, companies need to be able to identify these stakeholders and assess their influence. The first part of this paper will discuss the relevant theory and introduce a model to analyse and identify the most significant stakeholder groups and their influence on corporate...... behaviour. Based on a recent survey of Danish compa-nies, the second part of the paper will report on the success of a variety of stakeholders in forc-ing companies to introduce environment-related initiatives. The results will then be discussed in light of the theory and other reported results. The paper......Regulation has been an important instrument in pushing the business community towards im-proved environmental performance. However, there has also been increasing pressure from a growing number of stakeholders, including employees, customers, neighbours and NGOs, etc. In order to improve corporate...
Michelson, Kelly N; Frader, Joel; Sorce, Lauren; Clayman, Marla L; Persell, Stephen D; Fragen, Patricia; Ciolino, Jody D; Campbell, Laura C; Arenson, Melanie; Aniciete, Danica Y; Brown, Melanie L; Ali, Farah N; White, Douglas
Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.
Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim
Although patient charges for health-care services may contribute to a more sustainable health-care financing, they often raise public opposition, which impedes their introduction. Thus, a consensus among the main stakeholders on the presence and role of patient charges should be worked out to assure their successful implementation. To analyse the acceptability of formal patient charges for health-care services in a basic package among different health-care system stakeholders in six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Qualitative data were collected in 2009 via focus group discussions and in-depth interviews with health-care consumers, providers, policy makers and insurers. The same participants were asked to fill in a self-administrative questionnaire. Qualitative and quantitative data are analysed separately to outline similarities and differences in the opinions between the stakeholder groups and across countries. There is a rather weak consensus on patient charges in the countries. Health policy makers and insurers strongly advocate patient charges. Health-care providers overall support charges but their financial profits from the system strongly affects their approval. Consumers are against paying for services, mostly due to poor quality and access to health-care services and inability to pay. To build consensus on patient charges, the payment policy should be responsive to consumers' needs with regard to quality and equity. Transparency and accountability in the health-care system should be improved to enhance public trust and acceptance of patient payments. © 2012 John Wiley & Sons Ltd.
Pedersen, Kamilla; Moeller, Martin Holdgaard; Paltved, Charlotte
OBJECTIVES: The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students....... Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients. CONCLUSION: The format of patient cases included in teaching may have a substantial impact...
Carrying out a project as planned is not a guarantee for success. Projects may fail because project management does not take the requirements, wishes and concerns of stakeholders sufficiently into account. Projects can only be successful though contributions from stakeholders. And in the end, it is the stakeholders that evaluate whether they find that the project is a success. To manage stakeholders effectively, you need to know your stakeholders, their behaviours and attitudes towards the project. In Project Stakeholder Management, the authors give guidance on how to adopt an analytical and s
Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science.
Moura, Josemar de Almeida; Costa, Bruna Carvalho; de Faria, Rosa Malena Delbone; Soares, Taciana Figueiredo; Moura, Eliane Perlatto; Chiappelli, Francesco
Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient's health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement.
Luque, John S; Maupin, Jonathan N; Ferris, Daron G; Guevara Condorhuaman, Wendy S
Peru is characterized by high cervical cancer incidence and mortality rates. The country also experiences significant gaps in quality cervical cancer screening coverage for the population. This descriptive mixed methods study conducted in Cusco, Peru, aimed to assess the attitudes and perceptions of medical staff, health care workers, and patients toward a cervical cancer screening program that included both clinic-based and community outreach services conducted by a nongovernmental organization clinic (CerviCusco). The study also explored patient knowledge and attitudes around cervical cancer and about the human papillomavirus (HPV) to inform patient education efforts. The study employed structured interviews with key informants (n=16) primarily from CerviCusco, which provides cervical cancer prevention, screening, diagnosis and treatment services, and surveys with a sample of patients (n=30) receiving services at the clinic and at screening campaigns. The majority of key informant medical staff participants felt that the general public had a very negative view of government health services. One theme running throughout the interviews was the perception that the general population lacked a culture of preventive health care and would wait until symptoms were severe before seeking treatment. Regarding services that were received by patients at CerviCusco, the participants responded that the prices were reasonable and more affordable than some private clinics. Patients attending the rural health campaigns liked that the services were free and of good quality. CerviCusco has demonstrated its capacity to provide screening outreach campaigns to populations who had not previously had access to liquid-based cytology services. The finding that patients had generally low levels of knowledge about cervical cancer and the HPV vaccine prompted the development of culturally and linguistically appropriate educational and promotional materials to improve the educational component
Pipkin, Erin; Porter, Sean; Clark, Rickie
For every public project, there is a diverse group of stakeholders who need and want information. During this session we outline important stakeholders, how and when to involve them in the planning process, and how targeted messaging might be the key to your project’s success. We also discuss how to identify and manage stakeholders who oppose your project.
Full Text Available Objective: We learn about the methods, process, effects of each stakeholder and the principles of the disposition of medical dispute home and abroad through stakeholder analysis. Methods: We investigate the methods, process and the principles of the disposition of medical dispute home and abroad by literature retrieval, key informant interview and depth interview. Results: The stakeholders of medical disputes mainly include patients and families, medical staff and hospitals, pharmaceutical companies, governments, laws, non-government organizations and media. They play different roles in medical disputes and have different effects. Over all, patients and families, medical staff and hospitals have the greatest effect and then laws, media, government, non-government organizations and pharmaceutical companies. Conclusion: Different stakeholders affect the disposition of medical disputes differently. It is crucial to establish harmonious relationship between patients and doctors and to build harmonious society by untangling the responsibility between all the stakeholders and dispose medical disputes quickly and effectively.
Lowes, Lesley; Robling, Michael R; Bennert, Kristina; Crawley, Charlotte; Hambly, Helen; Hawthorne, Kamila; Gregory, John W
AIM This paper focuses on stakeholders' active involvement at key stages of the research as members of a Stakeholder Action Group (SAG), particularly in the context of lay stakeholder involvement. Some challenges that can arise and wider issues (e.g. empowerment, the impact of user involvement) are identified and explored within the literature on service user involvement in health care research, reflecting on the implications for researchers. BACKGROUND In the DEPICTED study, lay and professional stakeholders were actively involved in developing a complex research intervention. Lay stakeholders comprised teenage and adult patients with diabetes, parents and patient organization representatives. Professional stakeholders were from a range of disciplines. METHODS Three 1-day research meetings were attended by 13-17 lay stakeholders and 10-11 professional stakeholders (plus researchers). The SAG was responsible for reviewing evidence, advising on developing ideas for the research intervention and guiding plans for evaluation of the intervention in a subsequent trial. Formal evaluations were completed by stakeholders following each SAG meeting. RESULTS Throughout the first (developmental) stage of this two-stage study, lay and professional stakeholders participated or were actively involved in activities that provided data to inform the research intervention. Lay stakeholders identified the need for and contributed to the design of a patient-held tool, strongly influenced the detailed design and content of the research intervention and outcome questionnaire, thus making a major contribution to the trial design. CONCLUSION Stakeholders, including teenagers, can be actively involved in designing a research intervention and impact significantly on study outcomes. © 2010 Blackwell Publishing Ltd.
Sedereviciute, Kristina; Valentini, Chiara
are identified based on the dimensions of connectivity and the content shared. Accordingly, the study introduces four groups of important actors from social media: unconcerned lurkers, unconcerned influencers, concerned lurkers and concerned influencers and integrates them into the existing Stakeholder Salience...... in finding stakeholders on new environments (social media), where connectivity and relationships play a key role. The argument stems from the need to assess stakeholder presence beyond the dyadic ties. Consequently, the combination of the Stakeholder Salience Model (SSM) and social network analysis (SNA......) is proposed as a more holistic solution for stakeholder identification including those from social media. A process of finding “unknown” but important stakeholders from social media was identified incorporating the content search and the principles of SNA. Consequently, stakeholders from social media...
Malvey, Donna; Fottler, Myron D; Slovensky, Donna J
In the highly competitive health care environment, the survival of an organization may depend on how well powerful stakeholders are managed. Yet, the existing strategic stakeholder management process does not include evaluation of stakeholder management performance. To address this critical gap, this paper proposes a systematic method for evaluation using a stakeholder report card. An example of a physician report card based on this methodology is presented.
Full Text Available John S Luque,1 Jonathan N Maupin,2 Daron G Ferris,3,4 Wendy S Guevara Condorhuaman4 1Department of Public Health Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, 2School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, 3Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA; 4CerviCusco, Cusco, Peru Background: Peru is characterized by high cervical cancer incidence and mortality rates. The country also experiences significant gaps in quality cervical cancer screening coverage for the population.Objective: This descriptive mixed methods study conducted in Cusco, Peru, aimed to assess the attitudes and perceptions of medical staff, health care workers, and patients toward a cervical cancer screening program that included both clinic-based and community outreach services conducted by a nongovernmental organization clinic (CerviCusco. The study also explored patient knowledge and attitudes around cervical cancer and about the human papillomavirus (HPV to inform patient education efforts.Methods: The study employed structured interviews with key informants (n=16 primarily from CerviCusco, which provides cervical cancer prevention, screening, diagnosis and treatment services, and surveys with a sample of patients (n=30 receiving services at the clinic and at screening campaigns.Results: The majority of key informant medical staff participants felt that the general public had a very negative view of government health services. One theme running throughout the interviews was the perception that the general population lacked a culture of preventive health care and would wait until symptoms were severe before seeking treatment. Regarding services that were received by patients at CerviCusco, the participants responded that the prices were reasonable and more affordable than some private clinics. Patients attending the rural health campaigns liked that the services
The purpose of this study is to develop a stakeholder map to describe the most important stakeholders and the process of stakeholder relationships in higher education. According to the perspective of the balanced scorecard, the classification of stakeholders integrates stakeholders into strategic management. Stakeholder maps are essential in…
Public Health Agency
The following suite of nine leaflets for patients and visitors to healthcare settings include information on healthcare associated infections, C. difficile, MRSA, norovirus, scabies, ESBL resistant bacteria, multi-drug resistant bacteria and laundry and hand hygiene guidance.
Lauesen, Linne Marie
, the global warming, the disasters of global consumerism in terms of the collapse of the Rana Plaza factory in the fashion industry, are examples of how the stakeholder concept cannot continue to be defined as narrow as corporations usually does. The butterfly effect of globalism has shown to be – yes, global...... how to revise the stakeholder concept according to corporate responsibility, company stakeholding and globalism. It points to shortcomings in various global trade systems such as banking, fashion and IT markets, and through these it suggests and discusses a new way of defining the stakeholder concept...
Yazdanshenas, Hamed; Bazargan, Mohsen; Jones, Loretta; Vawer, May; Seto, Todd B; Farooq, Summer; Taira, Deborah A
Approximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed. The goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension. In-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors. A number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider. Information from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve
Mazet, J A K; Uhart, M M; Keyyu, J D
The stakeholders in One Health include the ultimate beneficiaries (i.e. animals, people and the environment) and the organisations that work to protect them (i.e. research institutes, government ministries, international organisations and professional bodies). However, identifying these stakeholders who will contribute to One Health activities and develop solutions to complex health problems can be difficult, as these problems often affect all sectors of society. In addition, evolving concepts about health and its dependence on environmental resilience necessitate the inclusion of ministries, organisations and disciplines that may not have been traditionally considered to be related to health. The multilateral organisations with greatest responsibilities in the global health arena have recognised that the best way to protect health security and promote overall global well-being is to work together across disciplinary and jurisdictional boundaries. Permanent regional networks and ad hoc networks created to tackle specific issues (both of which require donor investment) are also facilitating improved disease surveillance and collaborative approaches to synchronised interventions across country borders. These networks necessarily involve the key ministries for One Health, those of health, agriculture/livestock, and natural resources/environment. Ministries play a critical role in the formulation and implementation of policies for the promotion of health and disease control. They contribute to all stages of the One Heath process, as do universities, which engage by generating knowledge and capacity through teaching, research and extension services. Similarly, non-governmental organisations have a key role in stewardship; resource mobilisation; generation of knowledge; capacity development; intervention design; and implementation. Finally, communities, including rural and indigenous peoples, particularly those that are in close proximity to natural areas, are at the
The concept of a ‘stakeholder’ is often misused in the academic literature; stakeholders can range from the few actors with which the organisation has a direct interaction (Carroll 1993), to anything that can exert some form of influence over the organisation, including nature, the deceased...... and the unborn (Starik 1995). It is therefore necessary to provide a precise definition of the stakeholder concept to maintain academic rigour. However, a specification of the nature of the stakeholder concept is generally missing in political marketing literature. This paper addresses this issue by discussing...... how the stakeholder concept is understood, and then applies the stakeholder concept to the political marketing context, proposing a definition of the stakeholder concept for political marketing research....
The concept of a ‘stakeholder’ is often misused in the academic literature; stakeholders can range from the few actors with which the organisation has a direct interaction (Carroll 1993), to anything that can exert some form of influence over the organisation, including nature, the deceased and t...... how the stakeholder concept is understood, and then applies the stakeholder concept to the political marketing context, proposing a definition of the stakeholder concept for political marketing research....... and the unborn (Starik 1995). It is therefore necessary to provide a precise definition of the stakeholder concept to maintain academic rigour. However, a specification of the nature of the stakeholder concept is generally missing in political marketing literature. This paper addresses this issue by discussing...
Madsen, Henning; Ulhøi, John Parm
Regulation has been an important instrument in pushing the business community towards a more sustainable way of conduct. But recently an increasing pressure from a growing number of stakeholders including employees, customers, neighbours, NGO's etc has been observed. The purpose of this paper...
Uldam, Julie; Krause Hansen, Hans
Corporations are increasingly expected to act responsibly. The purpose of this paper is to examine two types of corporate responses to these expectations: overt and covert responses. Specifically, it examines oil companies’ involvement in multi-stakeholder initiatives and sponsorships (overt...... responses) and their monitoring of critics, including non-governmental organisations (NGOs) and activist organisations (covert responses)....
Nowik, Patrik; Bujila, Robert; Kull, Love; Andersson, Jonas; Poludniowski, Gavin
The purpose of this study was to evaluate the dosimetric impact of including the patient table in Monte Carlo CT dose estimates for both spiral scans and scan projection radiographs (SPR). CT scan acquisitions were simulated for a Siemens SOMATOM Force scanner (Siemens Healthineers, Forchheim, Germany) with and without a patient table present. An adult male, an adult female and a pediatric female voxelized phantom were simulated. The simulated scans included tube voltages of 80 and 120 kVp. Spiral scans simulated without a patient table resulted in effective doses that were overestimated by approximately 5% compared to the same simulations performed with the patient table present. Doses in selected individual organs (breast, colon, lung, red bone marrow and stomach) were overestimated by up to 8%. Effective doses from SPR acquired with the x-ray tube stationary at 6 o’clock (posterior-anterior) were overestimated by 14-23% when the patient table was not included, with individual organ dose discrepancies (breast, colon, lung red bone marrow and stomach) all exceeding 13%. The reference entrance skin dose to the back were in this situation overestimated by 6-15%. These results highlight the importance of including the patient table in patient dose estimates for such scan situations.
Pitcher, Paula R.
The purpose of the present study is to analyze stakeholder theory and its applicability to community college accountability. Community colleges have been using strategic planning as a management approach that includes the process of strategic action, and many organizations claim that they collaborate with their stakeholders during this process.…
Voinov, Alexey; Kolagani, Nagesh; McCall, Michael K; Glynn, Pierre D.; Kragt, Marit E; Ostermann, Frank O; Pierce, Suzanne A; Ramu, Palaniappan
This paper updates and builds on ‘Modelling with Stakeholders’ Voinov and Bousquet, 2010 which demonstrated the importance of, and demand for, stakeholder participation in resource and environmental modelling. This position paper returns to the concepts of that publication and reviews the progress made since 2010. A new development is the wide introduction and acceptance of social media and web applications, which dramatically changes the context and scale of stakeholder interactions and participation. Technology advances make it easier to incorporate information in interactive formats via visualization and games to augment participatory experiences. Citizens as stakeholders are increasingly demanding to be engaged in planning decisions that affect them and their communities, at scales from local to global. How people interact with and access models and data is rapidly evolving. In turn, this requires changes in how models are built, packaged, and disseminated: citizens are less in awe of experts and external authorities, and they are increasingly aware of their own capabilities to provide inputs to planning processes, including models. The continued acceleration of environmental degradation and natural resource depletion accompanies these societal changes, even as there is a growing acceptance of the need to transition to alternative, possibly very different, life styles. Substantive transitions cannot occur without significant changes in human behaviour and perceptions. The important and diverse roles that models can play in guiding human behaviour, and in disseminating and increasing societal knowledge, are a feature of stakeholder processes today.
National Oceanic and Atmospheric Administration, Department of Commerce — The National Marine Fisheries Service (NMFS) conducted a survey of fisheries stakeholders on the Gulf and East Coasts of the United States seeking their views on...
Friedman, Andrew L; Miles, Samantha
... of the concept on practice and policy. However, as the concept has become more popular, the path has become tangled with the many different ways the concept has been used. For example, different practices have come to be called stakeholder activities, particularly by those seeking to use the label to legitimize their actions. Also, a range of different definitions as to what a stakeholder is has emerged. Concentrating on these issues encourages a view of a second future path of the stake...
Cargill, Stephanie Solomon; Baker, Lauren Lyn; Goold, Susan Dorr
Develop an accessible exercise to engage underserved populations about research funding priorities; analyze the criteria they use to prioritize research; contrast these criteria to those currently used by Patient Centered Outcomes Research Institute (PCORI). Academic and community partners collaborated to develop an Ipad exercise to facilitate group deliberation about PCOR funding priorities. 16 groups (n = 183) of underserved individuals in both urban and rural areas participated. Recordings were qualitatively analyzed for prioritization criteria. Analysis yielded ten codes, many of which were similar to PCORI criteria, but all of which challenged or illuminated these criteria. Directly involving underserved populations in determining funding criteria is both feasible and important, and can better fulfill PCORI's goal of incorporating patient priorities.
Nikkanen, T.A.V.; Maekinen, E.; Ekfors, T.O.; Hakkarainen, S.; Drysun, B.
Osteonecrosis of the femoral head developed in two patients with malignant lymphoma treated with combined chemotherapy. Pain was the main symptom. It was not possible to radiographically distinguish the necrotic lesions from metastatic tumour growth, and in both cases only histological examination revealed the true nature of bone destruction. The large doses of corticosteroids included in the treatment regiments were most likely of more importance in the etiology of the necrosis than the cytostatic drugs proper. (orig.) [de
Abstract: This article analyzes the conflict of interests between shareholders andother stakeholders, including when such conflicts of interests may arise. It is arguedthat shareholder value cannot be justified simply by referring to any prerogativeproperty rights of the shareholders. Instead, sh...... cautious the legal systemshould use a doctrine based on the `company's interests'. In addition, the notion of afirm's social responsibility is critically evaluated together with the associated pitfallsof accepting this concept....
Jones, Ray; Young, Kim; Munro, James; Miller, Heather; Brelsford, Stephanie; Aronsson, Jennie; Goodman, Benny; Peters, Jane
Globally, universities aim to involve people who use health services to enrich the nursing curriculum for students, but there can be barriers to this involvement. Many also want students to contribute to local communities. Online communication can help connect students to service users to achieve these aims. The online British patient feedback site, Patient Opinion, gathers comments from service users about services and encourages service responses to the comments. To explore the feasibility and acceptability of five ways of including Patient Opinion in the undergraduate nursing curriculum. Five case studies using mixed data collection methods. British University with nursing students across two campuses, accustomed to using webinars, video presentations and social media. Students from different years participated in the five approaches of making use of Patient Opinion in the curriculum; 18 students took part in an online forum to discuss Patient Opinion in the curriculum. We trialled timetabled webinars, video-linked lectures, optional enhanced access for self-study, optional audit of service user comments for two local hospitals, and optional Twitter and Tweetchat. Students discussed the aims and approaches in an online forum. Of the five approaches trialled, webinars seemed effective in ensuring that all nursing students engaged with the topic. Video-linked lectures provided an alternative when timetabling did not allow webinars, but were less interactive. The three optional approaches (Tweetchats, audit exercise, self-directed study) provided opportunities for some students to enhance their learning but students needed guidance. Sending a summary of student reviews of patients' feedback to local hospitals illustrated how students might be agents of change in local health services. Experience from these case studies suggests that webinars followed by use of Patient Opinion preparing for placements may be a sustainable way of embedding feedback sites in the
Auta, Asa; Strickland-Hodge, Barry; Maz, Julia
Background In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients' access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective This research was carried out to investigate stakeholders' views on granting prescribing authority to pharmacists in Nigeria. Setting The study was conducted in Nigeria. Methods Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure Stakeholders' perception on the granting of prescribing authority to pharmacists in Nigeria. Results Three major themes emerged from the interviews: (1) prescribing as a logical role for pharmacists, (2) pharmacist prescribing- an opportunity or a threat and (3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients' access to medicines, reduce doctors' workload and promote the utilisation of pharmacists' skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists' inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all
Laude, Daniel; Weibel, Antoinette; Sachs, Sybille; Schafheitle, Simon Daniel
Stakeholder theory has addressed the role of trust in organization-stakeholder relationships in depth. Although it is similarly relevant, distrust as a distinct construct from (low) trust has received relatively little consideration by stakeholder theorists. Thus, this article focuses on stakeholder distrust and reflects on the findings of distrust research in organizational studies and the implications for stakeholder theory. For this purpose, we conduct a systematic literature review of org...
Full Text Available Abstract Background Patient reported outcome measures (PROMs are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice. Methods Taking PROMs recommended for chronic obstructive pulmonary disease (COPD as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors. Results Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs’ administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation. Conclusions Adjusting PROMs’ format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs’ purpose and benefit to patients may help to prevent inequality when using PROMs in health services.
Dennedy, Michael Conall
Approximately 7% of women of reproductive age manifest polycystic ovary syndrome (PCOS) and <0.5% have other causes of hyperandrogenism including congenital adrenal hyperplasia (CAH), androgen-secreting tumour of an ovary or an adrenal gland, Cushing\\'s syndrome or hyperthecosis. The presence of features atypical of PCOS should prompt more extensive evaluation than that usually undertaken. Features atypical of PCOS include the onset of symptoms outside the decade of 15-25 years, rapid progression of symptoms, the development of virilization and a serum testosterone concentration in excess of twice the upper limit of the reference range. Ethnic background, family history and specific clinical findings, e.g. Cushingoid appearance, may inform a focused investigation. Otherwise, patients should have measurement of 17-hydroxyprogesterone (17-OHP) under basal conditions ideally in the early morning, and if abnormal, they should have measurement of 17-OHP one hour after the administration of synthetic ACTH, 250 microg i.v., to screen for CAH, which is present in approximately 2% of hyperandrogenic patients. The overnight cortisol suppression test employing 1 mg dexamethasone at midnight is a sensitive test for Cushing\\'s syndrome. Coronal tomographic (CT) scanning of the adrenals and transvaginal ultrasonography of the ovaries are the investigations of choice when screening for tumours in these organs. Less frequently required is catheterization and sampling from both adrenal and ovarian veins, which is a technically demanding procedure with potential complications which may provide definitive diagnostic information not available from other investigations. Illustrative case reports highlight some complexities in the investigation of hyperandrogenic patients presenting with features atypical of PCOS and include only the ninth case report of an androgen-secreting ovarian teratoma.
Burns, Karen E A; Jacob, Sonu Karottaiyamvelil; Aguirre, Valeria; Gomes, Janice; Mehta, Sangeeta; Rizvi, Leena
Stakeholder engagement in research is expected to provide unique insights, make research investments more accountable and transparent, and ensure that future research is applicable to patients and family members. To inform the design of a trial of strategies for weaning from mechanical ventilation, we sought to identify preferences of patient visitors regarding outcome and treatment measures. We conducted an interviewer-administered questionnaire of visitors of critically ill patients in two family waiting rooms serving three intensive care units (ICUs) in Toronto, Canada. Respondents rated the importance of general and ventilation-related outcomes in two hypothetical scenarios (before a first spontaneous breathing trial, and after a failed spontaneous breathing trial) and selected a preferred technique for the breathing trials. With regard to the patient they were visiting, respondents identified the most important outcome to them at ICU admission, during the ICU stay, and at ICU discharge. We analyzed 322 questionnaires (95.5% response rate). All outcomes were highly rated (average range: 7.82-9.74). Across scenarios, outcomes rated as most important were ICU and hospital survival (9.72, 9.70), avoiding complications (9.45), quality of life (9.394), patient comfort (9.393), and returning to previous living arrangements (9.31). Overall, the most important ventilation-related outcomes were being ventilator-free (8.95), avoiding reintubation (8.905), and passing a spontaneous breathing trial (8.903). Passing a spontaneous breathing trial assumed greater importance after an initial failed attempt. "Time to event" outcomes were less important to visitors. We did not identify a preferred spontaneous breathing trial technique. Although ICU survival was the most important outcome at ICU admission and during the ICU stay, visitors rated quality of life higher than hospital survival at ICU discharge. Visitors to critically ill patients prioritized two general outcomes (ICU
Peláez, Sandra; Bacon, Simon L; Lacoste, Guillaume; Lavoie, Kim L
Adherence to daily asthma controller medication has been shown to be the most effective component of asthma self-management; however, patient's adherence to asthma medication remains poor. This study aimed to understand how patients' long-term asthma controller medication adherence may be improved and facilitated by comparing key asthma stakeholders' perspectives. Six focus group interviews including 38 asthma stakeholders (n = 13 patients, n = 13 pulmonologist physicians, and n = 12 allied healthcare professionals) were conducted. Interviews were qualitatively analysed. Although similar themes were brought up across different asthma stakeholders, the way in which they were framed differed across stakeholders. The most salient discussion revolved around the content and the moment in which asthma education should be approached to facilitate patients' adherence to asthma medication. Asthma medication adherence is a complex process and successful interventions aimed at its improvement would benefit from: (a) making an effort to understand patients' experiences and negotiate the treatment regimen, rather than imposing recommendations; (b) considering treatment as a shared responsibility involving the patient, the healthcare professional(s), and the patients' social networks; and, (c) taking into account different stakeholders' concerns, needs, perspectives, and knowledge.
Kim, S H; Kim, U K; Chae, J J; Kim, D J; Oh, H Y; Kim, B J; Lee, C C
Hypokalaemic periodic paralysis (hypoPP) is an autosomal dominant disorder involving the abnormal function of ion channels and it is characterized by paralysis attacks of varying severity, accompanied by a fall in blood potassium levels. Linkage analysis showed that the candidate locus responsible for hypoPP was localized to chromosome 1q31-32, and this locus encoded the muscle dihydropyridine-sensitive calcium channel alpha(1)-subunit (CACNA1S). So far, three different mutations in CACNA1S gene have been identified in patients with hypoPP: Arg528His, Arg1239His and Arg1239Gly in Caucasian patients. However, there are few reports about the mutations of CACNA1S gene in other races. In this study, four Korean families with five hypoPP patients were screened for mutations of CACNA1S gene with polymerase chain reaction-based restriction analysis and single-strand conformation polymorphism analysis. To determine the mode of inheritance, haplotype analysis was done with three microsatellite markers (D1S1726, CACNL1A3, and D1S1723). Arg528His mutation was detected in three families, and one family had no known mutations. Moreover, for the first time, we detected de novo Arg528His mutations in two out of three families with hypoPP. Haplotype analysis using three microsatellite markers (D1S1726, CACNL1A3, and D1S1723) suggested the occurrence of de novo Arg528His mutations in two of the three families with Arg528His mutation. Arg528His mutations of CACNA1S, including de novo Arg528His mutations, were found in Korean patients with hypoPP. These results imply that de novo mutation, in addition to non-penetrance, is one of the genetic mechanisms that can explain the previous clinical observation that hypoPP occurs sporadically without family history.
Full Text Available Background: Celiac disease (CD is a common autoimmune disorder. Efficient identification of patients may improve chronic management of the disease. Prior studies have shown searching International Classification of Diseases-9 (ICD-9 codes alone is inaccurate for identifying patients with CD. In this study, we developed automated classification algorithms leveraging pathology reports and other clinical data in Electronic Health Records (EHRs to refine the subset population preselected using ICD-9 code (579.0. Materials and Methods: EHRs were searched for established ICD-9 code (579.0 suggesting CD, based on which an initial identification of cases was obtained. In addition, laboratory results for tissue transglutaminse were extracted. Using natural language processing we analyzed pathology reports from upper endoscopy. Twelve machine learning classifiers using different combinations of variables related to ICD-9 CD status, laboratory result status, and pathology reports were experimented to find the best possible CD classifier. Ten-fold cross-validation was used to assess the results. Results: A total of 1498 patient records were used including 363 confirmed cases and 1135 false positive cases that served as controls. Logistic model based on both clinical and pathology report features produced the best results: Kappa of 0.78, F1 of 0.92, and area under the curve (AUC of 0.94, whereas in contrast using ICD-9 only generated poor results: Kappa of 0.28, F1 of 0.75, and AUC of 0.63. Conclusion: Our automated classification system presented an efficient and reliable way to improve the performance of CD patient identification.
Lidya Wati Evelina
Full Text Available The objective of this article is to determine how event organizers collaborate with stakeholders including the media, particular community, sponsors, participants, venue providers, accommodation providers, carteres, legal and finance personnel, production, local trade, transportation providers, government and associations for implementation Public Relations event. This paper discusses about the things that must be done for the cooperation and the benefits of cooperation undertaken. The method used in this paper is qualitative research method based on observations, literature and case studies. The results of this research note that the event organizers or companies can together with the stakeholders (the other party make an event as mutually beneficial Public Relations. This means that all parties can achieve through the event. At the conclusion of an event Public Relations, all stakeholders involved for their own purposes. Event organizer must ensure that all stakeholders work together effectively in accordance with the agreed schedule and budget. One important feature of the agreement is to maintain a good flow of communication according to the needs of its stakeholders. All information is documented to avoid misunderstandings. Collaboration between stakeholders continuously until the event is completed. Discussion of issues that arise during the event takes place between the committee with various stakeholders is an important thing for the evaluation and response to the events that occurred.
This is a summary of the plenary sessions and small group discussion sessions from the fourth National Stakeholder Workshop sponsored by the DOE Office of Worker and Community Transition held in Atlanta, Georgia on March 13--15, 1996. Topics of the sessions included work force planning and restructuring, worker participation in health and safety, review of actions and commitments, lessons learned in collective bargaining agreements, work force restructuring guidance, work force planning, update on community transition activities. Also included are appendices listing the participants and DOE contacts.
Krol, D G H; de Kruif, J
As a result of recent reforms in Dutch health care, healthcare providers are having to operate more and more like commercial organisations and adopt some of the rules prevailing in the profit sector. Because missions statements can be an efficient means of useful communication with internal and external stakeholders they can make a useful contribution to the way healthcare institutions are managed and to their status and reputation. Research shows that in view of this the quality of the messages conveyed via mission statements is important. To ascertain which stakeholders are mentioned in the mission statements of Dutch mental healthcare providers and to quantify the quality of the messages conveyed to them via mission statements. We examined the mission statements of 34 mental health providers to find out which stakeholders were included. The message conveyed to the stakeholders was quantified by means of a validated measuring instrument devised specifically for this purpose. Patients were referred to in all mission statements and the quality of the messages conveyed was of higher quality than the messages conveyed to other stakeholders. Other important stakeholders on whom the institutions depended were referred to much less frequently and the quality of sections of text referring to them was definitely inferior. Mission statements frequently serve as management tool for Dutch mental healthcare providers. The potential benefits that these statements could bestow on the providers are not being fully exploited because the standard of communication with several internal and external stakeholders is of poor quality.
Nielsen, Camilla Palmhøj; Lauritsen, Sarah Wadmann; Kristensen, Finn Børlum; Bistrup, Marie Louise; Cecchetti, Americo; Turk, Eva
This article explains how the issue of stakeholder involvement was addressed in the European network for Health Technology Assessment (EUnetHTA) Project and describes the structures of future stakeholder involvement in the EUnetHTA Collaboration. Initiatives led to a dialogue with stakeholders and exchanging views and expectations on health technology assessment (HTA) processes and the future development of EUnetHTA. The methods of involving different stakeholder groups in EUnetHTA included general information to stakeholders about EUnetHTA, targeted information on a Web site, analysis of stakeholder opinions on HTA and EUnetHTA, and development of a draft stakeholder policy. First steps were taken to organize processes to consolidate the legitimacy of EUnetHTA and its products and encourage the representation of interests, thus contributing to promoting the utilization of HTA in national/regional policy making. A stakeholder Web site, analyses of stakeholder opinions on HTA and EUnetHTA in a discussion topic catalog, and a draft stakeholder policy resulted from the work. Stakeholder involvement in EUnetHTA is necessary to ensure the legitimacy and prospects for utilization of EUnetHTA and its products. The described activities and results create the foundation for a continued dialogue with, and involvement of, stakeholders. The EUnetHTA stakeholder meeting can be considered as a successful experience of dialogue between EUnetHTA and stakeholders, which should be continued. Our experience shows the challenge of obtaining balanced stakeholder representation across the identified stakeholder groups. Continued attention should be given to achieving balanced stakeholder representation.
Lloyd-Williams, Mari; Abba, Katharine; Crowther, Jacqueline
People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care. The review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and supportive care needs for people with dementia. These articles included consensus statements, models of care; studies of why models of care, for example Advanced Care Planning were not being implemented; and carer reports of care in the last year of life. Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.
Heckel, Maria; Herbst, Franziska A; Adelhardt, Thomas; Tiedtke, Johanna M; Sturm, Alexander; Stiel, Stephanie; Ostgathe, Christoph
Information lacks about institutional stakeholders' perspectives on management approaches of multidrug-resistant bacterial organism in end-of-life situations. The term "institutional stakeholder" includes persons in leading positions with responsibility in hospitals' multidrug-resistant bacterial organism management. They have great influence on how strategies on multidrug-resistant bacterial organism management approaches in institutions of the public health system are designed. This study targeted institutional stakeholders' individual perspectives on multidrug-resistant bacterial organism colonization or infection and isolation measures at the end of life. Between March and December 2014, institutional stakeholders of two study centers, a German palliative care unit and a geriatric ward, were queried in semistructured interviews. Interviews were audiotaped, transcribed verbatim, and analyzed qualitatively with the aid of the software MAXQDA for qualitative data analysis using principles of Grounded Theory. In addition, two external stakeholders were interviewed to enrich data. Key issues addressed by institutional stakeholders (N=18) were the relevance of multidrug-resistant bacterial organism in palliative and geriatric care, contradictions between hygiene principles and patients' and family caregivers' needs and divergence from standards, frame conditions, and reflections on standardization of multidrug-resistant bacterial organism end-of-life care procedures. Results show that institutional stakeholders face a dilemma between their responsibility in protecting third persons and ensuring patients' quality of life. Until further empirical evidence establishes a clear multidrug-resistant bacterial organism management approach in end-of-life care, stakeholders suggest a case-based approach. The institutional stakeholders' perspectives and their suggestion of a case-based approach advance the development process of a patient-, family-, staff-, and institutional
Tridandapani, Srini; Olsen, Kevin; Bhatti, Pamela
This study was conducted to determine whether facial photographs obtained simultaneously with radiographs improve radiologists' detection rate of wrong-patient errors, when they are explicitly asked to include the photographs in their evaluation. Radiograph-photograph combinations were obtained from 28 patients at the time of portable chest radiography imaging. From these, pairs of radiographs were generated. Each unique pair consisted of one new and one old (comparison) radiograph. Twelve pairs of mismatched radiographs (i.e., pairs containing radiographs of different patients) were also generated. In phase 1 of the study, 5 blinded radiologist observers were asked to interpret 20 pairs of radiographs without the photographs. In phase 2, each radiologist interpreted another 20 pairs of radiographs with the photographs. Radiologist observers were not instructed about the purpose of the photographs but were asked to include the photographs in their review. The detection rate of mismatched errors was recorded along with the interpretation time for each session for each observer. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between the two phases. A p value of error detection rates without (0/20 = 0%) and with (17/18 = 94.4%) photographs were different (p = 0.0001). The average interpretation times for the set of 20 radiographs were 26.45 (SD 8.69) and 20.55 (SD 3.40) min, for phase 1 and phase 2, respectively (two-tailed Student t test, p = 0.1911). When radiologists include simultaneously obtained photographs in their review of portable chest radiographs, there is a significant improvement in the detection of labeling errors. No statistically significant difference in interpretation time was observed. This may lead to improved patient safety without affecting radiologists' throughput.
Angel Guevara E.
Full Text Available An ELISA test was developed to detect Paragonimus-specific antibodies, including IgG subclasses, using P. mexicanus crude water-soluble antigens. The test was standardized to detect antibodies in sera of Ecuadorian patients with pulmonary paragonimiasis and negative controls from the endemic area. The detected mean levels of IgG (0.753, SEM: 0.074 and IgM (0.303, SEM: 0.033 were significantly elevated (P<0.05. Within the IgG subclasses, IgG4 showed the highest detected mean level (0.365, SEM: 0.116 and the other three subclasses showed considerably lower mean levels (IgG1, 0.186 SEM: 0.06; IgG2, 0.046 SEM: 0.01; IgG3, 0.123 SEM: 0.047. The number of P. mexicanus eggs found in sputum of infected individuals showed a positive correlation with the level of antibodies detected for IgM, IgG and its subclasses (P<0.001. The relevance of these findings in Ecuadorian patients suffering from pulmonary paragonimiasis is discussed.
Barrios, V; Escobar, C; Llisterri, J L; Rodríguez Roca, G; Badimón, J J; Vergara, J; Prieto, M Á; Serrano, A; Cinza, S; Murillo, C
To determine the prevalence and incidence of cardiovascular risk factors and cardiovascular events in Spain, as well as the quality of the follow-up in clinical practice. In this study the baseline data of the first interim analysis of IBERICAN are shown (n=830). IBERICAN is a multicenter, longitudinal and observational population-based study of patients daily attended in primary care setting according to clinical practice in Spain. Subjects between 18 and 85 years daily attended in primary care setting are being included consecutively. Treatment of patients will be performed according only to clinical criteria of investigators. Blood pressure control was defined according to 2013 European guidelines of hypertension; LDL-cholesterol control was defined according to 2012 European guidelines of cardiovascular prevention; diabetes control was defined as HbA1ccardiovascular risk factors with a poor control. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
Hofstra, W A; Hageman, G; de Weerd, A W
As early as in 1898, it was noted that there was a need to find "a plausible explanation of the long recognized affinities of migraine and epilepsy". However, results of recent studies are clearly conflicting on this matter. In this cross-sectional study, we aimed to define the prevalence and characteristics of both seizure-related and interictal headaches in patients with epilepsy (5-75years) seeking help in the tertiary epilepsy clinic SEIN in Zwolle. Using a questionnaire, subjects were surveyed on the existence of headaches including characteristics, duration, severity, and accompanying symptoms. Furthermore, details on epilepsy were retrieved from medical records (e.g., syndrome, seizure frequency, and use of drugs). Diagnoses of migraine, tension-type headache, or unclassifiable headache were made based on criteria of the International Classification of Headache Disorders. Between March and December 2013, 29 children and 226 adults were evaluated, 73% of whom indicated having current headaches, which is significantly more often when compared with the general population (pheadache, while 29% had solely seizure-related headaches and 22% had both. Migraine occurs significantly more often in people with epilepsy in comparison with the general population (pheadaches conforms to results in the general population. These results show that current headaches are a significantly more frequent problem amongst people with epilepsy than in people without epilepsy. When comparing migraine prevalence, this is significantly higher in the population of patients with epilepsy. Copyright © 2014 Elsevier Inc. All rights reserved.
The Canadian Energy Pipeline Association (CEPA) commissioned Ipsos-Reid to conduct a telephone survey to obtain an independent assessment of the level of knowledge and attitudes of four pipeline industry stakeholder groups in relation to Canada's pipeline industry and the individual member companies of CEPA. Included in the survey, which was conducted in the summer and fall of 2001, were 1000 people from the general population across Canada, 1,372 landowners who have CEPA member pipelines crossing their land, 400 adjacent landowners who own land within 2.5 km of a CEPA member pipeline, and 50 news media personnel. The survey revealed that there is a much higher level of knowledge than expected, and a positive attitude towards the energy pipeline industry. Results indicated that more than 80 per cent of landowners, adjacent landowners and the general public agree that Canadians can trust pipelines to safely transport oil and natural gas products across the country. A very strong percentage (88 to 97 per cent) of landowners agree that pipeline operators are generally good neighbours, that local pipeline companies are environmentally responsible and that the pipeline industry is necessary to transport energy products such as oil and natural gas across the country. 82 per cent of the adjacent landowners agree that pipeline companies make significant investments to maintain pipelines in Canada. As far as the general public is concerned, 95 per cent agree that the energy pipeline industry is important to the Canadian economy and 92 per cent believe pipeline incidents occur rarely or occasionally. 96 per cent of media also believe the economic impact of the pipeline industry is important to Canada and to local regions. CEPA's strategy is to raise awareness about pipeline safety, environmental performance and community involvement of the industry. The topics that survey respondents wanted to learn more about were: the economic impact of the energy pipeline industry
Bridoux, F.; Stoelhorst, J.W.
Instrumental stakeholder theory proposes a positive relationship between fairness toward stakeholders and firm performance. Yet, some firms are successful with an arms-length approach to stakeholder management, based on bargaining power rather than fairness. We address this puzzle by relaxing the
Interviews with stakeholders are one-to-one conversations about a specific topic or issue. The primary purpose of these interviews is to obtain project-relevant information and elicit stakeholder reactions and suggestions.
Canella, Claudia; Mikolasek, Michael; Rostock, Matthias; Beyer, Jörg; Guckenberger, Matthias; Jenewein, Josef; Linka, Esther; Six, Claudia; Stoll, Sarah; Stupp, Roger; Witt, Claudia M
Although cancer-related fatigue (CRF) has gained increased attention in the past decade, it remains difficult to treat. An integrative approach combining conventional and complementary medicine interventions seems highly promising. Treatment programs are more likely to be effective if the needs and interests of the people involved are well represented. This can be achieved through stakeholder engagement. The aim of the study was to develop an integrative CRF treatment program using stakeholder engagement and to compare it to an expert version. In a qualitative study, a total of 22 stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5 nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a local Swiss Cancer League) were interviewed either face-to-face or in a focus group setting. For data analysis, qualitative content analysis was used. With stakeholder engagement, the integrative CRF treatment program was adapted to usual care using a prioritizing approach and allowing more patient choice. Unlike the expert version, in which all intervention options were on the same level, the stakeholder engagement process resulted in a program with 3 different levels. The first level includes mandatory nonpharmacological interventions, the second includes nonpharmacological choice-based interventions, and the third includes pharmacological interventions for severe CRF. The resulting stakeholder based integrative CRF treatment program was implemented as clinical practice guideline at our clinic (Institute for Complementary and Integrative Medicine, University Hospital Zurich). Through the stakeholder engagement approach, we integrated the needs and preferences of people who are directly affected by CRF. This resulted in an integrative CRF treatment program with graded recommendations for interventions and therefore potentially greater sustainability in a usual care setting.
This paper presents stakeholder types involved in sustainable land management (SLM), their interests and ... (DAs), and Rural Kebele Administration (RKA) offices were major stakeholders involved in SLM activities in the ... Key words: Stakeholders; farmer-expert linkages; resource management; Ethiopia. Introduction.
Hansen, Morten Balle; Vedung, Evert
This article introduces a new approach to program theory evaluation called theory-based stakeholder evaluation or the TSE model for short. Most theory-based approaches are program theory driven and some are stakeholder oriented as well. Practically, all of the latter fuse the program perceptions of the various stakeholder groups into one unitary…
A Department of Defense acquisition program is influenced by a large number of external stakeholders, including operational users, oversight authorities, contractors and suppliers, and interfacing program managers...
Ray, Kristin N; Miller, Elizabeth
Stakeholder engagement is an emerging field with little evidence to inform best practices. Guidelines are needed to improve the quality of research on stakeholder engagement through more intentional planning, evaluation and reporting. We developed a preliminary framework for planning, evaluating and reporting stakeholder engagement, informed by published conceptual models and recommendations and then refined through our own stakeholder engagement experience. Our proposed exploratory framework highlights contexts and processes to be addressed in planning stakeholder engagement, and potential immediate, intermediate and long-term outcomes that warrant evaluation. We use this framework to illustrate both the minimum information needed for reporting stakeholder-engaged research and the comprehensive detail needed for reporting research on stakeholder engagement.
Full Text Available In an increasingly global and highly competitive business world of today, the business sector pays meticulous attention to stakeholders - groups or individuals, which affect or are affected by business decisions. The paper examines the methodology of identifying key stakeholders, demonstrates the process of their various mapping models, as well as the manner in which stakeholders, in cooperation with a corporation, create the opportunity to be engaged at an early stage of a project, activity or business decision, thus establishing a precedent according to which both sides benefit. By doing so, the business sector can ensure that its actions will receive 'a social licence to operate', whereas various groups of stakeholders will be offered a possibility to be included in business dealings for the sake of protecting their interests. The authors of the paper have analysed a two-way process of stakeholder management in establishing corporate reputation which is reflected in business performance and results. It was concluded that stakeholder engagement should foster innovation and lead to broader social prosperity, achieving the main goal of sustainability: business excellence according to the principles of the triple final result, by realizing synergy between the social community, environment and profit.
Zhao, Dong; McCoy, Andrew P; Kleiner, Brian M; Mills, Thomas H; Lingard, Helen
Safety management in construction is an integral effort and its success requires inputs from all stakeholders across design and construction phases. Effective risk mitigation relies on the concordance of all stakeholders' risk perceptions. Many researchers have noticed the discordance of risk perceptions among critical stakeholders in safe construction work, however few have provided quantifiable evidence describing them. In an effort to fill this perception gap, this research performs an experiment that investigates stakeholder perceptions of risk in construction. Data analysis confirms the existence of such discordance, and indicates a trend in risk likelihood estimation. With risk perceptions from low to high, the stakeholders are architects, contractors/safety professionals, and engineers. Including prior studies, results also suggest that designers have improved their knowledge in building construction safety, but compared to builders they present more difficultly in reaching a consensus of perception. Findings of this research are intended to be used by risk management and decision makers to reassess stakeholders' varying judgments when considering injury prevention and hazard assessment.
Full Text Available Stephen Wotman1, Catherine A Demko1, Kristin Victoroff1, Joseph J Sudano2, James A Lalumandier11Department of Community Dentistry, Case Western Reserve University, School of Dental Medicine, Cleveland, OH, USA; 2Center of Health Care Research and Policy, Case Western Reserve University, School of Medicine, Cleveland, OH, USAAbstract: This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist’s and half of the hygienist’s patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction.Keywords: dental practice, dental practice core activities, direct observation of dental practice, Dental Davis Observation Code, dentist, hygienist patient behaviors
Full Text Available Aims. To evaluate the prognostic significance of serum interleukin-6 (IL-6 in colorectal cancer (CRC. Patients and Methods. Preoperative serum IL-6 was measured in 233 CRC patients and 13 healthy controls. Relationships between IL-6 and various clinicopathological factors were evaluated, and the overall survival (OS and disease-free survival (DFS rates according to IL-6 status were calculated for all patients and according to disease stage. Results. The mean IL-6 level was 6.6 pg/mL in CRC patients and 2.6 pg/mL in healthy controls. Using a cutoff of 6.3 pg/mL, obtained using receiver operating characteristic curve analysis, 57 patients had a high IL-6 level. The mean value was higher for stage II disease than for stage III disease. IL-6 status correlated with C-reactive protein (CRP and carcinoembryonic antigen levels, obstruction, and pT4 disease. The OS differed according to the IL-6 status for all patients, whereas the DFS differed for all patients and for those with stage II disease. The Cox proportional hazards model showed that pT4 disease was an independent risk factor for recurrence in all CRC patients; IL-6, CRP, and pT4 were significant risk factors in stage II patients. Conclusions. The preoperative IL-6 level influences the risk of CRC recurrence.
Lu, Yingjie; Wu, Yang; Liu, Jingfang; Li, Jia; Zhang, Pengzhu
Background Health care social media used for health information exchange and emotional communication involves different types of users, including patients, caregivers, and health professionals. However, it is difficult to identify different stakeholders because user identification data are lacking due to privacy protection and proprietary interests. Therefore, identifying the concerns of different stakeholders and how they use health care social media when confronted with huge amounts of heal...
Shell Canada's social performance plan was outlined in this presentation. Stakeholder engagement is a key strategy in the company's response to the concerns and broader priorities of different groups and individuals affected by their operations. A review of the business and societal values of stakeholder engagement was presented. Key benefits include greater profitability; protection of the environment; effective resource management; community benefits; and the delivery of value to customers. It was suggested that a continuous engagement process helps companies to assess impacts and work on strategies to avoid and mitigate negative impacts. A framework for social performance management was presented. It was noted that accountability and transparency are key components of Shell's progress towards sustainable development, and their direct and indirect contributions to the communities and societies where they operate. The social impact of core business operations is now a focus of the company. Key concerns of the social performance plan include environmental and health impacts; land use and changes in local economies; cultural concerns; and infrastructure impacts. An outline of Shell's Listening and Responding Program was also provided. refs., tabs., figs
Salloum, Ramzi G; Shenkman, Elizabeth A; Louviere, Jordan J; Chambers, David A
One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE) is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. We conducted a systematic literature search (up to December 2016) of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s), healthcare setting, and implementation outcome. Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1) characterizing demand for therapies and treatment technologies (n = 32), (2) comparing implementation strategies (n = 22), (3) incentivizing workforce participation (n = 11), and (4) prioritizing interventions (n = 10). Stakeholders included providers (n = 27), patients (n = 25), caregivers (n = 5), and administrators (n = 2). The remaining studies (n = 16) engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators). The following implementation outcomes were discussed: acceptability (n = 75), appropriateness (n = 34), adoption (n = 19), feasibility (n = 16), and fidelity (n = 3). The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the past decade. As DCEs are more widely used as a
Fu, Xiaona; Yang, Haipo; Wei, Cuijie; Jiao, Hui; Wang, Shuo; Yang, Yanling; Han, Chunxi; Wu, Xiru; Xiong, Hui
Mutations in the fukutin-related protein (FKRP) gene have been associated with dystroglycanopathies, which are common in Europe but rare in Asia. Our study aimed to retrospectively analyze and characterize the clinical, myopathological and genetic features of 12 Chinese patients with FKRP mutations. Three patients were diagnosed with congenital muscular dystrophy type 1C (MDC1C) and nine patients were diagnosed with limb girdle muscular dystrophy type 2I (LGMD2I). Three muscle biopsy specimens had dystrophic changes and reduced glycosylated α-dystroglycan staining, and two showed reduced expression of laminin α2. Two known and 13 novel mutations were identified in our single center cohort. Interestingly, the c.545A>G mutation was found in eight of the nine LGMD2I patients as a founder mutation and this founder mutation in Chinese patients differs from the one seen in European patients. Moreover, patients homozygous for the c.545A>G mutation were clinically asymptomatic, a less severe phenotype than in compound heterozygous patients with the c.545A>G mutation. The 13 novel mutations of FKRP significantly expanded the mutation spectrum of MDC1C and LGMD2I, and the different founder mutations indicate the ethnic difference in FKRP mutations.
Palmhøj Nielsen, Camilla; Wadmann, Sarah; Børlum Kristensen, Finn
Objectives: This article explains how the issue of stakeholder involvement was addressed in the European network for Health Technology Assessment (EUnetHTA) Project and describes the structures of future stakeholder involvement in the EUnetHTA Collaboration. Methods: Initiatives led to a dialogue...... with stakeholders and exchanging views and expectations on health technology assessment (HTA) processes and the future development of EUnetHTA. The methods of involving different stakeholder groups in EUnetHTA included general information to stakeholders about EUnetHTA, targeted information on a Web site, analysis...... of stakeholder opinions on HTA and EUnetHTA, and development of a draft stakeholder policy. Results: First steps were taken to organize processes to consolidate the legitimacy of EUnetHTA and its products and encourage the representation of interests, thus contributing to promoting the utilization of HTA...
Kornum, Niels; Mühlbacher, Hans
This article introduces the special issue on multi-stakeholder virtual dialogue. Research as well as managerial practice in marketing has traditionally focused on single stakeholders and a one-way communication perspective. This special issue takes a novel approach by directing attention to the s......This article introduces the special issue on multi-stakeholder virtual dialogue. Research as well as managerial practice in marketing has traditionally focused on single stakeholders and a one-way communication perspective. This special issue takes a novel approach by directing attention...... success. While marketing literature increasingly recognizes that divers stakeholders have an impact on a company''s success, little is known about how virtual multi-stakeholder dialogue changes marketing research and management. This special issue provides insights on what roles stakeholders may play...
For the VIEWLS project an internet-based questionnaire on biofuels was distributed among a large group of stakeholders in the European Union, Accession Countries and the Americas in the second half of 2003. The purpose of the questionnaire was to collect information on stakeholders' opinion on biofuel related topics including the future potential of biofuels and drivers and barriers for the market introduction. Here the main results are presented. The results should only be regarded as indicative because no detailed statistical analysis was performed due to the difference in representation from different countries and stakeholder groups. (au)
For the VIEWLS project an internet-based questionnaire on biofuels was distributed among a large group of stakeholders in the European Union, Accession Countries and the Americas in the second half of 2003. The purpose of the questionnaire was to collect information on stakeholders' opinion on biofuel related topics including the future potential of biofuels and drivers and barriers for the market introduction. Here the main results are presented. The results should only be regarded as indicative because no detailed statistical analysis was performed due to the difference in representation from different countries and stakeholder groups
Charles, E; Bouby-Serieys, V; Thomas, P; Clément, J-P
Ageing is due to a progressive loss of the person's adaptation capability, whereas during this period environmental aggression increases. In the elderly, life events re-present a psychological traumatism that overwhelms the old person and related family, disrupting and fragilising homeostatic balance. A number of authors have suggested a possible link between life traumatisms and the dementia processes. The aim of this study is to reveal the presence of life traumatisms preceding the apparition of the dementia syndrome. This is a retrospective and comparative work based on the PIXEL study on complaints and demands from the principle informal caregivers of Alzheimer patients. It includes 565 patients presenting the criterion of dementia as defined by the DSM IV, and questionnaires filled out by the principle caregivers. One item of the questionnaire referred to life events which could have played a part in the development of the disorder. In a second stage, the reported events were classified into 4 distinct categories: loss, repeated or prolonged stress, psychotraumatism and depression-inducing events. The statistics were produced using SAS and Stat 10 software. Student's test, ANOVA and chi2-test were used. 372 caregivers answered the first item (65%); 76 of them believed there was no event while 296 related the disorder to one or several life events (79% of responders, 52% of the sample). These results confirm Persson and Clement's study which evidenced a higher frequency of stressing life events for subjects afflicted with dementia as compared with older people without any psychic disorder. Reported events and their respective frequency: spouse death (15.39%), parents' death (15%), familial difficulty (10.08%), anaesthesia (8.49%), child's death (4.42%), somatic disturbance (4%), depression (3.89%), retirement (3.89%), financial problems (2.65%), loneliness (2.65%), removal (1.76%), fall (1%), alcohol (0.8%), traumatism (0.53%), spouse care (0.35%), leaving for
de Brún, T; O'Reilly-de Brún, M; Van Weel-Baumgarten, E; Burns, N; Dowrick, C; Lionis, C; O'Donnell, C; Mair, F S; Papadakaki, M; Saridaki, A; Spiegel, W; Van Weel, C; Van den Muijsenbergh, M; MacFarlane, A
It is important for health care workers to know the needs and expectations of their patients. Therefore, service users have to be involved in research. To achieve a meaningful dialogue between service users, healthcare workers and researchers, participatory methods are needed. This paper describes how the application of a specific participatory methodology, Participatory Learning and Action (PLA) can lead to such a meaningful dialogue. In PLA all stakeholders are regarded as equal partners and collaborators in research.During 2011-2015, a European project called RESTORE used PLA in Austria, Greece, Ireland, The Netherlands and the UK to investigate how communication between primary health care workers and their migrant patients could be improved.Seventy eight migrants, interpreters, doctors, nurses and other key stakeholders (see Table 2) participated in 62 PLA sessions. These dialogues (involving discussions, activities, PLA techniques and evaluations) were generally 2-3 h long and were recorded and analysed by the researchers.Participants reported many positive experiences about their dialogues with other stakeholders. There was a positive, trusting atmosphere in which all stakeholders could express their views despite differences in social power. This made for better understanding within and across stakeholder groups. For instance a doctor changed her view on the use of interpreters after a migrant explained why this was important. Negative experiences were rare: some doctors and healthcare workers thought the PLA sessions took a lot of time; and despite the good dialogue, there was disappointment that very few migrants used the new interpreting service. Background In order to be effective, primary healthcare must understand the health needs, values and expectations of the population it serves. Recent research has shown that the involvement of service users and other stakeholders and gathering information on their perspectives can contribute positively to many
Scientists, politicians, the public, school children, our neighbours, you. All of these groups of people have a stake in CERN, and all are important to us. The list of stakeholders in an organisation as large and complex as CERN is a long and ever lengthening one. Each group has its own specific interests and needs in terms of what kind of information it requires from CERN and how we should engage. It’s important, therefore, for us to ensure that we’re communicating optimally with everyone we care about and who cares about us. This is something that CERN has always taken seriously. The CERN Courier, for example, was first published in 1959 and we had a pro-active public information office right from the start. Today, our stakeholder relations are spread between several groups and teams, reflecting the nature of CERN today. But while we’re already doing a good job, I think we can do better by exploiting the synergies between these teams, and that’s wh...
Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services.
Haines, Terry P; O'Brien, Lisa; Mitchell, Deb; Bowles, Kelly-Ann; Haas, Romi; Markham, Donna; Plumb, Samantha; Chiu, Timothy; May, Kerry; Philip, Kathleen; Lescai, David; McDermott, Fiona; Sarkies, Mitchell; Ghaly, Marcelle; Shaw, Leonie; Juj, Genevieve; Skinner, Elizabeth H
Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service. Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism
Bettmann, Michael A; Oikarinen, Helja; Rehani, Madan; Holmberg, Ola; del Rosario Perez, Maria; Naidoo, Anusha; Do, Kyung-Hyun; Dreyer, Keith; Ebdon-Jackson, Steve
The effective development and use of clinical imaging guidelines requires an understanding of who the stakeholders are, what their interests in the process are, and what roles they should play. If the appropriate stakeholders are not engaged in the right roles, it is unlikely that clinical imaging guidelines will be successfully developed, relied on, and actually used. Some stakeholders are obvious: for the development of clinical imaging guidelines, both imagers and those who request examinations, such as general practitioners, internists, and medical specialists, must be involved. To gain acceptance, other relevant groups are stakeholders, including medical societies, other health care professionals, insurers, health IT experts and vendors, and patients. The role of stakeholders must be dictated by their specific interest. For some, involvement in the creation of guidelines is the right role. For others, such as regulators or insurers, reviews or invitations to comment are required, and for others, such as medical educators, it is probably sufficient to provide information and create awareness. Only through a careful consideration of who the stakeholders are and what are their interests are the successful development, acceptance, and use of clinical imaging guidelines likely to occur. Future efforts must focus on collaboration, particularly among groups that create clinical imaging guidelines and those that can support their use, and on regulatory roles and mandates. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Gold, Sara K. Tedford; Abelson, Julia; Charles, Cathy A.
Abstract Objective To explore the extent and manner of patient participation in the planning of regional supportive care networks throughout the province of Ontario. We consider the disconnect between the rhetoric and reality of patient involvement in network planning and co‐ordination. Context In 1997, the Province of Ontario, Canada, established a new, regionalized cancer care system. By transferring responsibility to the regional level and to networks, the architects of the new provincial system hoped to broaden participation in decision making and to enhance the responsiveness of decisions to communities. Research approach Through a qualitative, multiple case study approach we evaluated the processes of involving patients in network development. In‐depth, semi‐structured interviews and document analysis were complemented by observations of provincial meetings, regional council and network meetings. Results The network development processes in the three case study regions reveal a significant gap between intentions to involve patients in health planning and their actual involvement. This gap can be explained by: (i) a lack of clear direction regarding networks and patient participation in these networks; (ii) the dominance of regional cancer centres in network planning activities; and, (iii) the emergence of competing provincial priorities. Discussion These three trends expose the complexity of the notion of public participation and how it is embedded in social and political contexts. The failed attempt at involving patients in health planning efforts is the result of benign neglect of public participation intents and the social and political contexts in which public and patient participation is meant to occur. PMID:16098150
Ewan, Lindsay A; McLinden, Daniel; Biro, Frank; DeJonckheere, Melissa; Vaughn, Lisa M
Health research that includes youth and family stakeholders increases the contextual relevance of findings, which can benefit both the researchers and stakeholders involved. The goal of this study was to identify youth and family adolescent health priorities and to explore strategies to address these concerns. Stakeholders identified important adolescent health concerns, perceptions of which were then explored using concept mapping. Concept mapping is a mixed-method participatory research approach that invites input from various stakeholders. In response to prompts, stakeholders suggested ways to address the identified health conditions. Adolescent participants then sorted the statements into groups based on content similarity and rated the statements for importance and feasibility. Multidimensional scaling and cluster analysis were then applied to create the concept maps. Stakeholders identified sexually transmitted infections (STIs) and obesity as the health conditions they considered most important. The concept map for STIs identified 7 clusters: General sex education, support and empowerment, testing and treatment, community involvement and awareness, prevention and protection, parental involvement in sex education, and media. The obesity concept map portrayed 8 clusters: Healthy food choices, obesity education, support systems, clinical and community involvement, community support for exercise, physical activity, nutrition support, and nutrition education. Ratings were generally higher for importance than for feasibility. The concept maps demonstrate stakeholder-driven ideas about approaches to target STIs and obesity in this context. Strategies at multiple social ecological levels were emphasized. The concept maps can be used to generate discussion regarding these topics and to identify interventions. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Rasmussen, Eva R; Valente de Freitas, Priscila; Bygum, Anette
Erythema marginatum is a characteristic skin rash seen in patients with hereditary angioedema (HAE); however, it can be confused with urticaria, leading to delay in correct diagnosis. The aim of this study was to clarify how often erythema marginatum is misinterpreted as urticaria, potentially...
Leticee, Nadia; Viard, Jean-Paul; Yamgnane, Amina; Karmochkine, Marina; Benachi, Alexandra
Contraception for HIV-positive women is a complex issue. Although the use of condoms is recommended, complementary methods of contraception are often prescribed. Antiretroviral therapy can lead to drug interactions and modify the efficacy of hormonal contraception. Two unintended pregnancies suggest that etonogestrel implants should be used with caution in patients on efavirenz. Copyright Â© 2012 Elsevier Inc. All rights reserved.
Full Text Available Background/Aims: Risk factor studies for acute kidney injury (AKI in China are lacking, especially those regarding non-traditional risk factors, such as laboratory indicators. Methods: All adult patients admitted to 38 tertiary and 22 secondary hospitals in China in any one month between July and December 2014 were surveyed. AKI patients were screened according to the Kidney Disease: Improving Global Outcomes’ definition of AKI. Logistic regression was used to analyze the risk factors for AKI, and Cox regression was used to analyze the risk of in-hospital mortality for AKI patients; additionally, a propensity score analysis was used to reconfirm the risk factors among laboratory indicators for mortality. Results: The morbidity of AKI was 0.97%. Independent risk factors for AKI were advancing age, male gender, hypertension, and chronic kidney disease. All-cause mortality was 16.5%. The predictors of mortality in AKI patients were advancing age, tumor, higher uric acid level and increases in Acute Physiologic Assessment and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. The hazard ratio (HR for mortality with uric acid levels > 9.1 mg/dl compared with ≤ 5.2 mg/dl was 1.78 (95% CI: 1.23 to 2.58 for the AKI patients as a group, and was 1.73 (95% CI: 1.24 to 2.42 for a propensity score-matched set. Conclusion: In addition to traditional risk factors, uric acid level is an independent predictor of all-cause mortality after AKI.
For health care, economists have developed cost-effectiveness analysis (CEA) as a "rational," analytic tool to set priorities. Attempts to use CEA to decide how to cut expenditures, however, have been met with stakeholders' resistance. This article presents an illustrative case study of the application of an approach explicitly designed to engage stakeholders with conflicting objectives in confronting tightening budgets. The outcome of this process, which engaged a group of stakeholders including patients, caregivers, clinicians, and managers, was a strategy that reconfigured services to produce more health gain at reduced total cost. I argue that the key factors that led to overcoming resistance to change were (1) the collective character of the deliberations; (2) the analysis of the whole pathway; (3) the presence of patients; and (4) the development of a model based on CEA principles, which provided a credible rationale for difficult decisions.
Ballman, Kathleen; Garritano, Nicole; Beery, Theresa
Using standardized patients (SP) presenting with a specific complaint has been a mainstay in health care education. Increased use of technology has facilitated the move of instruction from the on-campus classroom to distance learning for many nurse practitioner programs. Using interactive case studies provides distance learners SP encounters. This technologically facilitated encounter gives the distance learner the opportunity for integrative thinking and development of problem solving and clinical reasoning skills.
Stolk-Vos, Aline C; van de Klundert, Joris J; Maijers, Niels; Zijlmans, Bart L M; Busschbach, Jan J V
To develop a method to define a multi-stakeholder perspective on health-service quality that enables the expression of differences in systematically identified stakeholders' perspectives, and to pilot the approach for cataract care. Mixed-method study between 2014 and 2015. Cataract care in the Netherlands. Stakeholder representatives. We first identified and classified stakeholders using stakeholder theory. Participants established a multi-stakeholder perspective on quality of cataract care using concept mapping, this yielded a cluster map based on multivariate statistical analyses. Consensus-based quality dimensions were subsequently defined in a plenary stakeholder session. Stakeholders and multi-stakeholder perspective on health-service quality. Our analysis identified seven definitive stakeholders, as follows: the Dutch Ophthalmology Society, ophthalmologists, general practitioners, optometrists, health insurers, hospitals and private clinics. Patients, as dependent stakeholders, were considered to lack power by other stakeholders; hence, they were not classified as definitive stakeholders. Overall, 18 stakeholders representing ophthalmologists, general practitioners, optometrists, health insurers, hospitals, private clinics, patients, patient federations and the Dutch Healthcare Institute sorted 125 systematically collected indicators into the seven following clusters: patient centeredness and accessibility, interpersonal conduct and expectations, experienced outcome, clinical outcome, process and structure, medical technical acting and safety. Importance scores from stakeholders directly involved in the cataract service delivery process correlated strongly, as did scores from stakeholders not directly involved in this process. Using a case study on cataract care, the proposed methods enable different views among stakeholders concerning quality dimensions to be systematically revealed, and the stakeholders jointly agreed on these dimensions. The methods
Szendroe, G.; Axelsson, B.; Leitz, W.
The radiation burden from CT-examinations is still growing in most countries and has reached a considerable part of the total from medical diagnostic x-ray procedures. Efforts for avoiding excess radiation doses are therefore especially well motivated within this field. A survey of CT-examination techniques practised in Sweden showed that standard settings for the exposure variables are used for the vast majority of examinations. Virtually no adjustments to the patient's differences in anatomy have been performed - even for infants and children on average the same settings have been used. The adjustment of the exposure variables to the individual anatomy offers a large potential of dose savings. Amongst the imaging parameters, a change of the radiation dose will primarily influence the noise. As a starting point it is assumed that, irrespective of the patient's anatomy, the same level of noise can be accepted for a certain diagnostic task. To a large extent the noise level is determined by the number of photons that are registered in the detector. Hence, for different patient size and anatomy, the exposure should be adjusted so that the same transmitted photon fluence is achieved. An appendix with a ready reckoner for dose estimation for CT-scanners used in Sweden is attached. 7 refs, 5 figs, 8 tabs
The aim of this study is to examine stakeholder involvement in an Enterprise Resource Planning (ERP) System project that involves implementation and improvement of the implemented system. The study targets stakeholders, their classification, and their degree of importance during different phases of an ERP project life cycle, i.e. planning, implementation, stabilisation and improvement. The study shows that stakeholder involvement and their salience vary along the ERP project life cycle a...
Md. Mashiur Rahman
Full Text Available In every life cycle of the project there are numerous people or organizations involved either directly or indirectly. While these type of people and organizations involved are called stakeholders and these may include the project team, client or customer, community, environment, suppliers, government. Stakeholders contribute and share their experiences, knowledge, and insights to support the project throughout its life cycle and therefore it is crucial to capture their input. However, before initiation of the project, stakeholders need to be identified. Following the fact that there are strategies and processes for stakeholder identification, it is not clear what skills are needed to employ those strategies for stakeholder identification. These skills are exceedingly important to have because in today's corporate world, the project team must be flexible in every aspect of their job and be able to complement their skills for the success of stakeholder identification. Using literature review, this paper seeks to describe the skills of project leader needed to identify the project team and the external stakeholders. Inductive approach was followed in this study and data was collected qualitatively using secondary sources. There are two essential skills i.e. relationship building skills and communication skills for internal stakeholders and four major skills i.e. communication skills, people skills, intellectual skills and conceptual skills for external stakeholders are identified for the identification of project stakeholders through literature review considering the sustainability issues in the project management.
Riyarto, Sigit; Hidayat, Budi; Johns, Benjamin; Probandari, Ari; Mahendradhata, Yodi; Utarini, Adi; Trisnantoro, Laksono; Flessenkaemper, Sabine
This paper assesses the extent of the financial burden due to out-of-pocket payments for health care incurred by people living with HIV (PLHIV) and the effect of this burden on their financial capacity. Data were collected in a cross-sectional survey of 353 PLHIV from three cities in Indonesia (Jakarta, Jogjakarta and Merauke). Respondents in Jakarta were sampled from one hospital and one non-governmental organization working with PLHIV. In Jogjakarta and Merauke, all HIV patients on antiretroviral therapy (ART) who came to selected hospitals during the interview period were asked to participate in the survey. The survey collected data on the frequency and extent of payments for HIV-related care, with answers cross-checked against medical records. Results show that PLHIV had different burdens of payments in the different geographical areas. On average, respondents in Jogjakarta spent 68%, and PLHIV on ART in Jakarta spent 96%, of monthly expenditure for HIV-related care, indicating a substantial financial burden for many ART patients. These patients depended on several sources of finance to cover the costs of their care, with donations from their immediate family being the most common method, selling assets and payments from personal income being the second most common method in Jakarta and Jogjakarta, respectively. Most PLHIV in these two areas did not have insurance. In Merauke, there were little observed out-of-pocket payments because the government covers medical costs via the local budget and health insurance for the poor. The results of this study confirm previous findings that providing subsidized ART drugs alone does not ensure financial accessibility to HIV care. Thus, the government of Indonesia at central and local levels should consider covering HIV care additional to providing antiretroviral drugs free of charge. Social health insurance should also be encouraged.
Bordeaux, Jeremy S; Martires, Kathryn J; Goldberg, Dori; Pattee, Sean F; Fu, Pingfu; Maloney, Mary E
Few prospective studies have evaluated the safety of dermatologic surgery. We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use. Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded. Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae. The study was limited to one academic dermatology practice. The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Miller, B.; Sinclair, J. [Elon University, Elon, NC (United States). School Community
Focus group research was used to examine how community stakeholders, a group with local industry experience, responded to coal industry advocacy messages. The stakeholders expressed beliefs about both the advertiser and the coal industry, and while their knowledge led to critical consideration of the industry campaign, they also expressed a desire to identify with positive messages about their community. Applying a postpositivist research perspective, a new model is introduced to integrate these beliefs in terms of advertiser trust and industry accountability under the existing theoretical framework of persuasion knowledge. Agent and topic knowledge are combined in this model based on responses to the industry advocacy campaign. In doing so, this study integrates a priori theory within a new context, extending the current theoretical framework to include an understanding of how community stakeholders - a common target for marketplace advocacy - interpret industry messages.
Merchant, Thomas E.; Kiehna, Erin N.; Li Chenghong; Shukla, Hemant; Sengupta, Saikat; Xiong Xiaoping; Gajjar, Amar; Mulhern, Raymond K.
Purpose: Model the effects of radiation dosimetry on IQ among pediatric patients with central nervous system (CNS) tumors. Methods and Materials: Pediatric patients with CNS embryonal tumors (n = 39) were prospectively evaluated with serial cognitive testing, before and after treatment with postoperative, risk-adapted craniospinal irradiation (CSI) and conformal primary-site irradiation, followed by chemotherapy. Differential dose-volume data for 5 brain volumes (total brain, supratentorial brain, infratentorial brain, and left and right temporal lobes) were correlated with IQ after surgery and at follow-up by use of linear regression. Results: When the dose distribution was partitioned into 2 levels, both had a significantly negative effect on longitudinal IQ across all 5 brain volumes. When the dose distribution was partitioned into 3 levels (low, medium, and high), exposure to the supratentorial brain appeared to have the most significant impact. For most models, each Gy of exposure had a similar effect on IQ decline, regardless of dose level. Conclusions: Our results suggest that radiation dosimetry data from 5 brain volumes can be used to predict decline in longitudinal IQ. Despite measures to reduce radiation dose and treatment volume, the volume that receives the highest dose continues to have the greatest effect, which supports current volume-reduction efforts
Hansen, Steffen Foss
In order to facilitate stakeholder discussions on how to regulate nanotechnology, the opensource program multicriteria mapping (MCM) was used to structure 26 interviews with stakeholders in the USA. MCM offers a systematic part quantitative, part qualitative approach to clarify why some regulatory options (bans, moratoriums, voluntary measures, etc.) were deemed to be acceptable/unacceptable by various stakeholders and which criteria stakeholders used to evaluate the different regulatory options. Adopting an incremental approach and implementing a new regulatory framework was evaluated as the best options whereas a complete ban and no additional regulation of nanotechnology were found to be the least favorable. Criteria applied differed substantially among stakeholders and included social, ethical, regulatory, environmental, and health issues. Opinions on future regulation seem far less polarized than expected and it seems that stakeholders would welcome a combination of voluntary measures, an incremental approach and forming of a new regulatory framework.
Reiman, M P; Thorborg, K; Covington, K
for diagnosis and assessment of FAIS. Diagnostic imaging was the domain with the highest level of agreement. Domains such as patient-reported outcome measures (PRO's) and physical examination were identified as non-diagnostic measures (rather as assessments of disease impact). CONCLUSION: Although it also had...... the greatest level of variability in description of examination domains, diagnostic imaging continues to be the preeminent diagnostic measure for FAIS. No single domain should be utilized as the sole diagnostic or assessment parameter for FAIS. While not all investigated domains provide diagnostic capability...... for FAIS, those that do not are able to serve purpose as a measure of disease impact (e.g., impairments and activity limitations). The clinical relevance of this Delphi survey is the understanding that a comprehensive assessment measuring both diagnostic capability and disease impact most accurately...
Abe, James; Lobo, Jennifer M; Trifiletti, Daniel M; Showalter, Timothy N
Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. A range of stakeholders provided valuable insights regarding the design of a personalized decision
Scholtens, B.; Zhou, Y.
We analyze how shareholder performance can be associated with stakeholder relations. As such, we try to find out whether there is an association between financial performance and stakeholder relations with respect to different theoretical notions about the firm. Financial performance is
Jordan, Matt; Chrislip, David; Workman, Emily
Stakeholder engagement and collaboration are essential to the development of an effective state plan. Engaging a diverse group of stakeholders tasked with working together to create education policies that will have a positive, lasting impact on students is not as easy as it sounds. Experts in the field argue that the traditional stakeholder…
Eriksen, Rikke Augustinus; Morsing, Mette
Based on a systematic data collection we study one of the first pioneering company-stakeholder communication campaigns in social media: the case of energy company Vattenfall A/S’s pan-European campaign ‘The Climate Manifesto’. Our findings challenge the general assumption, that stakeholder intera...
Mehta, Saurabh; Fawzi, Wafaie
increase lymphoid cell differentiation, which leads to an increase in CCR5 receptors. These receptors are essential for attachment of HIV to the lymphocytes and therefore, an increase in their number is likely to increase HIV replication. Vitamin A supplementation in HIV-infected children, on the other hand, has been associated with protective effects against mortality and morbidity, similar to that seen in HIV-negative children. The risk for lower respiratory tract infection and severe watery diarrhea has been shown to be lower in HIV-infected children supplemented with vitamin A. All-cause mortality and AIDS-related deaths have also been found to be lower in vitamin A-supplemented HIV-infected children. The benefits of multivitamin supplementation, particularly vitamins B, C, and E, have been more consistent across studies. Multivitamin supplementation in HIV-infected pregnant mothers has been shown to reduce the incidence of adverse pregnancy outcomes such as fetal loss and low birth weight. It also has been shown to decrease rates of MTCT among women who have poor nutritional or immunologic status. Further, multivitamin supplementation reduces the rate of HIV disease progression among patients in early stage of disease, thus delaying the need for ART by prolonging the pre-ART stage. In brief, there is no evidence to recommend vitamin A supplementation of HIV-infected pregnant women; however, periodic vitamin A supplementation of HIV-infected infants and children is beneficial in reducing all-cause mortality and morbidity and is recommended. Similarly, multivitamin supplementation of people infected with HIV, particularly pregnant women, is strongly suggested.
Franz, Nancy K.
A hallmark of Extension includes the involvement of stakeholders in research and program needs assessment, design, implementation, evaluation, and reporting. A data party can be used to enhance this stakeholder involvement specifically in data analysis. This type of event can not only increase client participation in Extension programming and…
Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett
Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.
Demand for stakeholder involvement has become imperative in the field of radioactive waste management. Providing for fair and competent stakeholder involvement, however, raises several questions of practice, for example: How to address issues raised by stakeholders? How to take stakeholders' views into consideration if they are divergent or conflicting? This paper reviews eight case studies prepared for the Topical Session on Addressing Issues Raised by Stakeholders, aimed at analysing the impacts of stakeholder involvement on decisions in RWM organisations. The studies outline the experiences of the following organisations: Canadian Nuclear Safety Commission (CNSC); Canadian Nuclear Waste Management Organization (NWMO); Nuclear Waste Management Organisation of Japan (NUMO); Posiva, Finland; Radioactive Waste Repository Authority, Czech Republic (RAWRA); Swedish Radiation Protection Authority (SSI); United Kingdom Environment Agency; United States Environmental Protection Agency (EPA). Case study reports are included in the Annex of this volume. The paper outlines the main trends and lessons learned from the above case studies. The first section focuses on impacts of stakeholder involvement on specific RWM decisions regarding policy and process. Examples presented in the second section illustrate how stakeholders' concerns may influence general decision-making practices and organisational behaviour. In the third section various approaches to handling divergent stakeholder views are introduced. The paper concludes with recommendations extracted and derived from the eight reports. (author)
Virgolesi, M; Marchetti, A; Piredda, M; Pulimeno, A M L; Rocco, G; Stievano, A; De Marinis, M G
In literature, there is evidence that all stakeholders need to be involved in the curricula building process to make sure that health professionals are "educated" to meet the stakeholders' "demands". In Italy, the involvement of stakeholders in the definition of university curricula is ratified by various regulations. To describe the major experiences of stakeholder involvement in nursing education, identify the main stakeholders for nursing education, and the processes in which they are involved. The search strategy included an electronic exploration of the relevant databases. The search terms were: Stakeholders, Curriculum, Nursing Education combined with Boolean operators. The references of the retrieved articles were hand searched for additional related studies. Most of the studies identified were from the United Kingdom, Australia, and the USA. In Italy, no relevant studies were found. The most frequently identified stakeholders were: students, clinicians, educators, nurse managers. They were mainly involved during profound changes in the curricula and the implementation of new educational approaches. Stakeholders are mostly involved in countries with a private funding system for universities. Such funding systems have probably developed in the academia a greater propensity to involve stakeholders, to provide recognition of success when starting new programs, and are perceived more as marketing research. This seems contrary to the spirit of the Italian and European regulatory interventions, which instead, provide a structured commitment to consolidating and expanding the collaboration among universities, users, and the world of labor. This latter collaboration should facilitate internship activities, lifelong learning, and employability of the newly-graduated professionals.
On June 17--18, 1998, the Department of Energy`s (DOE) Office of Worker and Community Transition convened its sixth National Stakeholder Workshop at the Ramada Plaza Hotel Old Town in Alexandria, Virginia. Approximately 325 stakeholders attended representing DOE headquarters and field offices, contractors, labor organizations, state and local government, education and community interest groups. The meeting addressed the progress made on the issues and challenges identified at the last stakeholder`s meeting in Oakland, California on April 9--11, 1997. Also discussed were the full range of the Department`s work force issues and creative solutions to the inherent challenges of simultaneously implementing the Department`s post Cold-War mission, work force restructuring guidance, contract reform objectives, asset disposition, performance-based management requirements, and business process improvement policies. The format of the Workshop included several plenary sessions and a number of small group discussion sessions. The small group sessions focused on topics related to labor issues, work force restructuring, work force planning, community transition, and employee concerns. The sessions provided a wide range of views on worker and community transition issues. The plenary sessions of the Workshop included presentations on the following topics: welcome and introductions; opening remarks; building a better labor-management relationship; keynote speech from Secretary of Energy Federico Pena; meeting tomorrow`s challenges (early site closures); harnessing the contracting process to encourage local growth; and, the British experience in economic conversion.
Reinwald, Anja Kaldahl; Kræmmergaard, Pernille
). This paper contributes to this literature by reporting the findings from a case study in a Danish local government who has reached the stage of transformational government. Using a grounded theory approach, information about the local government was initially collected and further analyzed within...... a stakeholder perspective. The paper reports how they succeeded in involving the most important stakeholders in the process of reaching transformational government. Finally the paper offers six lessons learned, based on the case study, about how to manage the involved stakeholders to reach transformational...
Gjerdrum Pedersen, Esben Rahbek; Hove Henriksen, Morten; Frier, Claus
Purpose – The objective of the paper is to describe and discuss how the biotech company Novozymes integrates stakeholder thinking into everyday sustainability practices. Design/methodology/approach – The paper is based on first-hand experiences as well as secondary information from Novozymes...... to make sense of stakeholder thinking. Originality/value – The contribution of this paper is to provide a detailed analysis of how various stakeholder relations management methods can be used in practice to integrate sustainability in an organisation....
Mosavi, Firas; Laurell, Anna; Ahlström, Håkan
Whole body (WB) magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) has become increasingly utilized in cancer imaging, yet the clinical utility of these techniques in follow-up of testicular cancer patients has not been evaluated. The purpose of this study was to evaluate the feasibility of WB MRI with continuous table movement (CTM) technique, including multistep DWI in follow-up of patients with testicular cancer. WB MRI including DWI was performed in follow-up of 71 consecutive patients (median age, 37 years; range 19-84) with histologically confirmed testicular cancer. WB MRI protocol included axial T1-Dixon and T2-BLADE sequences using CTM technique. Furthermore, multi-step DWI was performed using b-value 50 and 1000 s/mm(2). One criterion for feasibility was patient tolerance and satisfactory image quality. Another criterion was the accuracy in detection of any pathological mass, compared to standard of reference. Signal intensity in DWI was used for evaluation of residual mass activity. Clinical, laboratory and imaging follow-up were applied as standard of reference for the evaluation of WB MRI. WB MRI was tolerated in nearly all patients (69/71 patients, 97%) and the image quality was satisfactory. Metal artifacts deteriorated the image quality in six patients, but it did not influence the overall results. No case of clinical relapse was observed during the follow-up time. There was a good agreement between conventional WB MRI and standard of reference in all patients. Three patients showed residual masses and DWI signal was not restricted in these patients. Furthermore, DWI showed abnormally high signal intensity in a normal-sized retroperitoneal lymph node indicating metastasis. The subsequent (18)F-FDG PET/CT could verify the finding. WB MRI with CTM technique including multi-step DWI is feasible in follow-up of patients with testicular cancer. DWI may contribute to important added-value data to conventional MRI sequences
A. V. Mordyk
Full Text Available Abstract. In order to optimize the detection and diagnosis of genital tuberculosis evaluation of the specific local antituberculosis immunity in 39 patients with infertility entered to the Department of Gynecology for the implementation of therapeutic and diagnostic laparoscopy has been carried out. All patients were divided into 3 groups: the 1st one included patients with tubal-peritoneal infertility, the group 2 included patients with infertility not associated with the defeat of the fallopian tubes, the third group was presented by patients with tubal-peritoneal infertility associated with genital tuberculosis who completed the basic course of anti-tuberculosis treatment. It was established that in case of the tubal-peritoneal infertility the local humoral immunity was characterised by increasing of IgM in the whole peritoneal fluid. Among women who recovered from genital tuberculosis increasing of IgA and IgG to M. tuberculosis was revealed in contrast to patients with infertility not associated with damage of fallopian tubes (p < 0.05. In 25% of patients of the 1st group genital tuberculosis was diagnosed. The diagnostic criteria for early detection of genital tuberculosis were determined and the algorithm of genital tuberculosis identification have been proposed.
Kilpatrick, Kelley; Jabbour, Mira; Fortin, Chantal
To explore patient and family perceptions of team effectiveness of teams those include nurse practitioners in acute and primary care. Nurse practitioners provide safe and effective care. Patients are satisfied with the care provided by nurse practitioners. Research examining patient and family perceptions of team effectiveness following the implementation of nurse practitioners in teams is lacking. A descriptive qualitative design was used. We used purposeful sampling to identify participants in four clinical specialties. We collected data from March 2014-January 2015 using semi-structured interviews and demographic questionnaires. Content analysis was used. Descriptive statistics were generated. Participants (n = 49) believed that the teams were more effective after the implementation of a nurse practitioner and this was important to them. They described processes that teams with nurse practitioners used to effectively provide care. These processes included improved communication, involvement in decision-making, cohesion, care coordination, problem-solving, and a focus on the needs of patients and families. Participants highlighted the importance of interpersonal team dynamics. A human approach, trust, being open to discussion, listening to patient and family concerns and respect were particularly valued by participants. Different processes emerged as priorities when data were examined by speciality. However, communication, trust and taking the time to provide care were the most important processes. The study provides new insights into the views of patients and families and micro-level processes in teams with nurse practitioners. The relative importance of each process varied according to the patient's health condition. Patients and providers identified similar team processes. Future research is needed to identify how team processes influence care outcomes. The findings can support patients, clinicians and decision-makers to determine the processes to focus on to
Hornack, Sarah E; Yates, Brian T
Gender-sensitive services (GSS) attempt to make substance use treatment better for women, but at what cost and with what results? We sought answers to these questions in a federally-funded study by measuring separately the patient and provider costs of adding GSS, outcomes, and cost-outcome relationships for 12 mixed-gender intensive inpatient programs (IIP) that varied in amounts and types of GSS. GSS costs to female inpatients included time devoted to GSS and expenses for care of dependents while in the IIP. GSS costs to providers included time spent with patients, indirect services, treatment facilities, equipment, and materials. Offering more GSS was expected to consume more patient and provider resources. Offering more GSS also was expected to enhance outcomes and cost-outcome relationships. We found that average GSS costs to patients at the IIPs were $585 ($515-$656) per patient. Average GSS costs to providers at the IIPs were $344 ($42-$544) per patient. GSS costs to patients significantly exceeded GSS costs to providers. Contrary to previous research, offering more GSS services to patients did not result in significantly higher costs to patients or providers. IIPs offering more GSS may have delivered fewer traditional services, but this did not significantly affect outcomes, i.e., days until returning to another substance use treatment. In fact, median cost-outcome for these IIPs was a promising 35 treatment-free days, i.e., over a month, per $100 of GSS resources used by patients and providers. Copyright © 2017 Elsevier Ltd. All rights reserved.
Despite the increasing promotion of stakeholder engagement in science contributing to environmental decision making, the mechanisms for identifying which stakeholders should be included are rarely strategic or documented. When documented, many of these efforts use ad hoc and/or ...
Even as stakeholder engagement in systems dynamic modeling efforts is increasingly promoted, the mechanisms for identifying which stakeholders should be included are rarely documented. Accordingly, for an Environmental Protection Agency’s Triple Value Simulation (3VS) mode...
Bracke, M.B.M.; Greef, de K.H.; Hopster, H.
Continued concern for animal welfare may be alleviated when welfare would be monitored on farms. Monitoring can be characterized as an information system where various stakeholders periodically exchange relevant information. Stakeholders include producers, consumers, retailers, the government,
Hietbrink, M.; Hartmann, Andreas; Dewulf, Geert P.M.R.
Understanding the process of stakeholder satisfaction is a prerequisite for successful stakeholder management. The expectancy disconfirmation model describes the process of stakeholder satisfaction by relating customers’ satisfaction with a product or service to discrepancy between the perceived
Martin, Graham P; Finn, Rachael
Current healthcare policy emphasises the need for more collaborative, team-based approaches to providing care, and for a greater voice for service users in the management and delivery of care. Increasingly, policy encourages 'partnerships' between users and professionals so that users, too, effectively become team members. In examining this phenomenon, this paper draws on insights from the organisational-sociological literature on team work, which highlights the challenges of bringing together diverse professional groups, but which has not, to date, been applied in contexts where users, too, are included in teams. Using data from a qualitative study of five pilot cancer-genetics projects, in which service users were included in teams responsible for managing and developing new services, it highlights the difficulties involved in making teams of such heterogeneous members-and the paradoxes that arise when this task is achieved. It reveals how the tension between integration and specialisation of team members, highlighted in the literature on teams in general, is especially acute for service users, the distinctiveness of whose contribution is more fragile, and open to blurring. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.
Cekic, Z.; Surlan, N.; Kosic, T.
When starting a construction project, one assumes, mostly through experience, what is the value the project will bring to investors, consultants, contractors and other stakeholders. However, the value of the project greatly depends on the perspective of the observer and which stakeholder is considering it. So, how is value perceived on the construction project? The purpose of this research is to obtain construction project value parameters utilizing the Delphi technique.
Lu, Yingjie; Wu, Yang; Liu, Jingfang; Li, Jia; Zhang, Pengzhu
Health care social media used for health information exchange and emotional communication involves different types of users, including patients, caregivers, and health professionals. However, it is difficult to identify different stakeholders because user identification data are lacking due to privacy protection and proprietary interests. Therefore, identifying the concerns of different stakeholders and how they use health care social media when confronted with huge amounts of health-related messages posted by users is a critical problem. We aimed to develop a new content analysis method using text mining techniques applied in health care social media to (1) identify different health care stakeholders, (2) determine hot topics of concern, and (3) measure sentiment expression by different stakeholders. We collected 138,161 messages posted by 39,606 members in lung cancer, diabetes, and breast cancer forums in the online community MedHelp.org over 10 years (January 2007 to October 2016) as experimental data. We used text mining techniques to process text data to identify different stakeholders and determine health-related hot topics, and then analyzed sentiment expression. We identified 3 significantly different stakeholder groups using expectation maximization clustering (3 performance metrics: Rand=0.802, Jaccard=0.393, Fowlkes-Mallows=0.537; Panalysis showed that patients and caregivers gradually changed their emotional state in a positive direction. The hot topics of interest and sentiment expression differed significantly among different stakeholders in different disease forums. These findings could help improve social media services to facilitate diverse stakeholder engagement for health information sharing and social interaction more effectively. ©Yingjie Lu, Yang Wu, Jingfang Liu, Jia Li, Pengzhu Zhang. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.04.2017.
Frih, Bechir; Mkacher, Wajdi; Jaafar, Hamdi; Frih, Ameur; Ben Salah, Zohra; El May, Mezry; Hammami, Mohamed
The purpose of this study was to evaluate the effects of 6 months of specific balance training included in endurance-resistance program on postural balance in haemodialysis (HD) patients. Forty-nine male patients undergoing HD were randomly assigned to an intervention group (balance training included in an endurance-resistance training, n = 26) or a control group (resistance-endurance training only, n = 23). Postural control was assessed using six clinical tests; Timed Up and Go test, Tinetti Mobility Test, Berg Balance Scale, Unipodal Stance test, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scale. All balance measures increased significantly after the period of rehabilitation training in the intervention group. Only the Timed Up and Go, Berg Balance Scale, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scores were improved in the control group. The ranges of change in these tests were greater in the balance training group. In HD patients, specific balance training included in a usual endurance-resistance training program improves static and dynamic balance better than endurance-resistance training only. Implications for rehabilitation Rehabilitation using exercise in haemodialysis patients improved global mobility and functional abilities. Specific balance training included in usual endurance resistance training program could lead to improved static and dynamic balance.
Full Text Available Corporate communications represent a modern communications discipline used by businesses across the globe to communicate with key stakeholders. Chief executive officers and executive management teams strive to create, protect and advance corporate reputation through corporate communications. Further, by communicating with key stakeholders the company adequately prepares for good news and future problems. With the benefit of technology and greater transparency, corporations of the future will continue to use corporate communications approaches to advance their business. Company's reputation derives from the way stakeholders perceive the organization, how they think, feel or act towards it. It is therefore vital that organizations interested in developing and building their reputational capital; pay careful attention to the way they are perceived and that they manage the relationships with their various stakeholders like a strategic resource. Stakeholders represent both opportunity and threat for the organizations. For instance, if an institution has a good reputation with stakeholders they may provide the organization more latitude to operate. On the other hand a poor reputation may result in creating the legislative that can make it more difficult for an institution to operate.
Harrisson, Norman; LOVE, June; Murray, Marc
The United Kingdom Atomic Energy Authority (UKAEA) was established in the 1950's to pioneer the development of nuclear energy within the UK. Today its primary mission is to decommission UK's former nuclear research sites and restore its environment in a way that is safe and secure, environmentally friendly, value for money and publicly Acceptable. UKAEA Dounreay celebrated its 50 birthday in 2005, having pioneered the development of fast reactor technology since 1955. Today the site is now leading the way in decommissioning. The Dounreay nuclear site licence covers an area of approximately 140 acres and includes 3 reactors: the Dounreay Material Test Reactor (DMTR), the Dounreay Fast Reactor (DFR), and the Prototype Fast Reactor (PFR). In addition there are 180 facilities on site which have supported the fast reactor programme, including a fuel reprocessing capability, laboratories and administration buildings. The reactors are now all in advanced stages of decommissioning. In October 2000 the Dounreay Site Restoration Plan (DSRP) was published to provide a framework for the site's restoration. The plan's objective was to reduce the site's hazards progressively by decontaminating and dismantling the plant, equipment and facilities, remediating contaminated ground and treating and packaging waste so it is suitable for long term storage or disposal. Whilst hailed as the most detailed plan integrating some 1500 activities and spanning 60 years it was criticised for having no stakeholder involvement. In response to this criticism, UKAEA developed a process for public participation over the following 2 years and launched its stakeholder engagement programme in October 2002. In order to provide a larger platform for the engagement process an advertisement was placed in the Scottish media inviting people to register as stakeholders in the Dounreay Site Restoration Plan. The stakeholder list now total over 1000. In October 2002 UKAEA launched their commitment to public
Moukaddam, Nidal; AufderHeide, Erin; Flores, Araceli; Tucci, Veronica
Difficult patients are often those who present with a mix of physical and psychiatric symptoms, and seem refractory to usual treatments or reassurance. such patients can include those with personality disorders, those with somatization symptoms; they can come across as entitled, drug-seeking, manipulative, or simply draining to the provider. Such patients are often frequent visitors to Emergency Departments. Other reasons for difficult encounters could be rooted in provider bias or countertransference, rather than sole patient factors. Emergency providers need to have high awareness of these possibilities, and be prepared to manage such situations, otherwise workup can be sub-standard and dangerous medical mistakes can be made. Copyright © 2015 Elsevier Inc. All rights reserved.
Biggane, Alice M; Brading, Lucy; Ravaud, Philippe; Young, Bridget; Williamson, Paula R
There are numerous challenges in including patients in a core outcome set (COS) study, these can vary depending on the patient group. This study describes current efforts to include patients in the development of COS, with the aim of identifying areas for further improvement and study. Using the COMET database, corresponding authors of COS projects registered or published from 1 January 2013 to 2 February 2017 were invited via a personalised email to participate in a short online survey. The survey and emails were constructed to maximise the response rate by following the academic literature on enhancing survey responses. Personalised reminder emails were sent to non-responders. This survey explored the frequency of patient input in COS studies, who was involved, what methods were used and whether or not the COS development was international. One hundred and ninety-two COS developers were sent the survey. Responses were collected from 21 February 2017 until 7 May 2017. One hundred and forty-six unique developers responded, yielding a 76% response rate and data in relation to 195 unique COSs (as some developers had worked on multiple COSs). Of focus here are their responses regarding 162 COSs at the published, completed or ongoing stages of development. Inclusion of patient participants was indicated in 87% (141/162) of COSs in the published completed or ongoing stages and over 94% (65/69) of ongoing COS projects. Nearly half (65/135) of COSs included patient participants from two or more countries and 22% (30/135) included patient participants from five or more countries. The Delphi survey was reported as being used singularly or in combination with other methods in 85% (119/140) of projects. Almost a quarter (16/65) of ongoing studies reported using a combination of qualitative interviews, Delphi survey and consensus meeting. These findings indicated that the Delphi survey is the most popular method of facilitating patient participation, while the combination of
Miles, Susan; Crevel, Rene; Chryssochoidis, George
At present, the most useful approaches to communicating information about food allergy to different stakeholder groups are not understood. Stakeholders include allergic consumers, their carers, health professionals, public authorities (regulators and compliance authorities), retailers...... common needs regarding, for example, causes and symptomology of food allergy. In addition, some specific information needs for different stakeholders were also identified. The industrial sector requires more information about clear guidelines for labelling practices, whereas the allergic consumers...... that required by other stakeholders (for example, consumers). The results therefore suggest that targeted information strategies may be the most resource-efficient way to communicate effectively to different stakeholders about food allergy. However, those information channels which are best suited to specific...
Kenna, Dervla T D; Lilley, Daniel; Coward, Amy; Martin, Kate; Perry, Claire; Pike, Rachel; Hill, Robert; Turton, Jane F
We aimed to establish the prevalence of different Burkholderia species among UK cystic fibrosis (CF) and non-CF patients over a 2 year period. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry was used to identify isolates to genus level, followed by recA/gyrB sequence clustering or species-specific PCR. In all, 1047 Burkholderia isolates were submitted for identification from 361 CF patients and 112 non-CF patients, 25 from the hospital environment and three from a commercial company. Potential cross-infection was assessed by pulsed-field gel electrophoresis (PFGE) and multi- locus-sequence typing (MLST). MICs were determined for 161 Burkholderia cepacia complex (Bcc) isolates. CF Trust registry data were sought to examine clinical parameters relating to Bcc infection. Burkholderia multivorans was the most prevalent species among CF patients affecting 56 % (192) patients, followed by Burkholderia cenocepacia IIIA (15 %; 52 patients). Five novel recA clusters were found. Among non-CF patients, Burkholderia cepacia was the most prevalent species (37/112; 34 %), with 18 of 40 isolates part of a UK-wide B. cepacia 'cluster'. This and three other clusters were investigated by PFGE and MLST. Cable-pili positive isolates included two novel sequence types and representatives of ET12. Antibiotic susceptibility varied between and within species and CF/non- CF isolates. CF Trust registry data suggested no significant difference in lung function between patients harbouring B. cenocepacia, B. multivorans and other Bcc species (P=0.81). The dominance of B. multivorans in CF, the presence of a B. cepacia cluster among non-CF patients and the existence of putative novel species all highlighted the continuing role of Burkholderia species as opportunistic pathogens.
Phillipson, Jeremy; Lowe, Philip; Proctor, Amy; Ruto, Eric
It is commonly put forward that effective uptake of research in policy or practice must be built upon a foundation of active knowledge exchange and stakeholder engagement during the research. However, what is often lacking is a systematic appreciation of the specific practices of knowledge exchange and their relative merits. The paper reports on a 2009 survey of 21 research projects within the UK Research Councils' Rural Economy and Land Use Programme regarding the involvement and perceived impact of over a thousand stakeholders in the research. The survey reveals that most stakeholders were involved as research subjects or as event participants. Large numbers were also engaged in the research process itself, including involvement in shaping the direction of research. Stakeholder engagement is perceived as bringing significant benefits to the process of knowledge production. A close relationship is found between mechanisms and approaches to knowledge exchange and the spread of benefits for researchers and stakeholders. Mutual benefits are gained from exchange of staff or where stakeholders are members of research advisory groups. Different stakeholder sectors are also associated with different patterns of engagement, which lead to contrasting impact patterns. Any efforts to alter knowledge exchange processes and outcomes must overcome these differing engagement tendencies. Overall, much greater attention should be given to early processes of knowledge exchange and stakeholder engagement within the lifetime of research projects. Copyright © 2011 Elsevier Ltd. All rights reserved.
Hamilton, Alison B; Brunner, Julian; Cain, Cindy; Chuang, Emmeline; Luger, Tana M; Canelo, Ismelda; Rubenstein, Lisa; Yano, Elizabeth M
The Veterans Health Administration (VHA) has undertaken primary care transformation based on patient-centered medical home (PCMH) tenets. VHA PCMH models are designed for the predominantly male Veteran population, and require tailoring to meet women Veterans' needs. We used evidence-based quality improvement (EBQI), a stakeholder-driven implementation strategy, in a cluster randomized controlled trial across 12 sites (eight EBQI, four control) that are members of a Practice-Based Research Network. EBQI involves engaging multilevel, inter-professional leaders and staff as stakeholders in reviewing evidence and setting QI priorities. The goal of this analysis was to examine processes of engaging stakeholders in early implementation of EBQI to tailor VHA's medical home for women. Four inter-professional regional stakeholder planning meetings were conducted; these meetings engaged stakeholders by providing regional data about gender disparities in Veterans' care experiences. Subsequent to each meeting, qualitative interviews were conducted with 87 key stakeholders (leaders and staff). Stakeholders were asked to describe QI efforts and the use of data to change aspects of care, including women's health care. Interview transcripts were summarized and coded using a hybrid deductive/inductive analytic approach. The presentation of regional-level data about gender disparities resulted in heightened awareness and stakeholder buy-in and decision-making related to women's health-focused QI. Interviews revealed that stakeholders were familiar with QI, with regional and facility leaders aware of inter-disciplinary committees and efforts to foster organizational change, including PCMH transformation. These efforts did not typically focus on women's health, though some informal efforts had been undertaken. Barriers to engaging in QI included lack of communication across clinical service lines, fluidity in staffing, and lack of protected time. Inter-professional, multilevel
Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne; Krasnik, Allan; Norredam, Marie
The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.
Natasja Koitzsch Jensen
Full Text Available Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes. Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.
Zink, A.M.; Wohlleber, E.; Engels, H.; Rødningen, O.K.; Ravn, K.; Heilmann, S.; Rehnitz, J.; Katzorke, N.; Kraus, C.; Blichfeldt, S.; Hoffmann, P.; Reutter, H.; Brockschmidt, F.F.; Kreiß-Nachtsheim, M.; Vogt, P.H.; Prescott, T.E.; Tümer, Z.; Lee, J.A.
Fragile X syndrome (FXS) is one of the most common causes of intellectual disability/developmental delay (ID/DD), especially in males. It is caused most often by CGG trinucleotide repeat expansions, and less frequently by point mutations and partial or full deletions of the FMR1 gene. The wide clinical spectrum of affected females partly depends on their X-inactivation status. Only few female ID/DD patients with microdeletions including FMR1 have been reported. We describe 3 female patients with 3.5-, 4.2- and 9.2-Mb de novo microdeletions in Xq27.3-q28 containing FMR1. X-inactivation was random in all patients, yet they presented with ID/DD as well as speech delay, macrocephaly and other features attributable to FXS. No signs of autism were present. Here, we further delineate the clinical spectrum of female patients with microdeletions. FMR1 expression studies gave no evidence for an absolute threshold below which signs of FXS present. Since FMR1 expression is known to be highly variable between unrelated females, and since FMR1 mRNA levels have been suggested to be more similar among family members, we further explored the possibility of an intrafamilial effect. Interestingly, FMR1 mRNA levels in all 3 patients were significantly lower than in their respective mothers, which was shown to be specific for patients with microdeletions containing FMR1. PMID:24715853
Yang, Xiuhong; Tan, Pengsheng; Song, Lianying; Lu, Zhanying
To compare the efficacy and safety of sequential therapy and modified bismuth-included quadruple therapy as a first-line Helicobacter pylori eradication in China. The patients were randomized to receive sequential therapy [n = 90; rabeprazole (20 mg twice daily) and amoxicillin (1 g twice daily) for 5 days, followed by rabeprazole (20 mg twice daily), tinidazole (500 mg twice daily) plus clarithromycin (500 mg twice daily) for another 5 days] or modified bismuth-included quadruple therapy [n = 109; rabeprazole (20 mg twice daily), levofloxacin hydrochloride (400 mg twice daily), clarithromycin (500 mg twice daily), and colloidal bismuth pectin (200 mg 3 times a day) for 7 days]. A follow-up urea breath test was applied 4 weeks later. A total of 199 patients were diagnosed with H. pylori infection. The intention-to-treat and per-protocol (PP) eradication rates were 91.7% and 92.6%, respectively, in the modified bismuth-included quadruple therapy group, and 74.4% and 76.1%, respectively, in the sequential therapy group. The eradication rates were significantly higher in the modified bismuth-included quadruple therapy group, compared with the sequential therapy group (P = 0.001 for intention to treat and P = 0.001 for PP). Adverse effects were reported by patients from both groups, but the difference did not reach significant level (P = 0.280). The modified bismuth-included quadruple therapy seemed to be superior to the sequential therapy as the first-line regimen for H. pylori eradication in Chinese patients.
Walker, Josephine; Chaar, Betty B; Vera, Numa; Pillai, Alvish S; Lim, Jessy S; Bero, Lisa; Moles, Rebekah J
Medicine access is a human right; yet, concerningly, there are international instances of shortages. Quantitative data has allowed WHO to propose global solutions; however, individualised understanding of specific regions is still required to work towards national solutions. Fiji has an established issue with medication supply and the aim of this study was to use qualitative methods to gain a fuller understanding of this context. Semi-structured interviews were used to gain the perspective of key stakeholders involved in the Fijian medicine supply chain in regards to causes, impacts and possible solutions of medicine shortages. Thematic analysis was used to analyse the interview data. In total, 48 stakeholders participated and the information was synthesised into three main themes, causes, impacts and solutions and the sub-themes including; political, system and patient causes, adverse health effects on patients, professional dissatisfaction, monetary loss and loss of faith in the health system, workarounds, operation improvements, government intervention and education and training. The situation in Fiji is not dissimilar to other instances of shortages around the world and hence international solutions like that proposed by WHO are feasible; however, they must be modified to be uniquely Fijian to work in this context.
Saporta, Mario A; Dang, Vu; Volfson, Dmitri; Zou, Bende; Xie, Xinmin Simon; Adebola, Adijat; Liem, Ronald K; Shy, Michael; Dimos, John T
Charcot-Marie-Tooth (CMT) disease is a group of inherited peripheral neuropathies associated with mutations or copy number variations in over 70 genes encoding proteins with fundamental roles in the development and function of Schwann cells and peripheral axons. Here, we used iPSC-derived cells to identify common pathophysiological mechanisms in axonal CMT. iPSC lines from patients with two distinct forms of axonal CMT (CMT2A and CMT2E) were differentiated into spinal cord motor neurons and used to study axonal structure and function and electrophysiological properties in vitro. iPSC-derived motor neurons exhibited gene and protein expression, ultrastructural and electrophysiological features of mature primary spinal cord motor neurons. Cytoskeletal abnormalities were found in neurons from a CMT2E (NEFL) patient and corroborated by a mouse model of the same NEFL point mutation. Abnormalities in mitochondrial trafficking were found in neurons derived from this patient, but were only mildly present in neurons from a CMT2A (MFN2) patient. Novel electrophysiological abnormalities, including reduced action potential threshold and abnormal channel current properties were observed in motor neurons derived from both of these patients. Human iPSC-derived motor neurons from axonal CMT patients replicated key pathophysiological features observed in other models of MFN2 and NEFL mutations, including abnormal cytoskeletal and mitochondrial dynamics. Electrophysiological abnormalities found in axonal CMT iPSC-derived human motor neurons suggest that these cells are hyperexcitable and have altered sodium and calcium channel kinetics. These findings may provide a new therapeutic target for this group of heterogeneous inherited neuropathies. Copyright © 2014 Elsevier Inc. All rights reserved.
Traditional societal and cultural background of Japanese in general indicates the intrinsic difficulty in involving the public as stakeholders in the process of any type of decision making in policy matters. It is characterized by the long-taught virtue of harmonization and obedience to others. In addition, characteristic system of Japanese traditional industrial society, such as lifetime employment, seniority-based wage system, and enterprise-based labour union, encourages the loyalty to the employer/company, but not to the public. The public or ordinary citizens would seldom come out as stakeholders and express their true feelings or real opinions, even though younger generation is notably getting out from such a trend. On the other hand, it is a common practice in Japanese society for any business or administrative transactions to try to obtain 'consensus' among relevant parties concerned (stakeholders) by negotiations behind the curtain prior to the formal discussion. In this sense, 'stakeholders involvement' is accepted and practised as a matter of course, but mostly for actions between parties of equivalently influential status levels or between 'directly relevant' parties such as those between the different government agencies, between regulators and industries. The concept of 'Involving the public in decision making as stakeholders' is not yet fully understood nor accepted in Japan both by regulators and by the public so far as the issue of radiation protection is concerned. These situations are explained with some examples. (author)
The aim of the paper is to explain the stakeholder theory in the context of performance measurement in integrated reporting. Main research methods used in the article include logical reasoning, critical analysis of academic literature, and observation. The principal result of the discussion is included in the statement that the stakeholder theory in the field of accounting is reflected in the so-called integrated reporting. Moreover, among the large variety of performance measurement methods,...
Devine, Emily Beth; Alfonso-Cristancho, Rafael; Devlin, Allison; Edwards, Todd C; Farrokhi, Ellen T; Kessler, Larry; Lavallee, Danielle C; Patrick, Donald L; Sullivan, Sean D; Tarczy-Hornoch, Peter; Yanez, N David; Flum, David R
To describe the inaugural comparative effectiveness research (CER) cohort study of Washington State's Comparative Effectiveness Research Translation Network (CERTAIN), which compares invasive with noninvasive treatments for peripheral artery disease, and to focus on the patient centeredness of this cohort study by describing it within the context of a newly published conceptual framework for patient-centered outcomes research (PCOR). The peripheral artery disease study was selected because of clinician-identified uncertainty in treatment selection and differences in desired outcomes between patients and clinicians. Patient centeredness is achieved through the "Patient Voices Project," a CERTAIN initiative through which patient-reported outcome (PRO) instruments are administered for research and clinical purposes, and a study-specific patient advisory group where patients are meaningfully engaged throughout the life cycle of the study. A clinician-led research advisory panel follows in parallel. Primary outcomes are PRO instruments that measure function, health-related quality of life, and symptoms, the latter developed with input from the patients. Input from the patient advisory group led to revised retention procedures, which now focus on short-term (3-6 months) follow-up. The research advisory panel is piloting a point-of-care, patient assessment checklist, thereby returning study results to practice. The cohort study is aligned with the tenets of one of the new conceptual frameworks for conducting PCOR. The CERTAIN's inaugural cohort study may serve as a useful model for conducting PCOR and creating a learning health care network. Copyright © 2013 Elsevier Inc. All rights reserved.
E Zigiriadis; A Nicolaides
The importance of organizational-stakeholder relationships is highlighted in most organizational studies literature. This article investigates the relationship between medical practices and their stakeholders and has been developed to provide guidance on stakeholder engagement and communication. It is intended to provide a useful reference point for all medical practices concerning stakeholder engagement activities. Direction is provided on how to identify and ul...
On April 9--11, 1997, the Department of Energy`s Office of Worker and Community Transition convened its fifth National Stakeholder Workshop. The workshop addressed a wide range of work force restructuring and community transition issues critical to the future success of the Department. Two important elements of the meeting were: (1) reviewing progress made on the challenges identified during the March 1996f stakeholder`s meeting in Atlanta, Georgia; and (2) identifying areas that needed priority attention during the early months of the second Clinton Administration. The format of the Workshop included several plenary sessions and a number of small group discussion sessions. The small group sessions focused on topics related to labor issues, work force restructuring, work force planning, community transition, and employee concerns. The sessions provided a wide range of views on worker and community transition issues. The workshop included presentations on the following topics: Welcome and introductions; Opening remarks; Community reuse organizations: recent accomplishments; Privatization: policy, practice and potential pitfalls; Department of Energy`s integrated training initiatives; Congressional perspective on work force restructuring; and, Privatization and the Ten Year Plan.
Etter, Michael; Castello, Itziar
The introduction of new information and communication technologies such social media platforms in organizations results in a new emerging logic of stakeholder engagement around sustainable development issues. We investigate how middle managers of a pharmaceutical corporation navigate between two...... competing logics of stakeholder engagement: the current (influence logic) and the new logic underlying social media (logic of community). With a longitudinal study of 26 months we observe how engagements failed since managers were not able to integrate certain symbolic and substantive elements of the new...... introduced by social media....
Li, Yijia; Zhu, Ting; Song, Xiaojing; Huang, Ying; Yang, Feifei; Guan, Shuo; Xie, Jing; Gohda, Jin; Hosoya, Noriaki; Kawana-Tachikawa, Ai; Liu, Wenjun; Gao, George Fu; Iwamoto, Aikichi; Li, Taisheng; Ishida, Takaomi
In China, HIV-1-infected patients typically receive antiretroviral therapy (ART) that includes lamivudine (3TC) as a reverse-transcriptase inhibitor (RTI) (ART-3TC). Previous studies from certain developed countries have shown that, in ART-3TC, 3TC-resistant HBV progressively emerges at an annual rate of 15–20% in patients coinfected with HIV-1 and HBV. This scenario in China warrants investigation because >10% of all HIV-infected patients in China are HBV carriers. We measured the occurrence of 3TC-resistant HBV during ART-3TC for HIV-HBV coinfection and also tested the effect of tenofovir disoproxil fumarate (TDF) used as an additional RTI (ART-3TC/TDF) in a cohort study in China. We obtained 200 plasma samples collected from 50 Chinese patients coinfected with HIV-1 and HBV (positive for hepatitis B surface antigen) and examined them for the prevalence of 3TC-resistant HBV by directly sequencing PCR products that covered the HBV reverse-transcriptase gene. We divided the patients into ART-3TC and ART-3TC/TDF groups and compared the efficacy of treatment and incidence of drug-resistance mutation between the groups. HIV RNA and HBV DNA loads drastically decreased in both ART-3TC and ART-3TC/TDF groups. In the ART-3TC group, HBV breakthrough or insufficient suppression of HBV DNA loads was observed in 20% (10/50) of the patients after 96-week treatment, and 8 of these patients harbored 3TC-resistant mutants. By contrast, neither HBV breakthrough nor treatment failure was recorded in the ART-3TC/TDF group. All of the 3TC-resistant HBV mutants emerged from the cases in which HBV DNA loads were high at baseline. Our results clearly demonstrated that ART-3TC is associated with the emergence of 3TC-resistant HBV in patients coinfected with HIV-1 and HBV and that ART-3TC/TDF reduces HBV DNA loads to an undetectable level. These findings support the use of TDF-based treatment regimens for patients coinfected with HIV-1 and HBV. PMID:26288093
Full Text Available In China, HIV-1-infected patients typically receive antiretroviral therapy (ART that includes lamivudine (3TC as a reverse-transcriptase inhibitor (RTI (ART-3TC. Previous studies from certain developed countries have shown that, in ART-3TC, 3TC-resistant HBV progressively emerges at an annual rate of 15-20% in patients coinfected with HIV-1 and HBV. This scenario in China warrants investigation because >10% of all HIV-infected patients in China are HBV carriers. We measured the occurrence of 3TC-resistant HBV during ART-3TC for HIV-HBV coinfection and also tested the effect of tenofovir disoproxil fumarate (TDF used as an additional RTI (ART-3TC/TDF in a cohort study in China. We obtained 200 plasma samples collected from 50 Chinese patients coinfected with HIV-1 and HBV (positive for hepatitis B surface antigen and examined them for the prevalence of 3TC-resistant HBV by directly sequencing PCR products that covered the HBV reverse-transcriptase gene. We divided the patients into ART-3TC and ART-3TC/TDF groups and compared the efficacy of treatment and incidence of drug-resistance mutation between the groups. HIV RNA and HBV DNA loads drastically decreased in both ART-3TC and ART-3TC/TDF groups. In the ART-3TC group, HBV breakthrough or insufficient suppression of HBV DNA loads was observed in 20% (10/50 of the patients after 96-week treatment, and 8 of these patients harbored 3TC-resistant mutants. By contrast, neither HBV breakthrough nor treatment failure was recorded in the ART-3TC/TDF group. All of the 3TC-resistant HBV mutants emerged from the cases in which HBV DNA loads were high at baseline. Our results clearly demonstrated that ART-3TC is associated with the emergence of 3TC-resistant HBV in patients coinfected with HIV-1 and HBV and that ART-3TC/TDF reduces HBV DNA loads to an undetectable level. These findings support the use of TDF-based treatment regimens for patients coinfected with HIV-1 and HBV.
Agostini, Paula; Naidu, Babu; Cieslik, Hayley; Steyn, Richard; Rajesh, Pala Babu; Bishay, Ehab; Kalkat, Maninder Singh; Singh, Sally
Following thoracotomy, patients frequently receive routine respiratory physiotherapy which may include incentive spirometry, a breathing technique characterised by deep breathing performed through a device offering visual feedback. This type of physiotherapy is recommended and considered important in the care of thoracic surgery patients, but high quality evidence for specific interventions such as incentive spirometry remains lacking. 180 patients undergoing thoracotomy and lung resection participated in a prospective single-blind randomised controlled trial. All patients received postoperative breathing exercises, airway clearance and early mobilisation; the control group performed thoracic expansion exercises and the intervention group performed incentive spirometry. No difference was observed between the intervention and control groups in the mean drop in forced expiratory volume in 1 s on postoperative day 4 (40% vs 41%, 95% CI -5.3% to 4.2%, p=0.817), the frequency of postoperative pulmonary complications (PPC) (12.5% vs 15%, 95% CI -7.9% to 12.9%, p=0.803) or in any other secondary outcome measure. A high-risk subgroup (defined by ≥2 independent risk factors; age ≥75 years, American Society of Anaesthesiologists score ≥3, chronic obstructive pulmonary disease (COPD), smoking status, body mass index ≥30) also demonstrated no difference in outcomes, although a larger difference in the frequency of PPC was observed (14% vs 23%) with 95% CIs indicating possible benefit of intervention (-7.4% to 2.6%). Incentive spirometry did not improve overall recovery of lung function, frequency of PPC or length of stay. For patients at higher risk for the development of PPC, in particular those with COPD or current/recent ex-smokers, there were larger observed actual differences in the frequency of PPC in favour of the intervention, indicating that investigations regarding the physiotherapy management of these patients need to be developed further.
S. Yu. Martsevich
Full Text Available Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. All patients (n=960 admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%, atrial fibrillation in 252 (26.8% patients, 199 (20.7% patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years. Low frequency of the antihypertensive therapy (34.5%, lipid-lowering therapy (0.7%, antiplatelet agents (5.7%, anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.
This report demonstrates the importance of stakeholder involvement throughout the life cycle of all nuclear facilities; including operating reactors, temporary spent fuel storage facilities and final radioactive waste repositories and follows what is defined in the IAEA Safety Standards GS-R-3 where the stakeholders' expectations (identified as 'interested parties' in GS-R-3) shall be taken into consideration 'in the activities and interactions in the processes of the management system, with the aim of enhancing the satisfaction of interested parties while at the same time ensuring that safety is not compromised'. This report explains how involving stakeholders in decision making processes, even for those stakeholder groups that do not have a direct role in making those decisions, can enhance public confidence in the application of nuclear science and technology. In addition, this report presents general guidance on stakeholder involvement. It does not provide detailed procedures for developing and implementing stakeholder involvement programmes, and specifics regarding stakeholder involvement for particular types of nuclear facilities. However, this publication references reports that provide such details. This publication provides assistance to those responsible for planning, designing, constructing, operating or decommissioning a nuclear facility. In addition, regulatory organizations and other authorities overseeing nuclear activities or managing nuclear facility licensing processes are often seen as the main source of independent information for the general public; therefore, stakeholder involvement can demonstrate capability and trustworthiness of regulatory organizations as well. The role of stakeholder involvement at different stages of a facility's life cycle is discussed, with suggestions on developing the components of a comprehensive stakeholder involvement plan. Included is guidance on focusing communication with certain stakeholders, applying various
Shirey, Maria R
This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author highlights the importance of stakeholder theory and discusses how to apply the theory to conduct a stakeholder analysis. This article also provides an explanation of how to use related stakeholder mapping techniques with targeted communication strategies.
Haavik, Trond; Aabrekk, Synnøve; Tommerup, Henrik M.
countries may be similar to a great extent. The various types of actors in the renovation business occur at different stages in the value chain. The traditional first line services such as carpenters, retail stores, heat pump agents, plumbers, electrician, etc. come in direct contact with the customer when......-stop-shop should offer tailor made services for sustainable renovation of a single family house. This should include the building envelope, insulation, window, materials, heating and ventilation system, and even financing. The one-stop-shop should have the knowhow about competent firms who can offer the additional...... to be that no actor alone possesses an overall competence to supply a holistic solution. Trustworthiness of the actors is another important factor to take into consideration when developing a one-stop-shop solution. The overall threat is the fact that a simple cost focus leads to limited renovation and reduce...
Full Text Available Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change. Design: Qualitative study. Setting: Community pharmacy in rural Mississippi. Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4, support staff (n=2, collaborating providers (n=4, patients (n=3, and a payer (n=1. Intervention: Semi-structured interviews and participant-observation techniques were used. Main outcome measures: Description of the community pharmacy's practice and business model and identification of practice change facilitators. Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges. Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy's successful establishment of a patient care practice. Type: Case Study
Stratton, J.A.; Byfield, P.E.; Byfield, J.E.; Small, R.C.; Benfield, J.; Pilch, Y.
Radiation therapy to either mediastinum or pelvis causes a rapid decrease in circulating lymphocytes of both B and T types and in addition an impairment in the function of the remaining lymphocytes, as measured by their ability to proliferate in response to mitogens. The acute depression is short-lived. Substantial recovery is apparent within 3 wk after cessation of therapy; however, most patients show a modest, chronic depression in both numbers and functional capacities of circulating lymphocytes. T cells are somewhat more sensitive than B cells, but both are affected. Irradiation of the thymus per se seems to have little influence on the acute changes which occur, as patients receiving pelvic and mediastinal (including thymic) radiotherapy show a similar degree of lymphopenia and depression of lymphocyte responsiveness
Dickinson, Rebecca; Raynor, David K; Knapp, Peter; MacDonald, Jan
Patient information leaflets (PILs) are required with all licensed medicines throughout the European Union (EU) and they must include information about all side effects and their likelihood. This has led to criticism of a lack of balance, with little information included about potential benefits. Recent European Medicines Agency guidance proposed the inclusion of benefit information, and this study examined the current prevalence and type of such information in PILs in the EU. A survey and content analysis of the English translation of PILs in the EUwas carried out. Random quota sampling was used on the most frequently dispensed (n = 50) and newly licensed medicines (n = 50) in 2011/2. Leaflets were searched for benefit information meeting predefined criteria, and data synthesised and categorised into 10 categories. Eighty-five (85%) leaflets described how the medicine works, with 45 providing information about the rationale for treatment (more commonly for newly licensed (32/50) than most commonly dispensed medicines (13/50; P information. Current PILs do not appropriately communicate information about benefit. At the basic level, around a half did not include information about treatment rationale or whether the treatment was to treat symptoms, curative or preventative. However, for true informed decision making, patients need quantitative information about benefits and none of the leaflets provided this. © 2016 Royal Pharmaceutical Society.
Henssler, Jonathan; Bschor, Tom
Objective: Combining antidepressants (ADs) for therapy of acute depression is frequently employed, but randomized studies have yielded conflicting results. We conducted a systematic review and meta-analysis aimed at determining efficacy and tolerability of combination therapy. Methods: MEDLINE, Embase, PsycINFO, and CENTRAL databases were systematically searched through March 2014 for controlled studies comparing combinations of ADs with AD monotherapy in adult patients suffering from acute depression. The prespecified primary outcome was standardized mean difference (SMD), secondary outcomes were response, remission, and dropouts. Results: Among 8688 articles screened, 38 studies were eligible, including 4511 patients. Combination treatment was statistically, significantly superior to monotherapy (SMD 0.29; 95% CI 0.16 to 0.42). During monotherapy, slightly fewer patients dropped out due to adverse events (OR 0.90; 95% CI 0.53 to 1.53). Studies were heterogeneous (I2 = 63%), and there was indication of moderate publication bias (fail-safe N for an effect of 0.1:44), but results remained robust across prespecified secondary outcomes and subgroups, including analyses restricted to randomized controlled trials and low risk of bias studies. Meta-regression revealed an association of SMD with difference in imipramine-equivalent dose. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors was superior to other combinations. Conclusion: Combining ADs seems to be superior to monotherapy with only slightly more patients dropping out. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors seems to be significantly more effective than other combinations. Overall, our search revealed a dearth of well-designed studies. PMID:27582451
Henssler, Jonathan; Bschor, Tom; Baethge, Christopher
Combining antidepressants (ADs) for therapy of acute depression is frequently employed, but randomized studies have yielded conflicting results. We conducted a systematic review and meta-analysis aimed at determining efficacy and tolerability of combination therapy. MEDLINE, Embase, PsycINFO, and CENTRAL databases were systematically searched through March 2014 for controlled studies comparing combinations of ADs with AD monotherapy in adult patients suffering from acute depression. The prespecified primary outcome was standardized mean difference (SMD), secondary outcomes were response, remission, and dropouts. Among 8688 articles screened, 38 studies were eligible, including 4511 patients. Combination treatment was statistically, significantly superior to monotherapy (SMD 0.29; 95% CI 0.16 to 0.42). During monotherapy, slightly fewer patients dropped out due to adverse events (OR 0.90; 95% CI 0.53 to 1.53). Studies were heterogeneous (I(2) = 63%), and there was indication of moderate publication bias (fail-safe N for an effect of 0.1:44), but results remained robust across prespecified secondary outcomes and subgroups, including analyses restricted to randomized controlled trials and low risk of bias studies. Meta-regression revealed an association of SMD with difference in imipramine-equivalent dose. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors was superior to other combinations. Combining ADs seems to be superior to monotherapy with only slightly more patients dropping out. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors seems to be significantly more effective than other combinations. Overall, our search revealed a dearth of well-designed studies. © The Author(s) 2016.
Xu, Mao; Li, Xiaoxi; Wang, Jun; Guo, Xiangyang
Airway management is crucial in clinical anesthesia. Many complications associated with airway management result from unexpected difficult airway, but predicting a difficult airway is a major challenge. We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis, a population with a high incidence of difficult airway. We randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013. Preoperatively, patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images. Difficult airway was defined as Cormack-Lehane grades III-IV. Logistic regression was used to identify a combined (clinical and radiological) model for difficult airway. A receiver operating characteristic (ROC) curve was used to describe the effectiveness of prediction. We identified three clinical predictive factors using the ROC curve: mouth opening, sternomental distance, and neck mobility. We created a clinical model using three factors: gender, age, and mouth opening, with odds ratios (OR) of 0.370, 1.034, and 0.358, respectively. Using the clinical and radiological parameters, we formulated a combined model with five risk factors: gender, mouth opening, atlanto-occipital gap, the angle from the second to sixth cervical vertebraes in the neutral position, and the angle difference of d (the angle between the laryngeal axis and the epiglottic axis) from the neutral position to extension (OR: 0.107, 0.355, 0.846, 1.057, and 0.952, respectively). The sensitivity and specificity of the combined model were 80.0% and 65.7%, respectively, and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model. The efficacy of the combined model including both clinical and
Posadzka, Ewa; Jach, Robert; Babczyk, Dorota; Knafel, Anna; Pityński, Kazimierz
Cancer antigen CA-125 is a marker that is primarily used to differentiate benign from malignant tumors as well as to monitor response to ovarian cancer treatment. Taken as a separate marker, it displays low sensitivity and specificity in ovarian cancer diagnosis; however, in combination with other markers it may be successfully applied especially in postmenopausal women. Elevated CA-125 levels in blood serum indicate cancerous as well as non-cancerous diseases. Research aiming to determine environmental factors that may have influence on antigen CA-125 level, and thus on the assessment of this marker's application in gynecological and oncological diseases continues. the aim of the present research is an attempt to estimate the influence of nicotinism on antigen CA-125 in blood serum in patients with diagnosed benign ovarian tumors including endometrial cysts. 174 women aged 16-85 years with diagnosed benign ovarian tumor were qualified for the study. In all patients level of antigen CA-125 in blood serum was assessed preoperatively and nicotinism history was taken. Also transvaginal ultrasound was performed to obtain preliminary diagnosis. Smoking and non-smoking patients were classified into two groups, namely of those with histopathologically confirmed cysts of endometrial type and those with non-endometrial benign ovarian tumors. statistical analysis did not prove any dependence between the CS-125 antigen level and nicotinism in any of these groups. Also additional analysis with division into premenopausal and postmenopausal patients did not determine any statistically significant dependence. Nicotinism does not significantly influence the CA-125 antigen level in patients with benign However, the connection between the addiction severity and its influence on antigen CA-125 in blood serum cannot be excluded. ovarian tumors or endometrial cysts.
A survey was conducted among members of the Ontario Energy Board's (OEB) various stakeholder groups in order to measure the Board's performance and to help the Board identify areas for improvement in the way it operates. The survey included telephone interviews with consumer groups, advocacy groups, the energy sector, electricity and gas distributors, financial organizations as well as other stakeholders. The topics addressed in the survey were key energy issues and priority issues; the perceived role of the OEB; the OEB strengths and weaknesses; the importance of various OEB functions; the overall performance of the OEB; an evaluation of OEB communication with industry and consumers; an evaluation of service quality; and, awareness and participation in regulatory policy initiatives. Respondents used a 10-point scale in their evaluation. This report presented the main findings and their interpretations. Major stakeholders identified electricity supply issues and the price of electricity as being the most important energy issues facing Ontario. This report also presented the detailed findings for questions regarding the lack of generator capacity, policy stability, the coal phase out program, electricity blackouts, conservation, electricity restructuring and investment. The major finding of the survey was an overall increase in satisfaction with the OEB's performance. It was suggested that the OEB can improve in timeliness and providing consumer information. The major areas of strength were found to be its professionalism in conducting hearings and the fairness of the Board's decisions and regulations. tabs
Full Text Available The aim of the paper is to explain the stakeholder theory in the context of performance measurement in integrated reporting. Main research methods used in the article include logical reasoning, critical analysis of academic literature, and observation. The principal result of the discussion is included in the statement that the stakeholder theory in the field of accounting is reflected in the so-called integrated reporting. Moreover, among the large variety of performance measurement methods, such as balanced scorecard and others, the concept of performance prism can be considered as the only method that fully takes into account the wide range of stakeholders. The analysis performed leads to the conclusion that development in accounting research takes into account the objectives of an organization in the context of the so-called corporate social responsibility as well as performance reporting oriented towards the communication of the company with its environment and the various stakeholder groups.
Ramzi G. Salloum
Full Text Available Abstract Background One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. Methods We conducted a systematic literature search (up to December 2016 of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s, healthcare setting, and implementation outcome. Results Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1 characterizing demand for therapies and treatment technologies (n = 32, (2 comparing implementation strategies (n = 22, (3 incentivizing workforce participation (n = 11, and (4 prioritizing interventions (n = 10. Stakeholders included providers (n = 27, patients (n = 25, caregivers (n = 5, and administrators (n = 2. The remaining studies (n = 16 engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators. The following implementation outcomes were discussed: acceptability (n = 75, appropriateness (n = 34, adoption (n = 19, feasibility (n = 16, and fidelity (n = 3. Conclusions The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the
Keogan, M T
Patients presenting with recurrent orogenital ulcers may have complex aphthosis, Behçet\\'s disease, secondary complex aphthosis (e.g. Reiter\\'s syndrome, Crohn\\'s disease, cyclical neutropenia) or non-aphthous disease (including bullous disorders, erythema multiforme, erosive lichen planus). Behçet\\'s syndrome is a multi-system vasculitis of unknown aetiology for which there is no diagnostic test. Diagnosis is based on agreed clinical criteria that require recurrent oral ulcers and two of the following: recurrent genital ulcers, ocular inflammation, defined skin lesions and pathergy. The condition can present with a variety of symptoms, hence a high index of suspicion is necessary. The most common presentation is with recurrent mouth ulcers, often with genital ulcers; however, it may take some years before diagnostic criteria are met. All patients with idiopathic orogenital ulcers should be kept under review, with periodic focused assessment to detect evolution into Behçet\\'s disease. There is often a delay of several years between patients fulfilling diagnostic criteria and a diagnosis being made, which may contribute to the morbidity of this condition. Despite considerable research effort, the aetiology and pathogenesis of this condition remains enigmatic.
Denora, Paola S; Schlesinger, David; Casali, Carlo; Kok, Fernando; Tessa, Alessandra; Boukhris, Amir; Azzedine, Hamid; Dotti, Maria Teresa; Bruno, Claudio; Truchetto, Jeremy; Biancheri, Roberta; Fedirko, Estelle; Di Rocco, Maja; Bueno, Clarissa; Malandrini, Alessandro; Battini, Roberta; Sickl, Elisabeth; de Leva, Maria Fulvia; Boespflug-Tanguy, Odile; Silvestri, Gabriella; Simonati, Alessandro; Said, Edith; Ferbert, Andreas; Criscuolo, Chiara; Heinimann, Karl; Modoni, Anna; Weber, Peter; Palmeri, Silvia; Plasilova, Martina; Pauri, Flavia; Cassandrini, Denise; Battisti, Carla; Pini, Antonella; Tosetti, Michela; Hauser, Erwin; Masciullo, Marcella; Di Fabio, Roberto; Piccolo, Francesca; Denis, Elodie; Cioni, Giovanni; Massa, Roberto; Della Giustina, Elvio; Calabrese, Olga; Melone, Marina A B; De Michele, Giuseppe; Federico, Antonio; Bertini, Enrico; Durr, Alexandra; Brockmann, Knut; van der Knaap, Marjo S; Zatz, Mayana; Filla, Alessandro; Brice, Alexis; Stevanin, Giovanni; Santorelli, Filippo M
Autosomal recessive spastic paraplegia with thinning of corpus callosum (ARHSP-TCC) is a complex form of HSP initially described in Japan but subsequently reported to have a worldwide distribution with a particular high frequency in multiple families from the Mediterranean basin. We recently showed that ARHSP-TCC is commonly associated with mutations in SPG11/KIAA1840 on chromosome 15q. We have now screened a collection of new patients mainly originating from Italy and Brazil, in order to further ascertain the spectrum of mutations in SPG11, enlarge the ethnic origin of SPG11 patients, determine the relative frequency at the level of single Countries (i.e., Italy), and establish whether there is one or more common mutation. In 25 index cases we identified 32 mutations; 22 are novel, including 9 nonsense, 3 small deletions, 4 insertions, 1 in/del, 1 small duplication, 1 missense, 2 splice-site, and for the first time a large genomic rearrangement. This brings the total number of SPG11 mutated patients in the SPATAX collection to 111 cases in 44 families and in 17 isolated cases, from 16 Countries, all assessed using homogeneous clinical criteria. While expanding the spectrum of mutations in SPG11, this larger series also corroborated the notion that even within apparently homogeneous population a molecular diagnosis cannot be achieved without full gene sequencing. 2008 Wiley-Liss, Inc.
Holbrook, W P; Brodin, P; Balciuniene, I; Brukiene, V; Bucur, M V; Corbet, E; Dillenberg, J; Djukanovic, D; Ekanayake, K; Eriksen, H; Fisher, J; Goffin, G; Hull, P; Kumchai, T; Lumley, P; Lund, J; Mathur, V; Novaes, A; Puriene, A; Roger-Leroi, V; Saito, I; Turner, S; Mabelya, L
Inequalities within dentistry are common and are reflected in wide differences in the levels of oral health and the standard of care available both within and between countries and communities. Furthermore there are patients, particularly those with special treatment needs, who do not have the same access to dental services as the general public. The dental school should aim to recruit students from varied backgrounds into all areas covered by the oral healthcare team and to train students to treat the full spectrum of patients including those with special needs. It is essential, however, that the dental student achieves a high standard of clinical competence and this cannot be gained by treating only those patients with low expectations for care. Balancing these aspects of clinical education is difficult. Research is an important stimulus to better teaching and better clinical care. It is recognized that dental school staff should be active in research, teaching, clinical work and frequently administration. Maintaining a balance between the commitments to clinical care, teaching and research while also taking account of underserved areas in each of these categories is a difficult challenge but one that has to be met to a high degree in a successful, modern dental school.
Galindo-Izquierdo, María; Rodriguez-Almaraz, Esther; Pego-Reigosa, José M; López-Longo, Francisco J; Calvo-Alén, Jaime; Olivé, Alejandro; Fernández-Nebro, Antonio; Martinez-Taboada, Víctor; Vela-Casasempere, Paloma; Freire, Mercedes; Narváez, Francisco J; Rosas, José; Ibáñez-Barceló, Mónica; Uriarte, Esther; Tomero, Eva; Zea, Antonio; Horcada, Loreto; Torrente, Vicenç; Castellvi, Iván; Calvet, Joan; Menor-Almagro, Raúl; Zamorano, María A Aguirre; Raya, Enrique; Díez-Álvarez, Elvira; Vázquez-Rodríguez, Tomás; García de la Peña, Paloma; Movasat, Atusa; Andreu, José L; Richi, Patricia; Marras, Carlos; Montilla-Morales, Carlos; Hernández-Cruz, Blanca; Marenco de la Fuente, José L; Gantes, María; Úcar, Eduardo; Alegre-Sancho, Juan J; Manero, Javier; Ibáñez-Ruán, Jesús; Rodríguez-Gómez, Manuel; Quevedo, Víctor; Hernández-Beriaín, José; Silva-Fernández, Lucía; Alonso, Fernando; Pérez, Sabina; Rúa-Figueroa, Iñigo
The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ± 12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P lupus activity at the time of the last visit (P treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.
This report documents the input from key stakeholders of the National Security Technology Incubator (NSTI) in developing a new technology incubator and related programs for southern New Mexico. The technology incubator is being developed as part of the National Security Preparedness Project (NSPP), funded by a Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant. This report includes identification of key stakeholders as well as a description and analysis of their input for the development of an incubator.
Merkhofer, L.; Conway, R.; Anderson, B.
Local public opposition to federal bureaucratic decisions has resulted in public agencies rethinking the role of stakeholders in decision making. Efforts to include stakeholders directly in the decision-making process are on the increase. Unfortunately, many attempts to involve members of the public in decisions involving complex technical issues have failed. A key problem has been defining a meaningful role for the public in the process of arriving at a technical decision. This paper describes a successful effort by Sandia National Laboratories (SNL) in New Mexico to involve stakeholders in an important technical decision associated with its Environmental Restoration (ER) Project. The decision was where to locate a Corrective Action Management Unit (CAMU), a facility intended to consolidate and store wastes generated from the cleanup of hazardous waste sites. A formal priority setting process known as the Laboratory Integration Prioritization System (LIPS) was adapted to provide an approach for involving the public. Although rarely applied to stakeholder participation, the LIPS process proved surprisingly effective. It produced a consensus over a selected site and enhanced public trust and understanding of Project activities
Full Text Available Fibromyalgia poses a challenge for therapy. Recent guidelines suggest that fibromyalgia should be treated within a multidisciplinary therapy approach. No data are available that evaluated multimodal treatment strategies of Integrative Medicine (IM. We conducted a controlled, nonrandomized pilot study that compared two inpatient treatment strategies, an IM approach that included fasting therapy and a conventional rheumatology (CM approach. IM used fasting cure and Mind-Body-Medicine as specific methods. Of 48 included consecutive patients, 28 were treated with IM, 20 with CM. Primary outcome was change in the Fibromyalgia Impact Questionnaire (FIQ score after the 2-week hospital stay. Secondary outcomes included scores of pain, depression, anxiety, and well being. Assessments were repeated after 12 weeks. At 2 weeks, there were significant improvements in the FIQ (P<0.014 and for most of secondary outcomes for the IM group compared to the CM group. The beneficial effects for the IM approach were reduced after 12 weeks and no longer statistically significant with the exception of anxiety. Findings indicate that a multimodal IM treatment with fasting therapy might be superior to CM in the short term and not inferior in the mid term. Longer-term studies are warranted to assess the clinical impact of integrative multimodal treatment in fibromyalgia.
Ioannides, K.G.; Tzialla, C.E.; Papachristodoulou, C.A.; Papanikolaou, C.; Apostolopoulos, C.
The setting up of the Greek Stakeholders Group in the framework of the EC Food and Agriculture Restoration Management Involving Networked Groups (FARMING) project is described. The Group included members from more than 20 governmental and non-governmental organisations, having interest and/or responsibilities in the management of a crisis following a nuclear accident. The stakeholders, during their meetings in 2002, discussed the agricultural countermeasures and rural waste disposal options which have been compiled by the EC Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems (STRATEGY) project. All stakeholders agreed that the most preferable were those options that ensure public acceptance, minimise environmental impact and maintain farming practices and acceptable living and working conditions. Their views are synoptically presented along with the major conclusions from the stakeholders meetings regarding nuclear crisis management
Full Text Available This study aims at finding a synergetic partnership model between vocational high schools (SMK with stakeholders for the educational implementation of SMK in developing their graduate entrepreneurship. The study employed Research and Development as research method. The first-year results of the study are as follows: (1 a synergetic and sustainable partnership between SMK and stakeholders in developing the graduate entrepreneurship is very essential mainly in the aspects of curriculum development, implementation of learning strategies, utilization of human resources, evaluation, and distribution of graduates; (2 the existing partnership between SMK and stakeholders has not specifically developed graduate entrepreneurship, but more in the form of implementation of industrial working practices (prakerin which includes learning activities, utilization of human resources, and evaluation of learning; (3 partnership between SMK and stakeholders is very necessary, starting from the planning and development of the curriculum.
Busa, Tiffany; Panait, Nicoleta; Chaumoitre, Kathia; Philip, Nicole; Missirian, Chantal
Terminal 7q deletion is rarely reported in the literature. Holoprosencephaly and sacral dysgenesis are found in association with this deletion, due to haploinsufficiency of SHH and HLBX9 genes respectively. We report on a 2-year-old boy with 7q35-36.3 deletion encompassing SHH identified by oligonucleotide array comparative genomic hybridization. In addition to other frequent features, the patient presented with esophageal atresia and tracheoeosophageal fistula diagnosed at birth. This case, together with two others previously described, one presenting with esophageal atresia, the other with congenital esophageal stenosis, confirms the possible association between congenital esophageal malformations and 7q terminal deletion including SHH. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Nava, C; Lamari, F; Héron, D; Mignot, C; Rastetter, A; Keren, B; Cohen, D; Faudet, A; Bouteiller, D; Gilleron, M; Jacquette, A; Whalen, S; Afenjar, A; Périsse, D; Laurent, C; Dupuits, C; Gautier, C; Gérard, M; Huguet, G; Caillet, S; Leheup, B; Leboyer, M; Gillberg, C; Delorme, R; Bourgeron, T; Brice, A; Depienne, C
The striking excess of affected males in autism spectrum disorders (ASD) suggests that genes located on chromosome X contribute to the etiology of these disorders. To identify new X-linked genes associated with ASD, we analyzed the entire chromosome X exome by next-generation sequencing in 12 unrelated families with two affected males. Thirty-six possibly deleterious variants in 33 candidate genes were found, including PHF8 and HUWE1, previously implicated in intellectual disability (ID). A nonsense mutation in TMLHE, which encodes the ɛ-N-trimethyllysine hydroxylase catalyzing the first step of carnitine biosynthesis, was identified in two brothers with autism and ID. By screening the TMLHE coding sequence in 501 male patients with ASD, we identified two additional missense substitutions not found in controls and not reported in databases. Functional analyses confirmed that the mutations were associated with a loss-of-function and led to an increase in trimethyllysine, the precursor of carnitine biosynthesis, in the plasma of patients. This study supports the hypothesis that rare variants on the X chromosome are involved in the etiology of ASD and contribute to the sex-ratio disequilibrium. PMID:23092983
Ravera, Maura; Cannavò, Rossella; Noberasco, Giuseppe; Guasconi, Alessandro; Cabib, Ursula; Pieracci, Laura; Pegoraro, Valeria; Brignoli, Ovidio; Cricelli, Claudio; Deferrari, Giacomo; Paoletti, Ernesto
The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care. From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35-74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made. The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026-0.051 for United Kingdom, and 0.018, 95% CI 0.010-0.027 for Italy, both P calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.
Beck, J.E.; Ison, S.A.
This paper describes a powerful planning tool that can enable government, private industries, and public interest organizations to actualize their visions through sound decision making. The stakeholder focused interactive planning model is designed to integrate and ultimately gain stakeholder investment in the success of attainment of their vision. The only concessions required of the planning organization using this process is the acceptance of the premise that sustained vision success requires the support of both internal and external stakeholders and that each step in the process must be used as a validation of the previous step and essential to the completion of the next step. What is stakeholder/public involvement? It is the process in which the stakeholders (both internal and external) values, interests and expectations are included in decision-making processes. The primary goal of public involvement efforts is to include all those who have a stake in the decision, whether or not they have already been identified. Stakeholders are individuals, contractors, clients, suppliers, public organizations, state and local governments, Indian tribes, federal agencies, and other parties affected by decisions
Maeda, Yasunori; Elborn, J Stuart; Parkins, Michael D; Reihill, James; Goldsmith, Colin E; Coulter, Wilson A; Mason, Charlene; Millar, B Cherie; Dooley, James S G; Lowery, Colm J; Ennis, Madeleine; Rendall, Jacqueline C; Moore, John E
A study was undertaken to examine the population structure of viridans group streptococci (VGS) in the sputum of adult patients with cystic fibrosis (CF). Freshly expectorated sputa (n=58) from 45 adult CF patients were examined by selective conventional culture on Mitis-Salivarius agar and yielded 190 isolates of VGS. Sequence analyses of the rpnB and 16-23S rRNA ITS genes identified these isolates to belong to 12 species of VGS and included S. anginosus, S. australis, S. cristatus, S. gordonii, S. infantis, S. mitis, S. mutans, S. oralis, S. parasanguinis, S. pneumoniae, S. salivarius and S. sanguinis. The most frequently VGS organism isolated was S. salivarius (47/190; 24.7%), followed by S. mitis (36/190; 19%), S. sanguinis (25/190; 13.2%), S. oralis (20/190; 11.0%), S. pneumoniae (19/190; 10.0%), S. parasanguinis (16/190; 8.4%), S. infantis (11/190; 5.8%), S. gordonii (7/190; 3.7%), S. anginosus (4/190; 2.1%), S. cristatus (2/190; 1.1%), S. australis (1/190; 0.5%), S. mutans (1/190; 0.5%) and S. agalactiae (1/190; 0.5%). All, but four, patients harboured at least one VGS species, which ranged from one to five streptococcal species, with a mean of 2.85 species per patient. There was no clonality at the subspecies level employing ERIC RAPD PCR. Antibiotic susceptibility was determined by Minimum Inhibitory Concentration (MIC) testing against penicillin, erythromycin and ciprofloxacin. Overall, resistance to penicillin with all VGS was 73/190 (38.4%) and 167/190 (87.9%) for erythromycin. With regard to ciprofloxacin, 27/190 (14.2%) were fully resistant, whilst a further 21/190 (11.1%) showed intermediate resistance, which equated to approximately three quarters (74.7%) of isolates being fully sensitive to this agent. In addition, as a comparator control population, we examined antibiotic susceptibility, as above, in a non-CF population comprising 12 individuals (50 VGS isolates), who were not receiving chronic antibiotics. In comparison, 8% and 38% of VGS
Pedersen, Kamilla; Holdgaard, Martin Møller; Paltved, Charlotte
OBJECTIVES: The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students' ...... unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry....
Vega-Leinert, de la A.C.; Schröter, D.; Leemans, R.; Fritsch, U.; Pluimers, J.C.
A stakeholder dialogue was embedded in the ATEAM project to facilitate the development and dissemination of its European-wide vulnerability assessment of global change impacts. Participating stakeholders were primarily ecosystem managers and policy advisers interested in potential impacts on
Hebert, Jonathan R.
A best practice in the discipline of project management is to identify all key project stakeholders prior to the execution of a project. When stakeholders are properly identified, they can be consulted to provide expert advice on project activities so that the project manager can ensure the project stays within the budget and schedule constraints. The problem addressed by this study is that managers fail to properly identify key project stakeholders when using stakeholder theory because there are multiple conflicting definitions for the term stakeholder. Poor stakeholder identification has been linked to multiple negative project outcomes such as budget and schedules overruns, and this problem is heightened in certain industries such as aerospace. The purpose of this qualitative study was to explore project managers' and project stakeholders' perceptions of how they define and use the term stakeholder within the aerospace industry. This qualitative exploratory single-case study had two embedded units of analysis: project managers and project stakeholders. Six aerospace project managers and five aerospace project stakeholders were purposively selected for this study. Data were collected through individual semi-structured interviews with both project managers and project stakeholders. All data were analyzed using Yin's (2011) five-phased cycle approach for qualitative research. The results indicated that the aerospace project managers and project stakeholder define the term stakeholder as "those who do the work of a company." The participants build upon this well-known concept by adding that, "a company should list specific job titles" that correspond to their company specific-stakeholder definition. Results also indicated that the definition of the term stakeholder is used when management is assigning human resources to a project to mitigate or control project risk. Results showed that project managers tended to include the customer in their stakeholder definitions
Despite comprehensive school reform (CSR) model developers' best intentions to make school stakeholders adhere strictly to the implementation of model components, school stakeholders implementing CSR models inevitably make adaptations to the CSR model. Adaptations are made to CSR models because school stakeholders internalize CSR model practices…
... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Stakeholder engagement. 155.52 Section... REGISTRATION STANDARDS AND REGISTRATION REVIEW Registration Review Procedures § 155.52 Stakeholder engagement... Agency may meet with stakeholders regarding a forthcoming or ongoing registration review. For example...
De infoavond licht de stakeholders in over de planning en invulling van de circuits en de praktische organisatie ervan. De stakeholders worden ingelicht over de huidige realisaties binnen het project, zowel op nationaal als internationaal niveau. Het geeft aan de stakeholders eveneens de kans om te netwerken.
... Center in Washington, DC. This annual PHEMCE event will bring together private- and public-sector stakeholders including: Federal Officials, International Governments, Industry, Healthcare Providers, First...
Leensen, Monique C J; Groeneveld, Iris F; Heide, Iris van der; Rejda, Tomas; van Veldhoven, Peter L J; Berkel, Sietske van; Snoek, Aernout; Harten, Wim van; Frings-Dresen, Monique H W; de Boer, Angela G E M
To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes. Longitudinal prospective intervention study using a one-group design. Two hospitals in the Netherlands. Of the eligible patients, 56% participated; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included. Patients completed questionnaires on RTW, the importance of work, work ability (WAI), RTW self-efficacy, fatigue (MFI), and quality of life (EORTC QLQ C-30) at baseline and 6, 12 and 18 months follow-up. Before and after the exercise programme 1-repetition maximum (1RM) muscle strength and cardiorespiratory fitness (VO 2 peak) were assessed. Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme, 59% of the cancer patients returned to work, 86% at 12 months and 83% at 18 months. In addition, significant improvements (pfatigue levels were significantly reduced. After completing the exercise programme, 1RM muscle strength was significantly increased but there was no improvement in VO 2 peak level. RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Kimani, Tabitha; Ngigi, Margaret; Schelling, Esther; Randolph, Tom
extending the OH network to include the other 50% stakeholders and fostering of the process at subnational-level building on available cross-sectoral platforms. PMID:27330042
Negev, Maya; Davidovitch, Nadav; Garb, Yaakov; Tal, Alon
The literature on impact assessment (HIA) registers the importance of stakeholder participation in the assessment process, but still lacks a model for engaging stakeholders of diverse ethnic, professional and sectorial backgrounds. This paper suggests that the multicultural approach can contribute to HIA through a revision of the generic 5-step HIA model, and its implementation in a metropolitan plan in Southern Israel. The health issue scoped by the stakeholders in the HIA is related to land uses in the vicinity of the national hazardous industry and hazardous waste site. The stakeholders were representatives of the diverse populations at stake, including rural Bedouins and Jewish city dwellers, as well as representatives from the public sector, private sector, non-governmental organizations and academia. The case study revealed that a multicultural stakeholder participation process helps to uncover health issues known to the community which were not addressed in the original plan, and provides local knowledge regarding health conditions that is especially valuable when scientific data is uncertain or absent. It enables diverse stakeholders to prioritize the health issues that will be assessed. The case study also reveals ways in which the model needs revisions and improvements such as in recruitment of diverse participants. This paper presents a multicultural model of HIA and discusses some of the challenges that are faced when HIA is implemented in the context of current decision-making culture. -- Highlights: • We revised the generic HIA model in light of the multicultural approach. • We tested the model in a case study of zoning a hazardous industry site. • Multicultural stakeholder participation uncovers health issues known to communities. • It enables community prioritization of health issues. • We present a model for multicultural stakeholder participation in HIA
Full Text Available This study aims to address the issue of accountability in a waqf institution. Specifically, the focus of this study is to shed more light on how the mutawalli (waqf trustee discharges accountability in managing waqf. In so doing, an interpretive case study in one Indonesian waqf institution, that is, Dompet Dhuafa (DD, was undertaken. The data were obtained through semi-structured interviews. Other sources of data collection techniques employed along with the interviews include observations and document reviews. Furthermore, this study uses the accountability mechanisms as the conceptual lens. The accountability mechanisms consist of disclosure statements and reports, performance assessment, participation, self-regulation and social auditing. In addition to the accountability mechanims, the stakeholder salience theory is also used to understand how the mutawalli shows accountability to multiple stakeholders. The findings of this study reveal that although DD recognizes the salient nature of its stakeholders, it does not prevent the mutawalli from showing accountability to all stakeholders. The mutawalli is of the view that accountability is not limited to accounting and reporting. Moreover, the mutawalli believes that showing accountability to different groups of stakeholder requires different mechanisms of accountability. As such, this study concludes that DD’s commitment to accountability is proven through its effort to deal with stakeholder salience.
Emma G. E. Brooks
Full Text Available Contingent valuation is one of the most commonly used methodologies utilized in ecosystem service valuation, thereby including a participatory approach to many such assessments. However, inclusion of nonmonetary stakeholder priorities is still uncommon in ecosystem service valuations and disaggregation of stakeholders is all but absent from practice. We look at four site-scale wetland ecosystem service valuations from Asia that used nonmonetary participatory stated preference techniques from a range of stakeholders, and compare these prioritizations to those obtained from the largest monetary assessments available globally, the Ecosystem Service Value Database (ESVD. Stakeholder assessment suggests very different priorities to those from monetary assessments, yet priorities between different sites remained broadly consistent. Disaggregation of beneficiaries in one site showed marked differences in values between stakeholders. Monetary values correlate positively with values held by government officers and business owners, but negatively with fishermen and women who are relying most directly on the wetland ecosystem services. Our findings emphasize that ecosystem service assessment, monetary or otherwise, must capture the diversity of values present across stakeholder groups to incorporate site scale management issues, particularly in relation to poverty alleviation.
Madsen, Charlotte Bernhard; Crevel, René; Chan, Chun-Han
We have reached a point where it is difficult to improve food allergy risk management without an agreement on levels of acceptable risk. This paper presents and discusses the perspectives of the different stakeholders (allergic consumers, health professionals, public authorities and the food...... industry) on acceptable risk in food allergy. Understanding where these perspectives diverge and even conflict may help develop an approach to define what is acceptable. Uncertainty about food allergy, its consequences and how to manage them is the common denominator of the stakeholders’ views. In patients...... to all patients despite the fact that the risk to each is not identical. Regulators and the food industry struggle with the fact that the lack of management thresholds forces them to make case-by-case decisions in an area of uncertainty with penalties for under- or over-prediction. As zero risk...
Reignier, Jean; Dumont, Romain; Katsahian, Sandrine; Martin-Lefevre, Laurent; Renard, Benoit; Fiancette, Maud; Lebert, Christine; Clementi, Eva; Bontemps, Frederic
To assess decisions to forego life-sustaining treatment (LST) in patients too sick for intensive care unit (ICU) admission, comparatively to patients admitted to the ICU. Prospective observational cohort study. A medical-surgical ICU. Consecutive patients referred to the ICU during a one-yr period. None. Of 898 triaged patients, 147 were deemed too well to benefit from ICU admission. Decisions to forego LST were made in 148 of 666 (22.2%) admitted patients and in all 85 patients deemed too sick for ICU admission. Independent predictors of decisions to forego LST at ICU refusal rather than after ICU admission were: age; underlying disease; living in an institution; preexisting cognitive impairment; admission for medical reasons; and acute cardiac failure, acute central neurologic illness, or sepsis. Hospital mortality after decisions to forego LST was not significantly different in refused and admitted patients (77.5% vs. 86.5%; p = .1). Decisions to forego LST were made via telephone in 58.8% of refused patients and none of the admitted patients. Nurses caring for the patient had no direct contact with the ICU physicians for 62.3% of the decisions in refused patients, whereas meetings between nurses and physicians occurred in 70.3% of decisions to forego LST in the ICU. Patients or relatives were involved in 28.2% of decisions to forego LST at ICU refusal compared with 78.4% of decisions to forego LST in ICU patients (p refused patients (vs. none of admitted patients) and were associated with less involvement of nurses and relatives compared with decisions in admitted patients. Further work is needed to improve decisions to forego LST made under the distinctive circumstances of triage.
Full Text Available La importancia de la responsabilidad social empresarial (RSE radica en el involucramiento y el compromiso de la empresa hacia los diferentes grupos de interés que interactúan. Algunos grupos son afectados a causa de las actividades operacionales de las organizaciones, generando impactos en dimensiones sociales, económicas y ambientales. El enfoque central de la investigación es la determinación de la incidencia de la RSE en los patrones de vida de los grupos que intervienen en la cadena de valor ecuatoriana. En adelante estos son llamados stakeholders. Se precisa como antesala, los hechos y precedentes que marcaron la evolución y participación del modelo de negocio en los diferentes países de Latinoamérica. Sobre esta base, se realiza una revisión conceptual de la responsabilidad social en las empresas, la ISO 26000 y la posición de los stakeholders. El estudio se fundamenta en un análisis comparativo de países como: Chile, Colombia y Ecuador; identificando similitudes de su entorno, particularidades, fortalezas y debilidades en materia de RSE.
Dahm, Philipp; Oxman, Andrew D; Djulbegovic, Benjamin; Guyatt, Gordon H; Murad, M Hassan; Amato, Laura; Parmelli, Elena; Davoli, Marina; Morgan, Rebecca L; Mustafa, Reem A; Sultan, Shahnaz; Falck-Ytter, Yngve; Akl, Elie A; Schünemann, Holger J
Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/). Published by Elsevier Inc.
Eghtedar, Alireza; Verstovsek, Srdan; Estrov, Zeev; Burger, Jan; Cortes, Jorge; Bivins, Carol; Faderl, Stefan; Ferrajoli, Alessandra; Borthakur, Gautam; George, Solly; Scherle, Peggy A; Newton, Robert C; Kantarjian, Hagop M; Ravandi, Farhad
We conducted a phase 2 study of ruxolitinib in patients with relapsed/refractory leukemias. Patients with acceptable performance status (0-2), adequate organ function, and no active infection, received ruxolitinib 25 mg orally twice a day for 4 weeks (1 cycle). Response was assessed after every 2 cycles of treatment, and patients who completed 2 cycles were allowed to continue treatment until disease progression. Dose escalation to 50 mg twice daily was permitted in patients demonstrating a benefit. Thirty-eight patients, with a median age of 69 years (range, 45-88), were treated. The median number of prior therapies was 2 (range, 1-6). Twelve patients had JAK2V617F mutation. Patients received a median of 2 cycles of therapy (range, 1-22). Three of 18 patients with postmyeloproliferative neoplasm (MPN) acute myeloid leukemia (AML) showed a significant response; 2 achieved complete remission (CR) and one achieved a CR with insufficient recovery of blood counts (CRi). The responding patients with palpable spleens also had significant reductions in spleen size. Overall, ruxolitinib was very well tolerated with only 4 patients having grade 3 or higher toxicity. Ruxolitinib has modest antileukemic activity as a single agent, particularly in patients with post-MPN AML. The study was registered at www.clinicaltrials.gov as NCT00674479.
The author explains how local politicians look upon the dialogue regarding nuclear installations in their municipalities. As seen from the map of European reactors there is a lot of local districts affected by nuclear operations. What has a mayor from such a community to say about the shut-down phase of such operations and especially about the need for communication between stakeholders when closing and decommissioning a nuclear power reactor? To answer this question the author has structured his presentation into 4 parts as follows: 1. The European municipalities ? some characteristics; 2. The siting of NPPs (nuclear power plants) in Europe; 3. The shutdown, decommissioning and the dismantling phases; 4. Lessons learnt
Iwelunmor, Juliet; Gyamfi, Joyce; Plange-Rhule, Jacob; Blackstone, Sarah; Quakyi, Nana Kofi; Ntim, Michael; Zizi, Ferdinand; Yeboah-Awudzi, Kwasi; Nang-Belfubah, Alexis; Ogedegbe, Gbenga
The purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana. Using focus group discussions and in-depth interviews, qualitative data were obtained from 81 key stakeholders including patients, nurses, and site directors of participating community health centers involved in the TASSH trial. Qualitative data were analyzed using open and axial coding techniques. Analysis of the qualitative data revealed three themes that illustrate stakeholders' perceptions of the ongoing task-shifting strategy for blood pressure control in Ghana and they include: 1) awareness and understanding of the TASSH program; 2) reasons for participation and non-participation in TASSH; and 3) the benefit and drawbacks to the TASSH program. The findings support evidence that successful implementation of any task-shifting strategy must focus not only on individual patient characteristics, but also consider the role contextual factors such as organizational and leadership factors play. The findings also demonstrate the importance of understanding stakeholder's perceptions of evidence-based task-shifting interventions for hypertension control as it may ultimately influence the sustainable uptake of these interventions into "real world" settings.
listening to others in the strategy-making process rather than directly involving others in decision-making. Also, because non-stakeholders, such as paid-for consultants, are found to be note-worthy influencers in the CSR strategy-making process, it is concluded that the process is not only a stakeholder......A given characteristic of successful corporate social responsibility (CSR) programs is that they reflect stakeholder expectations and preferences for corporate behavior. This study examines the process by which this alignment is sought by CSR managers in the CSR strategy-making process. Through...... reliance on stakeholder management theories, and with a particular focus on how and why managers communicate with stakeholders, the extent to which the company-stakeholder alignment process in CSR strategy-making reflects modern, enlightened approaches to stakeholder relations is assessed. This assessment...
Mureşan, Mircea; Mureşan, Simona; Bara, Tivadar; Neagoe, Radu; Sala, Daniela; Suciu, Bogdan
The incisional hernia continues to be a frequent complication of laparotomies. The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall. A prospective longitudinal study was performed that included 142 patients. An analysis was performed on the individual data, the level of obesity, intra-surgical variations in intra-abdominal pressure, the intensity of post-surgical pain, the post-surgical complications, and the types of plasties of abdominal wall, simple and with polypropylene mesh. The analysis of studied group showed a general rate of relapse of 16.9%, and within the 4 procedures, 40.74% in the case of simple plasties, of 16.07% after the only plasties, 6.97% after the retro-muscular plasties, and 6.25% after the full substitution of parietal defect. On analysing the collected, hernia relapse was statistically significantly related to the level of obesity, variations in intra-abdominal pressure, post-surgical pain, and the type of procedure performed. Hernia is a frequent complication of laparotomies. Hernia relapse was more frequent in the case of simple plasties. Among the mesh procedures, the onlay plasty showed a higher rate of relapse and post-surgical complications. Hernia relapse was more frequent in the case of variations of intra-abdominal pressure, and with increased post-surgical pain. The use of an echography examination may increase the accuracy of the presence of hernia disease. Copyright © 2015 Academia Mexicana de Cirugía A.C. All rights reserved.
stakeholders including clinicians, decision-makers, patients and the public. In turn, it may facilitate their adoption in the country.
Hanson, Janice L; Stephens, Mark B; Pangaro, Louis N; Gimbel, Ronald W
There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system. In this paper we describe the quality of outpatient clinical notes from the perspective of multiple stakeholders. Using purposeful sampling for maximum diversity, we conducted focus groups and individual interviews with clinicians, nursing and ancillary staff, patients, and healthcare administrators at six federal health care facilities between 2009 and 2011. All sessions were audio-recorded, transcribed and qualitatively analyzed using open, axial and selective coding. The 163 participants included 61 clinicians, 52 nurse/ancillary staff, 31 patients and 19 administrative staff. Three organizing themes emerged: 1) characteristics of quality in clinical notes, 2) desired elements within the clinical notes and 3) system supports to improve the quality of clinical notes. We identified 11 codes to describe characteristics of clinical notes, 20 codes to describe desired elements in quality clinical notes and 11 codes to describe clinical system elements that support quality when writing clinical notes. While there was substantial overlap between the aspects of quality described by the four stakeholder groups, only clinicians and administrators identified ease of translation into billing codes as an important characteristic of a quality note. Only patients rated prioritization of their medical problems as an aspect of quality. Nurses included care and education delivered to the patient, information added by the patient, interdisciplinary information, and infection alerts as important content. Perspectives of these four stakeholder
Joosten, Yvonne A; Israel, Tiffany L; Williams, Neely A; Boone, Leslie R; Schlundt, David G; Mouton, Charles P; Dittus, Robert S; Bernard, Gordon R; Wilkins, Consuelo H
Engaging communities in research increases its relevance and may speed the translation of discoveries into improved health outcomes. Many researchers lack training to effectively engage stakeholders, whereas academic institutions lack infrastructure to support community engagement. In 2009, the Meharry-Vanderbilt Community-Engaged Research Core began testing new approaches for community engagement, which led to the development of the Community Engagement Studio (CE Studio). This structured program facilitates project-specific input from community and patient stakeholders to enhance research design, implementation, and dissemination. Developers used a team approach to recruit and train stakeholders, prepare researchers to engage with stakeholders, and facilitate an in-person meeting with both. The research core has implemented 28 CE Studios that engaged 152 community stakeholders. Participating researchers, representing a broad range of faculty ranks and disciplines, reported that input from stakeholders was valuable and that the CE Studio helped determine project feasibility and enhanced research design and implementation. Stakeholders found the CE Studio to be an acceptable method of engagement and reported a better understanding of research in general. A tool kit was developed to replicate this model and to disseminate this approach. The research core will collect data to better understand the impact of CE Studios on research proposal submissions, funding, research outcomes, patient and stakeholder engagement in projects, and dissemination of results. They will also collect data to determine whether CE Studios increase patient-centered approaches in research and whether stakeholders who participate have more trust and willingness to participate in research.
Zink, A M; Wohlleber, E; Engels, H
in all patients, yet they presented with ID/DD as well as speech delay, macrocephaly and other features attributable to FXS. No signs of autism were present. Here, we further delineate the clinical spectrum of female patients with microdeletions. FMR1 expression studies gave no evidence for an absolute...
Mukherjee, S.; Mukhopadhyay, A.; Banerjee, D.; Chandak, G.R.; Ray, K.
Heterogeneous mutations in factor IX (FIX) gene cause haemophilia B and a large number of mutations have been characterized. However, reports on gene defects among Indian haemophilia B patients are rare despite a high estimate of such patients in the country. We report identification of 22
Creative writing presents both a challenging and promising modality for psychotherapy. Though it has been used in various settings, the application within a session can be difficult. This case study presents a use of a web-based format to engage a resistant patient through her creative writing. Benefits and potential pitfalls of using a patient's writing in therapy are discussed.
Rutti, Raina M.; LaBonte, Joanne; Helms, Marilyn Michelle; Hervani, Aref Agahei; Sarkarat, Sy
Purpose: The purpose of this paper is to summarize the benefits of including a service learning project in college classes and focusses on benefits to all stakeholders, including students, community, and faculty. Design/methodology/approach: Using a snowball approach in academic databases as well as a nominal group technique to poll faculty, key…
Ahmad, R; Kyratsis, Y; Holmes, A
Health systems need efficient and effective innovation decisions to provide maximum benefit to patients, particularly in a climate of financial constraints. Although evidence-based innovations exist for helping to address healthcare-associated infections, the uptake and implementation of these is highly variable and in some cases very slow. To investigate innovation adoption decisions and implementation processes from an organizational perspective, focusing on the implications of stakeholder involvement during the innovation process. Thirty-eight technology adoption decisions and implementation processes were examined through 121 qualitative interviews in 12 National Health Service healthcare organizations across England. Stakeholder involvement varied across organizations with decisions highly exclusive to the infection prevention and control (IPC) team, to highly inclusive of wider organizational members. The context, including organizational culture, previous experience, and logistical factors influenced the level of stakeholder engagement. The timing of stakeholder involvement in the process impacted on: (i) the range of innovations considered; (ii) the technologies selected, and (iii) the success of technology implementation. Cases of non-adoption, discontinued adoption, and of successful implementation are presented to share learning. The potential benefits of stakeholder involvement for 'successful' innovation adoption are presented including a goal-oriented framework for involvement. Key stakeholder involvement can lead to innovation adoption and implementation compatible with structural and cultural contexts, particularly when involvement crosses the phases of initiation, decision-making and implementation. Involving members of the wider healthcare organization can raise the profile of IPC and reinforce efforts to make IPC everybody's business. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Pal, Surender Kumar; Sharma, Krishan; Prabhakar, Sudesh; Pathak, Ashis
The data on sociocultural, demographic, and psychosocial aspects and types of treatment strategies adopted by families of patients with epilepsy in northwestern India were collected by the interview schedule method from 400 patients (200 idiopathic and 200 symptomatic) at the outpatient department of the Neurology and Epilepsy Clinic of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Epilepsy was classified as idiopathic or symptomatic on the basis of clinical tests (EEG, CT scan, and MRI). It was observed that socioeconomic factors had no bearing on epilepsy in the present sample. Early onset, that is, before 20 years of age, reduced the chances of patients' finding a spouse among those who disclosed the disease information, thereby impacting the nuptial and fertility rates of patients with epilepsy. The present sample of patients was well informed about and sensitized to the efficacy of the modern system of medicine, as 80% of patients sought medical treatment on the very same day as or within a week of onset of seizures. The data were compatible with the framed hypothesis that well-being and safety of the patient would override the stigma burden factor, as 94% of the affected families made no attempt to hide the disease from their neighbors, friends, and colleagues, and teachers of the affected patients. Surprisingly, only 7.5% of the families admitted that they consulted a faith healer. Families did adopt some culturally prevalent methods to control involuntary movements during seizures. It can be concluded that trust in faith healers exists strongly as an undercurrent, but is not overtly admitted by the majority of patients. Some families concurrently visited modern hospitals and occult healers seeking a cure for the disease. The fear of having a child with epilepsy or other abnormalities discouraged married patients from becoming pregnant after developing epilepsy.
Deng, Kai; Yang, Li; Hu, Bing; Wu, Hao; Zhu, Hong; Tang, Chengwei
Background Carcinoembryonic antigen (CEA) is commonly used as a serum tumor marker in clinical practice; however, its prognostic value for gastric cancer patients remains uncertain. This meta-analysis was performed to assess the prognostic value of CEA and investigate CEA as a tumor marker. Methods PubMed, EMBASE and other databases were searched for potentially eligible studies. Forty-one studies reporting the prognostic effect of pretreatment serum CEA expression in gastric cancer patients were selected. Data on 14651 eligible patients were retrieved for the meta-analysis. Based on the data extracted from the available literature, the hazard ratio (HR) and 95% confidence interval (CI) for an adverse prognosis were estimated for gastric cancer patients with elevated pretreatment serum levels of CEA (CEA+) relative to patients with normal pretreatment CEA levels (CEA-). Results The CEA+ patients had a significantly poorer prognosis than the CEA- patients in terms of overall survival (OS: HR 1.716, 95% CI 1.594 - 1.848, P 0.05). In the pooled analyses of multivariate-adjusted HRs, the results suggested that pretreatment serum CEA may be an independent prognostic factor in gastric cancer (OS: HR 1.681, 95% CI 1.425 - 1.982; DSS: HR 1.900, 95% CI 1.441 - 2.505; DFS: HR 2.579, 95% CI 1.935 - 3.436). Conclusion/Significance The meta-analysis based on the available literature supported the association of elevated pretreatment serum CEA levels with a poor prognosis for gastric cancer and a nearly doubled risk of mortality in gastric cancer patients. CEA may be an independent prognostic factor for gastric cancer patients and may aid in determining appropriate treatment which may preferentially benefit the CEA+ patients. PMID:25879931
Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W
Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary
Full Text Available Alessandra N Bazzano,1 Lea Jones,1 Thoai D Ngo2 1Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; 2Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK Abstract: The study aimed to explore perceptions of stakeholders regarding misoprostol use in Cambodia, a setting with high maternal mortality. Semi-structured expert interviews were conducted with 21 participants in the capital, Phnom Penh. The sample included participants involved in providing reproductive health services through international and local health agencies and the pharmaceutical industry. A theme of controversy over the role of misoprostol in the context of reproductive health services emerged, along with a need to reconcile legitimate viewpoints in order to understand the place of misoprostol in the Cambodian reproductive health setting. Understanding stakeholder perspectives on misoprostol can shed light on the drug's role in reproductive health programming where maternal mortality is high and health facilities are still improving. Keywords: maternal mortality, misoprostol, post-partum hemorrhage, medical abortion, unsafe abortion, Cambodia
Haapasaari, Päivi Elisabet; Mäntyniemi, Samu; Kuikka, Sakari
Comprehensive problem framing that includes different perspectives is essential for holistic understanding of complex problems and as the first step in building models. We involved five stakeholders to frame the management problem of the Central Baltic herring fishery. By using the Bayesian belief...... support that explicitly includes the views of different stakeholder groups. It enables the examination of social and biological factors in one framework and facilitates bridging the gap between social and natural sciences. A benefit of the BBN approach is that the graphical model structures can...
Monestime, Gianina; Borger, Daniel K; Kim, Jenny; Lopez, Grisel; Allgaeuer, Michael; Jain, Dhanpat; Vortmeyer, Alexander; Wang, Hao-Wei; Sidransky, Ellen
Enzyme replacement therapy is standard of care for patients with Gaucher disease, as it significantly improves skeletal, visceral, and hematological symptoms. Few pathological studies have documented the extent of pathological findings in treated patients. Autopsy findings in five treated patients, who ultimately developed parkinsonism, ranged from the complete absence of Gaucher pathology to extensive involvement of multiple tissues, without correlation to age, genotype, spleen status, or dose/duration of therapy. Additional autopsies may elucidate modifiers and biomarkers contributing to disease burden and response to therapy. Published by Elsevier Inc.
Full Text Available Information Communication Technology (ICT researchers adapt and use tools from reference and cognate disciplines. This application of existing tools outside the context of their development has implications beyond the immediate problem context. ICT researchers have access to a wide variety of data sources including newer ones, such as the Internet, that may bring unexpected outcomes. ICT research can impact on researchers, their institutions and the researched in unexpected ways. People so affected are the stakeholders in ICT research activities. Reputations, welfare and property may be put at risk by unplanned events described in this paper. Legal aspects of ICT research are broadly identified and linked to the tort of negligence. The Social Research Association’s Code for researcher safety is described and its application extended to include the Internet as a potential data source. A common set of underlying ethical principles is identified suggesting that the ICT researcher can refine particular research protocols for specific social contexts.
Full Text Available The importance of organizational-stakeholder relationships is highlighted in most organizational studies literature. This article investigates the relationship between medical practices and their stakeholders and has been developed to provide guidance on stakeholder engagement and communication. It is intended to provide a useful reference point for all medical practices concerning stakeholder engagement activities. Direction is provided on how to identify and ultimately engage with stakeholders. It should hopefully further develop the effectiveness of engagement efforts that are undertaken between a medical practice and its stakeholders. The ability of a medical practice to cultivate and sustain strong relationships with its prominent stakeholder groups greatly enhances the likelihood that the relationship will endure. Medical practitioners in South Africa are generally in urgent need of pursuing new ways of delivering quality health care through developing new service models that have been developed with the help of relevant stakeholders. Since stakeholder relationship management is critical for corporate sustainability, medical practice management should seek strategic direction by investigating the relative competitive threat and relative supportive value of each stakeholder and then classify them accordingly.
Jensen, Maj Britt; Nielsen, Torsten O.; Knoop, Ann S.
Background: Following loco-regional treatment for early breast cancer accurate prognostication is essential for communicating benefits of systemic treatment. The aim of this study was to determine time to recurrence and long-term mortality rates in high risk patients according to patient characte......Background: Following loco-regional treatment for early breast cancer accurate prognostication is essential for communicating benefits of systemic treatment. The aim of this study was to determine time to recurrence and long-term mortality rates in high risk patients according to patient...... and EGFR positive. Multivariate categorical and fractional polynomials (MFP) models were used to construct prognostic subsets by clinicopathologic characteristics. Results: In a multivariate model, mortality rate was significantly associated with age, tumor size, nodal status, invasion, histological type...
Francolini, Giulio; Thomsen, Mette S; Yates, Esben S
BACKGROUND AND PURPOSE: To report on a Quality assessment (QA) of Skagen Trial 1, exploring hypofractionation for breast cancer patients with indication for regional nodal radiotherapy. MATERIAL AND METHODS: Deviations from protocol regarding target volume delineations and dose parameters (Dmin...
Mangurian, Christina; Modlin, Chelsea; Williams, Lindsey; Essock, Susan; Riano, Nicholas S; Shumway, Martha; Newcomer, John W; Dilley, James W; Schillinger, Dean
We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.
Kamba, Tomomi; Kamoto, Toshiyuki; Okubo, Kazutoshi; Teramukai, Satoshi; Kakehi, Yoshiyuki; Matsuda, Tadashi; Ogawa, Osamu
To clarify the contemporary clinical outcome of stage I seminoma and to provide information on treatment options to patients. A retrospective analysis of 425 patients who underwent orchiectomy for stage I seminoma between 1985 and 2006 at 25 hospitals in Japan. Relapse-free survival rates were calculated using the Kaplan-Meier method and clinicopathological factors associated with relapse were examined by univariate and multivariate analyses using the Cox proportional hazards model. A total of 30 out of 425 patients had relapsed. Relapse-free survival rates at 10 years were 79, 94 and 94% in the surveillance, chemotherapy and radiotherapy groups, respectively. Post-orchiectomy management and rete testis invasion were identified as independent predictive factors associated with relapse. Rete testis invasion remained to be an independent predictive factor, even if the cases with relapses in the contralateral testis were censored. Only one patient, who relapsed after adjuvant radiotherapy, died of the disease. Overall survival at 10 years was 100, 100 and 99% in the surveillance, chemotherapy and radiotherapy groups, respectively. More than half of the patients were lost to follow up within 5 years. The outcome of Japanese patients with stage I seminoma is similar to previously published Western reports. Surveillance policy is becoming a popular option in Japan, although the relapse rate in patients opting for surveillance policy is higher than those opting for adjuvant chemotherapy or radiotherapy. Rete testis invasion is an independent predictive factor associated with relapse regardless of the post-orchiectomy management. Long-term follow up is mandatory for detection of late relapse. © 2010 The Japanese Urological Association.
Madill, Catherine; Warhurst, Samantha; McCabe, Patricia
The act of communication is a complex, transient and often abstract phenomenon that involves many stakeholders, each of whom has their own perspective: the speaker, the listener, the observer and the researcher. Current research practices in voice disorder are frequently framed through a single lens - that of the researcher/clinician or their participant/patient. This single lens approach risks overlooking significant barriers to the basic human right of freedom of expression for those with a voice disorder as it omits consideration of the impact of voice disorder on the listener, and consideration of the wider impact of the voice in the occupational context. Recent research in the area of voice has developed a multiple lens and subsequent Stakeholder Model that acknowledges the experience and reality of multiple stakeholders viewing the same phenomenon, the voice. This research paradigm is built on Article 19 of the Universal Declaration of Human Rights as it considers the realities of all stakeholders in forming a deeper understanding of the causality, impact and aspects of communication disorder. The Stakeholder Model will be presented as a suggestion for future investigations of communication disorders more widely.
/strategic and broad/narrow dimensions. Building on the assumption that ‘political marketing is different’, the paper argues that stakeholders can be considered as direct or indirect depending on which of the three interaction marketplaces of the political exchange triad the political actor-stakeholder interaction......Stakeholders influence the ability of organisations to achieve their aims, but little work has been carried out into understanding the stakeholder concept as applied to the political marketing context. This paper first discusses the contextual nature of stakeholders using normative...... occurs in. Finally, it is proposed that in the political marketing context, the stakeholder concept can be defined as ‘context-specific actors that directly or indirectly influence or are influenced by the political actor’....
Any significant decisions regarding geologic disposal of radioactive waste will need a comprehensive public review and a thorough involvement of all relevant stakeholders, such as waste generators, waste management agencies, regulatory authorities, local communities and elected officials. The participation of non-technical stakeholders will become increasingly important as more countries move towards siting and implementing geologic repositories. The decision-making process and avenues for stakeholder involvement differ from country to country. It is important to identify similarities and differences, understand the key concerns of the various stakeholders, and develop means to interact effectively. The Nuclear Energy Agency recently set up a Forum on Stakeholder Confidence charged with distilling the lessons that can be learnt from national and international experience. These proceedings of the Forums first workshop held in August 2000 provide an overview of OECD countries' experience in the field of stakeholder confidence and radioactive waste disposal. (author)
Full text: A Workshop to extend the Involvement of Stakeholders in Decisions On restoration Management (WISDOM) will be held in Oxford in September 2003. The aim of the workshop is to promote awareness and interest in the wider application of stakeholder involvement in the formulation of strategies for the management of contaminated agricultural land and produce following a nuclear accident. A network of stakeholder groups has already been set up under the auspices of the European Communities 5th Framework Programme (FP5). The network, given the acronym FARMING, involves more than 100 stakeholders in UK, Finland, Belgium, Greece and France. Membership tends to be at a senior level and comprises a wide range of Government and non-government organizations, including the farming sector, the food, milk and water industries, consumers and green groups. The stakeholder groups have met regularly since 2001 and have advanced contingency planning and emergency response, both nationally and on a European basis. A compendium of countermeasure options produced by another FP5 project, STRATEGY, has helped provide stakeholders with a common focus for discussion and evaluation. The 2 1/2 day workshop comprises a mixture of invited and proffered papers as well as facilitated group discussions and plenary sessions that will address the following issues: lessons learnt from stakeholder engagement; influence of regional characteristics on countermeasure selection; practical aspects of countermeasure implementation; crisis management; maintaining consumer confidence; acceptability of intervention limits; social, ethical and economic consequences; future prospects for stakeholder networks. More than 30 FARMING stakeholders and facilitators have expressed an interest in attending the WISDOM workshop. GOs and NGOs will both be represented. There will also be representatives from the STRATEGY project and the European Commission. Invitations have been issued to representatives of a further
Heller, R; Fernando, I; MacDougall, M
This retrospective study assessed whether Quality Improvement Scotland national standards for the sexual health care offered to HIV-positive individuals are being met by the Edinburgh genitourinary (GU) medicine clinic; specifically whether HIV-positive patients are offered: (a) sexually transmitted infection (STI) screening annually and (b) syphilis testing six-monthly. The study also reviewed what factors were associated with a clinician's offer of STI screening and syphilis testing. Of the 509 patients seen within the study period, case notes documented that 64% were offered STI screens, and 69% were offered syphilis testing, results consistent with audits of services elsewhere. Sexual orientation (P offer of STI screening, while gender (P offer of syphilis testing. Our results suggest that one explanation for clinicians failing to offer STI screens and syphilis serology testing is their (implicit) risk assessment that STI testing is not required in individual patients.
Maiwald, Karin; de Rijk, Angelique; Guzman, Jaime; Schonstein, Eva; Yassi, Annalee
Introduction Workplace disability prevention is important, but stakeholders can differ in their appreciation of such interventions. We present a responsive evaluation of a workplace disability prevention intervention in a Canadian healthcare organization. Three groups of stakeholders were included: designers of the intervention, deliverers, and workers. The aim was to examine the appreciation of this intervention by analyzing the discrepancies with respect to what these various stakeholders s...
Full Text Available Stakeholders involvement in infrastructure development c.q. Light Rail Transit (LRT has a significant role since they affect the success of infrastructure management. This paper is primarily aimed to identify key stakeholders and responses that need to be applied to them. On the initial stage, a list of stakeholders was developed using research strategies such as case study and literature review. Sources were then chosen with certain criteria. They were assigned to score each stakeholder on the list. A stakeholder analysis was conducted to obtain a list of key stakeholders that have a significant impact on Jakarta’s LRT.
In an increasingly global and highly competitive business world of today, the business sector pays meticulous attention to stakeholders - groups or individuals, which affect or are affected by business decisions. The paper examines the methodology of identifying key stakeholders, demonstrates the process of their various mapping models, as well as the manner in which stakeholders, in cooperation with a corporation, create the opportunity to be engaged at an early stage of a project, activity ...
Novoa, Ana; Kaplan, Haylee; Wilson, John R. U.; Richardson, David M.
The regulation and management of alien species can be contentious, particularly when the stakeholders who benefit from alien species are different from those who suffer the costs. We propose a consultative process involving relevant stakeholders in invasive species management decisions. The process involves (1) the identification of relevant stakeholders, (2) assessing their perceptions, (3) enhancing interaction between stakeholders, (4) assessing changes in stakeholders' perceptions following interactions with other stakeholders, and (5) developing management recommendations in collaboration with stakeholders. We demonstrate the application of the process using the family Cactaceae (`cacti') in South Africa. Many species of cacti have been introduced to the country over the past two centuries, mostly for horticulture, food and fodder, and hundreds of other species have been introduced in the past few decades (or are likely to be introduced soon) for horticulture. Using the proposed process enabled the negotiation and participation of all stakeholders in decision making and helped minimize contentious situations by clarifying stakeholder's beliefs and exploring consensus solutions. Consequently, management objectives were broadly supported by all stakeholders. These results will be included in a national cactus management strategy for South Africa.
Nyboe, L.; Vestergaard, C. H.; Moeller, M. K.
OBJECTIVE: To compare the prevalence of metabolic syndrome (MetS) and metabolic abnormalities in patients with first-episode schizophrenia (FES) with sex- and age-matched healthy controls; to investigate changes in MetS during 1year of treatment; and to investigate predictors of MetS. METHODS...
Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul D.L.P.M.; Frith, Peter A.; Zwerink, Marlies; Monninkhof, Evelyn M.; van der Palen, Job; Effing-Tijdhof, Tanja W
Background: Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease.
Grøvle, Lars; Haugen, Anne J; Ihlebaek, Camilla M; Keller, Anne; Natvig, Bård; Brox, Jens I; Grotle, Margreth
Chronic nonspecific low back pain is accompanied by high rates of comorbid mental and physical conditions. The aims of this study were to investigate if patients with specific back pain, that is, sciatica caused by lumbar herniation, report higher rates of subjective health complaints (SHCs) than the general population and if there is an association between change in sciatica symptoms and change in SHCs over a 12-month period. A multicenter cohort study of 466 sciatica patients was conducted with follow-up at 3 months and 1 year. Comorbid SHCs were measured by 27 items of the SHC inventory. Odds ratios (ORs) for each SHC were calculated with comparison to a general population sample (n=928) by logistic regression. The SHC number was calculated by summing all complaints present. At baseline, the ORs for reporting SHCs for the sciatica patients were significantly elevated in 15 of the 27 items with a mean (S.D.) SHC number of 7.5 (4.4), compared to 5.2 (4.4) in the general population (Psciatica, the SHC number was reduced to normal levels. Among those with persisting or worsening sciatica, the number increased to a level almost double that of the general population. Compared to the general population, the prevalence of subjective health complaints in sciatica is increased. During follow-up, the number of health complaints increased in patients with persisting or worsening sciatica. Copyright © 2010 Elsevier Inc. All rights reserved.
Strike, Carol; Watson, Tara Marie; Kolla, Gillian; Penn, Rebecca; Bayoumi, Ahmed M
Community stakeholders express a range of opinions about supervised injection facilities (SIFs). We sought to identify reasons for ambivalence about SIFs amongst community stakeholders in two Canadian cities. We used purposive sampling methods to recruit various stakeholder representatives (n = 141) for key informant interviews or focus group discussions. Data were analyzed using a thematic process. We identified seven reasons for ambivalence about SIFs: lack of personal knowledge of evidence about SIFs; concern that SIF goals are too narrow and the need for a comprehensive response to drug use; uncertainty that the community drug problem is large enough to warrant a SIF(s); the need to know more about the "right" places to locate a SIF(s) to avoid damaging communities or businesses; worry that a SIF(s) will renew problems that existed prior to gentrification; concern that resources for drug use prevention and treatment efforts will be diverted to pay for a SIF(s); and concern that SIF implementation must include evaluation, community consultation, and an explicit commitment to discontinue a SIF(s) in the event of adverse outcomes. Stakeholders desire evidence about potential SIF impacts relevant to local contexts and that addresses perceived potential harms. Stakeholders would also like to see SIFs situated within a comprehensive response to drug use. Future research should determine the relative importance of these concerns and optimal approaches to address them to help guide decision-making about SIFs.
Castello, Itziar; Etter, Michael
We analyze the role of power transforming stakeholder engagement practices under the conditions of the network society. We look at how Global Health (pseudonym) managers navigate between two competing logics of stakeholder engagement: the current (influence logic) and the new logic underlying...... social media (logic of community). With a longitudinal study of 26 months we find that managers are able to integrate symbolic and substantive elements of the new logic but elements of the conditions of authority and hierarchy remain unchanged constraining new forms of stakeholder engagement. We relate...... our results to the current conceptualization of stakeholder engagement as firm centered....
Graversgaard, Morten; Jacobsen, Brian H.; Kjeldsen, Chris
with stakeholder involvement proposed a much longer network of streams (3800 km), yielding a better ecological outcome than the shorter stream network (1615 km) proposed by the Nature Agency for the same budget. Having a structured and fixed institutional frame around public participation (top-down meeting bottom...... of water councils in water planning has significant advantages, including the fact that the knowledge of local conditions helps to identify efficient solutions at lower costs, which can be useful for administrators, policy-makers, and other stakeholders implementing theWater Framework Directive in years...
In the aftermath of a large scale radioactive contamination, the authorities will have to decide on protective measures for reducing the contamination of the food chain. The overall aim is to reduce the dose of the population to an acceptable level while still guaranteeing sufficient foodstuffs and feeding stuffs on the market and also to limit the social, environmental and economic impact of the countermeasures implemented. Many countermeasures have been developed over the years, but their large scale feasibility and especially their acceptability have hardly been studied. Within the context of a European research project called Farming (2000-2004). SCK-CEN has organised stakeholder meetings, leading to guidance to the authorities for improvements in the emergency organisation. To improve emergency countermeasure decisions related to the food chain, especially as regards feasibility and acceptability, taking into account stakeholder opinions. The stakeholders include scientists and representatives from both governmental and non-governmental organisations
Ortiz, Miriam; Witt, Claudia M; Binting, Sylvia; Helmreich, Cornelia; Hummelsberger, Josef; Pfab, Florian; Wullinger, Michael; Irnich, Dominik; Linde, Klaus; Niggemann, Bodo; Willich, Stefan N; Brinkhaus, Benno
Background In a large randomised trial in patients with seasonal allergic rhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue medication. The aim of this paper is to describe the characteristics of the trial’s participating physicians and to describe the trial intervention in accordance with the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guidelines, to make details of the trial intervention more transparent to researchers a...
Tichopád, Aleš; Vítová, Veronika; Kořístek, Zdeněk; Lysák, Daniel
Peripheral blood stem cells (PBSCs) are preferred source of hematopoietic stem cells for autologous transplantation. Mobilization of PBSCs using chemotherapy and/or granulocyte colony-stimulating factor (G-CSF) however fails in around 20%. Combining G-CSF with plerixafor increases the mobilizations success. We compared cost-effectiveness of following schemes: the use of plerixafor "on demand" (POD) during the first mobilization in all patients with inadequate response, the remobilization with plerixafor following failure of the first standard mobilization (SSP), and the standard (re)mobilization scheme without plerixafor (SSNP). Decision tree models populated with data from a first-of-a-kind patient registry in six Czech centers (n = 93) were built to compare clinical benefits and direct costs from the payer's perspective. The success rates and costs for POD, SSP and SSNP mobilizations were; 94.9%, $7,197; 94.7%, $8,049; 84.7%, $5,991, respectively. The direct cost per successfully treated patient was $7,586, $8,501, and $7,077, respectively. The cost of re-mobilization of a poor mobilizer was $5,808 with G-CSF only and $16,755 if plerixafor was added. The total cost of plerixafor "on-demand" in the sub-cohort of poor mobilizers was $17,120. Generally, plerixafor improves the mobilization success by 10% and allows an additional patient to be successfully mobilized for incremental $11,803. Plerixafor is better and cheaper if used "on demand" than within a subsequent remobilization. Copyright © 2013 Wiley Periodicals, Inc.
Taniyama, Matsuo; Otsuka, Fumiko; Tozaki, Teruaki; Ban, Yoshiyuki
Thyrotoxic disease can be difficult to recognize in patients with resistance to thyroid hormone (RTH) because the clinical symptoms of thyrotoxicosis cannot be observed, and thyrotropin (TSH) may not be suppressed because of hormone resistance. Painless thyroiditis is a relatively common cause of thyrotoxicosis, but its occurrence in RTH has not been reported. We assessed the thyroid profile in a patient with RTH and episodes of thyrotoxicosis who experienced repeated painless thyroiditis. A 44-year-old Japanese woman with RTH, which was confirmed by the presence of a P453A mutation in the thyroid hormone receptor β (TRβ) gene, showed a slight elevation of the basal levels of thyroid hormones, which indicated that her pituitary RTH was mild. She experienced a slight exacerbation of hyperthyroxinemia concomitant with TSH suppression. A diagnosis of painless thyroiditis was made because of the absence of TSH receptor antibodies, low Tc-99m pertechnetate uptake by the thyroid gland, and transient suppression followed by a slight elevation of TSH following the elevation of thyroid hormones. The patient's complaints of general malaise and occasional palpitations did not change throughout the course of painless thyroiditis. Three years later, painless thyroiditis occurred again without any deterioration of the clinical manifestations. Mild pituitary RTH can be overcome by slight exacerbation of hyperthyroxinemia during mild thyrotoxicosis. When pituitary resistance is severe and TSH is not suppressed, thyrotoxicosis may be overlooked.
Full Text Available Cardiomyopathies might lead to end-stage heart disease with the requirement of drastic treatments like bridging up to transplant or heart transplantation. A not precisely known proportion of these diseases are genetically determined. We genotyped 43 index-patients (30 DCM, 10 ARVC, 3 RCM with advanced or end stage cardiomyopathy using a gene panel which covered 46 known cardiomyopathy disease genes. Fifty-three variants with possible impact on disease in 33 patients were identified. Of these 27 (51% were classified as likely pathogenic or pathogenic in the MYH7, MYL2, MYL3, NEXN, TNNC1, TNNI3, DES, LMNA, PKP2, PLN, RBM20, TTN, and CRYAB genes. Fifty-six percent (n = 24 of index-patients carried a likely pathogenic or pathogenic mutation. Of these 75% (n = 18 were familial and 25% (n = 6 sporadic cases. However, severe cardiomyopathy seemed to be not characterized by a specific mutation profile. Remarkably, we identified a novel homozygous PKP2-missense variant in a large consanguineous family with sudden death in early childhood and several members with heart transplantation in adolescent age.
Portalupi, Laura B; Lewis, Carmen L; Miller, Carl D; Whiteman-Jones, Kerry L; Sather, Kay A; Nease, Donald E; Matlock, Daniel D
People who have experienced illness due to significant disease, multimorbidity and/or advanced age are high utilizers of the health care system. Yet this population has had little formal opportunity to participate in guiding the health care research agenda, and few mechanisms exist for researchers to engage this population in an efficient way. We describe the process of developing a standing patient and family advisory panel to incorporate this population's voice into research in the USA. The panel was created at the University of Colorado. Preliminary panel development consisted of a needs assessment, information gathering and participant recruitment. We collected feedback from researchers who consulted with the panel and from panel members in order to better understand the experience from the patient and family member perspective. The patient and family research advisory panel consists of eight advisors who have experience with significant disease, multimorbidity and/or advanced age, two physicians and a program manager. The panel meets every other month for 2 hours with the main purpose of advising diverse researchers on health care studies. People with significant disease, multimorbidity and/or advanced age represent a growing demographic in the USA, and their engagement in research is essential as the model of health care delivery moves from volume to value. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com.
Pettigrew, Simone; Pescud, Melanie; Donovan, Robert J
This study investigated stakeholder perceptions of the Healthy Food and Drink Policy that was recently implemented in Western Australian public schools. A two-phase approach involving more than 1800 study participants assessed stakeholders' perceptions of the effects of the policy. Participating stakeholders included parents, principals, teachers, canteen managers, and Parents & Citizens Committee presidents. Despite numerous complaints being lodged when the policy was first introduced, the results suggest strong support across all stakeholder groups. A substantial majority of all stakeholder groups agreed that the policy has improved the healthiness of foods provided in schools and that the policy constitutes an important opportunity to educate children about healthy eating. The study outcomes indicate that policy makers should rely on representative data to assess stakeholder reactions to and support for new school food policies rather than giving undue credence to 'squeaky wheels'. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
This report gives an overview of completed research activities on the value ascribed by users, local communities and stakeholders to functions, goods and services (including non‐use values) derived from the aquatic resources in the study areas. The perceived impact of factors such as environmental...
Mayhew, Matthew J.; Caldwell, Rebecca J.; Goldman, Emily Grey
The purpose of this study was to derive an empirically based understanding of campus violence. Grounded in a communication paradigm offered by sociolinguistic scholars, we adopted a phenomenological approach for conducting and analyzing 23 interviews from campus community stakeholders, including students, staff, faculty, administrators, and…
Newman, Wayne R.
The purpose of this study was to determine how an urban school district's code of conduct aligned with actual school/class behaviors, and how stakeholders perceived the ability of this document to achieve its number one goal: safe and productive learning environments. Twenty participants including students, teachers, parents, and administrators…
In this article, the author introduces another key and, to-date, largely neglected stakeholder in high-school integrated curriculum programs (ICPs). If one wishes to have a deeper understanding of the unique, powerful, and lasting impacts of these programs, the author suggests to include the perspective and input of participants' parents. The…
Collier, Zachary A; Bates, Matthew E; Wood, Matthew D; Linkov, Igor
Dredging and disposal issues often become controversial with local stakeholders because of their competing interests. These interests tend to manifest themselves in stakeholders holding onto entrenched positions, and deadlock can result without a methodology to move the stakeholder group past the status quo. However, these situations can be represented as multi-stakeholder, multi-criteria decision problems. In this paper, we describe a case study in which multi-criteria decision analysis was implemented in a multi-stakeholder setting in order to generate recommendations on dredged material placement for Long Island Sound's Dredged Material Management Plan. A working-group of representatives from various stakeholder organizations was formed and consulted to help prioritize sediment placement sites for each dredging center in the region by collaboratively building a multi-criteria decision model. The resulting model framed the problem as several alternatives, criteria, sub-criteria, and metrics relevant to stakeholder interests in the Long Island Sound region. An elicitation of values, represented as criteria weights, was then conducted. Results show that in general, stakeholders tended to agree that all criteria were at least somewhat important, and on average there was strong agreement on the order of preferences among the diverse groups of stakeholders. By developing the decision model iteratively with stakeholders as a group and soliciting their preferences, the process sought to increase stakeholder involvement at the front-end of the prioritization process and lead to increased knowledge and consensus regarding the importance of site-specific criteria. Published by Elsevier B.V.
Ferrer, R; Zaragoza, R; Llinares, P; Maseda, E; Rodríguez, A; Quindós, G
Infections caused by Candida species are common in critically ill patients and contribute to significant morbidity and mortality. The EPICO Project (Epico 1 and Epico 2.0 studies) recently used a Delphi approach to elaborate guidelines for the diagnosis and treatment of this condition in critically ill adult patients. We aimed to evaluate the impact of a multifaceted educational intervention based on the Epico 1 and Epico 2.0 recommendations. Specialists anonymously responded to two online surveys before and after a multifaceted educational intervention consisting of 60-min educational sessions, the distribution of slide kits and pocket guides with the recommendations, and an interactive virtual case presented at a teleconference and available for online consultation. A total of 74 Spanish hospitals. Specialists of the Intensive Care Units in the participating hospitals. Specialist knowledge and reported practices evaluated using a survey. The McNemar test was used to compare the responses in the pre- and post-intervention surveys. A total of 255 and 248 specialists completed both surveys, in both periods, respectively. The pre-intervention surveys showed many specialists to be unaware of the best approach for managing invasive candidiasis. After both educational interventions, specialist knowledge and reported practices were found to be more in line with nearly all the recommendations of the Epico 1 and Epico 2.0 guidelines, except as regards de-escalation from echinocandins to fluconazole in Candida glabrata infections (p=0.055), and the duration of antifungal treatment in both candidemia and peritoneal candidiasis. This multifaceted educational intervention based on the Epico Project recommendations improved specialist knowledge of the management of invasive candidiasis in critically ill patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Forest, Valérie; Vergnon, Jean-Michel; Guibert, Cyril; Bitounis, Dimitrios; Leclerc, Lara; Sarry, Gwendoline; Pourchez, Jérémie
Mineralogical analyses of clinical samples have been proved useful to identify causal relationship between exposure to airborne particles and pulmonary diseases. The most striking example is asbestosis where the assessment of asbestos bodies in patient lung samples has allowed defining values specific of pathologies. However, this type of analyses only considers the micro-sized fraction of the particles, neglecting the specific impact of nano-sized particles which have been otherwise shown to be reactive and able to induce biological effects. Similarly, in nanotoxicology, the mineralogical analysis of pulmonary fluids could be used as an indicator of exposure to inhaled nanoparticles and could help investigations on the relationship between exposure to these nanoparticles and lung diseases. We designed this study first to demonstrate the technical feasibility of this approach, then to get a clear picture of the metals present, and in what form, in patient lungs and finally to determine if indeed it is worth investigating separately the micro, sub-micro and nano fractions. Broncho-alveolar lavages were recovered from 100 patients suffering from interstitial lung diseases. A protocol was specifically developed to isolate three fractions containing respectively microparticles, sub-microparticles and nanoparticles with ions. The metal content in each fraction was qualitatively and quantitatively characterized. Results showed significant differences between the three fractions in terms of metal load confirming that the separate analysis of the fractions is relevant. It also means that the assessment of the micro-sized fraction alone, as commonly done in clinical practice, only gives a partial view of the mineralogical analysis.
Ortiz, Miriam; Witt, Claudia M; Binting, Sylvia; Helmreich, Cornelia; Hummelsberger, Josef; Pfab, Florian; Wullinger, Michael; Irnich, Dominik; Linde, Klaus; Niggemann, Bodo; Willich, Stefan N; Brinkhaus, Benno
In a large randomised trial in patients with seasonal allergic rhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue medication. The aim of this paper is to describe the characteristics of the trial's participating physicians and to describe the trial intervention in accordance with the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guidelines, to make details of the trial intervention more transparent to researchers and physicians. ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) was a three-armed, randomised, controlled multicentre trial. 422 SAR patients were randomised to semi-standardised acupuncture plus rescue medication (RM, cetirizine), sham acupuncture plus RM or RM alone. We sent a questionnaire to trial physicians in order to evaluate their characteristics regarding their education about and experience in providing acupuncture. During the trial, acupuncturists were asked to diagnose all of their patients according to Chinese Medicine (CM) as a basis for the semi-standardised, individualized intervention in the acupuncture group. Every acupuncture point used in this trial had to be documented after each session Acupuncture was administered in outpatient clinics by 46 (mean age 47 ± 10 years; 24 female/ 22 male) conventionally-trained medical doctors (67% with postgraduate specialization such as internal or family medicine) with additional extensive acupuncture training (median 500 hours (1st quartile 350, 3rd quartile 1000 hours with 73% presenting a B-diploma in acupuncture training (350 hours)) and experience (mean 14 years in practice). The most reported traditional CM diagnosis was 'wind-cold invading the lung' (37%) and 'wind-heat invading the lung' (37%), followed by 'lung and spleen qi deficiency' (9%). The total number of needles used was higher in the acupuncture group compared to the sham acupuncture group (15.7 ± 2.5 vs. 10.0 ± 1.6). The trial interventions were
Kletke, S; Batmanabane, V; Dai, T; Vincent, A; Li, S; Gordon, K A; Papsin, B C; Cushing, S L; Héon, E
The co-occurrence of hearing impairment and visual dysfunction is devastating. Most deaf-blind etiologies are genetically determined, the commonest being Usher syndrome (USH). While studies of the congenitally deaf population reveal a variable degree of visual problems, there are no effective ophthalmic screening guidelines. We hypothesized that children with congenital sensorineural hearing loss (SNHL) and vestibular impairment were at an increased risk of having USH. A retrospective chart review of 33 cochlear implants recipients for severe to profound SNHL and measured vestibular dysfunction was performed to determine the ocular phenotype. All the cases had undergone ocular examination and electroretinogram (ERG). Patients with an abnormal ERG underwent genetic testing for USH. We found an underlying ocular abnormality in 81.81% (27/33) of cases; of which 75% had refractive errors, and 50% of those patients showed visual improvement with refractive correction. A total of 14 cases (42.42%; 14/33) had generalized rod-cone dysfunction on ERG suggestive of Usher syndrome type 1, confirmed by mutational analysis. This work shows that adding vestibular impairment as a criterion for requesting an eye exam and adding the ERG to detect USH increases the chances of detecting ocular anomalies, when compared with previous literature focusing only on congenital SNHL. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Nearly ten years have passed since the enactment of the federal Comprehensive Response, Compensation, and Liability Act (CERCLA), usually referred to as open-quotes Superfundclose quotes. Nearly four years have passed since CERCLA's major overhaul through the Superfund Amendments and Reauthorization Act (SARA). Although much still remains to be done under Superfund, there is now enough experience to assess how effectively it is working. A study being undertaken by the University of Tennessee's Waste Management Research and Education Institute will supply a portion of that assessment. The study was completed in the fall of 1990. Our study examines two related issues: the resources that will be needed in the coming years to fulfill the mandate of Superfund and other hazardous waste remediation programs, and the site-level experience to date in implementing CERCLA and SARA. This chapter discusses only the open-quotes site-level experienceclose quotes effort, and only its methodological approach. The purpose of the open-quotes site-level experienceclose quotes effort is to explore what counts as a open-quotes successfulclose quotes site in the eyes of different stakeholders in a Superfund cleanup - e.g., the affected community, the potentially responsible parties (PRPs), state and local officials, and the US Environmental Protection Agency (EPA)
Leensen, Monique C. J.; Groeneveld, Iris F.; van der Heide, Iris; Rejda, Tomas; van Veldhoven, Peter L. J.; van Berkel, Sietske; Snoek, Aernout; van Harten, Wim; Frings-Dresen, Monique H. W.; de Boer, Angela G. E. M.
Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to
Leensen, Monique C.J.; Groeneveld, Iris F.; Heide, Iris Van Der; Rejda, Tomas; Van Veldhoven, Peter L.J.; Berkel, Sietske Van; Snoek, Aernout; van Harten, Willem H.; Frings-Dresen, Monique H.W.; Boer, Angela G.E.M.
Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to
Driessen, P.H.; Hillebrand, B.
This study investigates how stakeholder orientation affects product innovation and takes the incorporation of green (ecological) issues as a specific context to study this question. The authors borrow insights from three streams of literature: (1) insights from stakeholder theory, combined with (2)
Nielsen, Morten Velsing; Bryndum, Nina; Bedsted, Bjørn
, the article illustrates the challenges of applying theory to five European stakeholder workshops co-organised by the authors. The illustration highlights the difficult interaction between theory and practice. The article concludes that while theoretical perspectives can provide general guidance, practical...... experience is essential when dealing with the trade-offs that are an intrinsic part of organising stakeholder workshops....
Gammelgaard, Britta; Bech Godskesen Andersen, Christina; Figueroa, Maria J.
Urban freight transport is a complex field characterised by many actors and stakeholders and thus many rationalities are at stake. This paper contributes to literature on urban freight governance by approaching the field with social system theory combined with the concepts of relationship platforms...... of value creation among stakeholders through this process is key to implementation of new urban freight solutions....
Verheyden, M.; Glidden, J.; Shahin, J.
How do we ensure that public policy represents the interests of all, rather than a select few? How will we ensure it draws upon the best insights and talents of key stakeholders? The European Commission’s DG CONNECT recently announced the results of its Stakeholder Engagement Survey, which is
Petra F.A. Dilling
As corporate social responsibility receives increased attention by company stakeholders, researchers are also increasingly exploring corporate social responsibility, its causes and implications. However little is known about the perception of corporate social responsibility. This study explores the link between stakeholder perception of corporate social responsibility and its relationship with underlying factors. The findings suggest that age of the corporation, community involvement, and cul...
... to achievelong-term conservation of marine resources. The promulgation of laws regarding MPAs in South Africa has triggered various responses from stakeholders affected by their declaration. This study focused on perceptions of stakeholders from recreational activity providers such as fishing and scuba diving within ...
Kraan, M.L.; Trapman, B.K.; Rasenberg, M.M.M.
This research project examines the concerns and questions of European stakeholders about pulse fishing, in order to assess to what extent the knowledge agenda on pulse fishing covers these issues. To get a first impression of the concerns about pulse fishing, and to get an idea of the stakeholders
Castello, Itziar; Etter, Michael
We analyze the role of power transforming stakeholder engagement practices under the conditions of the network society. We look at how Global Health (pseudonym) managers navigate between two competing logics of stakeholder engagement: the current (influence logic) and the new logic underlying...
Sperling, Joshua [National Renewable Energy Laboratory (NREL), Golden, CO (United States)
This presentation provides an overview of the curation of urban data and models through engaging SMART mobility stakeholders. SMART Mobility Urban Science Efforts are helping to expose key data sets, models, and roles for the U.S. Department of Energy in engaging across stakeholders to ensure useful insights. This will help to support other Urban Science and broader SMART initiatives.
Low, Poi Kee
This article reports on a qualitative study that set out to understand stakeholders' perception of the school counselling service in Singapore. Using semi-structured interviews, this study explored the perceptions of three main stakeholder groups, namely teachers and counsellors working within the schools and those working in the communities.…
Snehlata R Hingway
Full Text Available Multiple schwannomatosis, is defined as two or more, pathologically proven schwannomas, without radiographic evidence of vestibular nerve tumor, below 18 years, or absence of VIII nerve dysfunction beyond 30 years with absence of stigmata of neurofibromatosis 2 (NF2. The plexiform schwannoma (PS is a rare tumor. The gross appearance is an important diagnostic criterion for diagnosis of PSs. It is associated with NF2, which was ruled out in this case. Here we present a 50 year female patient with two nonintradermal schwannomas, in the supraclavicular and infraauricular deep soft tissues. One was plexiform, diagnosed on cytology and confirmed by histopathology. She also had multiple pulmonary and pleural lesions. Fine needle aspiration cytology smears from both supraclavicular and infraauricular lesions as well as the lung lesion sampled, showed spindle cells in a myxoid background, having wavy nuclei with pointed ends. Verocay body - like palisading of nuclei was noted.
Ferreira, Naomi Vidal; Cunha, Paulo Jannuzzi; da Costa, Danielle Irigoyen; dos Santos, Fernando; Costa, Fernando Oliveira; Consolim-Colombo, Fernanda; Irigoyen, Maria Cláudia
Introduction Peripheral arterial disease, as measured by the ankle–brachial index (ABI), is prevalent among the elderly, and is associated with functional performance, assessed by the 6-minute walk test (6MWT). Executive cognitive function (ECF) impairments are also prevalent in this population, but no existing study has investigated the association between ECF and functional performance in an elderly population including individuals with low ABI. Aim To investigate the association between functional performance, as measured by the 6MWT, and loss in ECF, in an elderly sample including individuals with low ABI. Method The ABI group was formed by 26 elderly individuals with low ABI (mean ABI: 0.63±0.19), and the control group was formed by 40 elderly individuals with normal ABI (mean ABI: 1.08±0.07). We analyzed functional performance using the 6MWT, global cognition using the Mini-Mental State Examination (MMSE), and ECF using the Digit Span for assessing attention span and working memory, the Stroop Color Word Test (SCWT) for assessing information processing speed and inhibitory control/impulsivity, and the Controlled Oral Word Association Test (COWAT) for assessing semantic verbal fluency and phonemic verbal fluency. We also used a factor analysis on all of the ECF tests (global ECF). Results Before adjustment, the ABI group performed worse on global cognition, attention span, working memory, inhibitory control/impulsivity, semantic verbal fluency, and phonemic verbal fluency. After adjustment, the ABI group performance remained worse for working memory and semantic verbal fluency. In a simple correlation analysis including all of the subjects, the 6MWT was associated with global cognition, attention span, working memory, information processing speed, inhibitory control/impulsivity, semantic verbal fluency, and global ECF. After adjustment, all the associations remained statistically significant. Conclusion This study found an independent association between
Božena Krce Miočić
Full Text Available Destination presents a set of different organizations and individuals who can work towards realising the same objectives or their objectives can be diametrically opposed. Harmonisation of such objectives in a unique strategic development of the entire destination is usually taken over by destination management organization (DMO established to accomplish the mentioned objective. The opposed interests in such a system as complex as tourism result in the degradation of space and society in which tourism takes place. Therefore sustainable development in tourism represents a primary concept of development today. Tourism is a fast growing phenomenon and its sustainable development represents a necessity. Besides the positive economic outputs of tourism, we should also mention its negative impact on the particular destination, the environmental degradation to some extent, as well as socio-economic elements of local community. Accordingly, multi-stakeholder concept in destination management should include all interest and influential groups in tourism development planning. Such integrated destination management connects all stakeholders independent from influence or interest powers to participate directly or indirectly in creating and implementing the quality tourism development. This concept’s basic function is connecting and coordinating stakeholders with different interests within a tourism destination, in order to create quality product and a recognizable destination image, and to achieve a long-term sustainable competitiveness on the market. However, based on the stakeholder approach, the most emphasized issue in sustainable tourism development concept is the government that holds a key role in socio-economic development. In this paper, we analysed current involvement of stakeholders in Zadar County tourism development and examined their interest in future involvement in sustainable destination development. Based on the analysis of focus group
Dixon, T.; Romanak, K.; Camps, A. P.
Stakeholder viewpoints and beliefs about geologic carbon storage are not always accurate, yet they may affect the future of carbon capture and storage (CCS). Gaps in stakeholder understanding and perspectives must be addressed, and natural systems that release CO2 can be valuable tools for communicating difficult scientific concepts because they provide tangible examples of geologic principles at work. Stakeholder perceptions commonly involve a misunderstanding of geologic scale and mechanisms, and can be charged with emotions fueled by media coverage of natural disasters. One example of an event widely cited by stakeholders is the CO2 release at Lake Nyos in Cameroon in August 1986 that killed 1700 people. This event is commonly thought by stakeholders to be an analogue for a release from a CO2 storage site; however, this release occurred under a rare combination of circumstances (a 208-m-deep volcanic crater lake) not analogous to an engineered CO2 storage site. Stakeholders therefore gravitate towards natural systems to form concepts and opinions of how CO2 might behave in a geological environment, but they often choose systems that are not true analogues but that gain attention through the media because they are associated with a disaster. When chosen correctly, natural releases of CO2 may create a level of clarity for stakeholders by providing tangible concrete examples that explain difficult scientific principles and provide familiar reference points to adapt different viewpoints. We present suggestions and examples presented by scientists at an IEAGHG Workshop Natural Releases of CO2: Building Knowledge for CO2 Storage Environmental Impact Assessments', held at Maria Laach, Germany, November 2010 which brought together researchers from the EU, North America, Japan, and Australia. It also included field observations of natural CO2 releases around the Laacher See caldera lake, CO2 springs, and the Wallenborn CO2 geyser. New information from international
Lauesen, Linne Marie
Stakeholder management has for the last three decades been concerned either with strategic business management or business ethics, values and quality. Many models have been developed, but recently the literature asks for more dynamic models instead of the staticism that characterizes some models....... This paper offers an ‘Organic Stakeholder Model’ based on decision making theory, risk assessment and adaption to a rapidly changing world combined with appropriate stakeholder theory for ethical purposes in decision making processes in businesses. The ‘Organic Stakeholder Model’ is based on empirical...... evidence from hybrid organizations as Publicly Owned Enterprises (POEs) mixed of private corporations and political administration. The model offers a new way of combining risk management with ethical decisionmaking processes by the inclusion of multiple stakeholders. Not only does the model apply...
Ravazzani, Silvia; Mormino, Sara
This paper explores collaborative learning activities involving HR and external stakeholders that organizations decide to plan and implement in order to obtain benefits in terms of knowledge sharing, stakeholder understanding and value creation. The increasing uncertainty and multiplicity...... of competitive pressures and stakeholder demands (Harrison, St. John, 1996) require organizations, and in particular HR, to take on a more strategic role aimed to build new capability and support the overarching business strategy (Ulrich, Beatty 2001). This study draws on Strategic Human Resource Management......, Strategic Human Resource Development and Stakeholder Management studies and, on this basis, investigates the case of an Italian bank to understand the nature and characteristics of collaborative learning activities towards external stakeholders. The investigation supports the proposition that HR development...
von Wallpach, Sylvia; Voyer, Benjamin; Kastanakis, Minas
important role in ongoing interactive identity development processes of stakeholders. The special section contributes to deepening the understanding of this reciprocal co-creation of stakeholder and brand identities, through a series of conceptual and empirical articles. The Introduction reviews four......This article introduces the special section on reciprocal co-creation of stakeholder and brand identities. Branding research and practice traditionally focus on the managerial creation and implementation of brand identity. Based on recent paradigmatic shifts from managerial to co-creative branding...... and from consumer to multi-stakeholder approaches in marketing, this special section develops a dynamic, process-oriented perspective on brand identity. Brand identity continuously emerges as a dynamic outcome of social processes of stakeholder interaction. Reciprocally, brand identity plays a potentially...
Full Text Available Organizations inform stakeholders about their current and future activities, processes, created value, strategic intentions, and other information that may influence the established relationships. Organizations choose to communicate with stakeholders by different means and in varied ways. The annual report represents a way of communicating between companies and their stakeholders, and it is offering comprehensive information about how companies operates and creates value. The business model is an emerging concept in management literature and practice. The concept describes the logic by which a organization creates, maintains and delivers value for its stakeholders. Through annual reports organisations can communicate to stakeholders information about their business models.We investigated how information about business models is explicitly communicated through annual reports, and how this information is reffering to stakeholders. Our paper aims to reveal which stakeholders are more often mentioned when organizations are communicating about business models through annual reports. This approach shows the attention degree given by organizations to stakeholders. We perceived this from a strategic point of view, as a strategic signal. Thus, we considered if the stakeholder is mentioned more frequent in the communicated message it has a greater role in communication strategy about business model. We conducted an exploratory research and have realized a content analysis.The analysed data consist in over a thousand annual reports from 96 organizations. We analysed the informations transmitted by organizations through annual reports. The annual reports were for a time period of 12 years. Most of the selected companies are multi-business, and are operating in different industries. The results show the stakeholder’s hierarchy based on how often they were mentioned in the communicated messages about business models through annual reports. Based on our
Wills, Monica; Brewer, Curtis; Knoeppel, Robert; Witte, James; Pargas, Roy; Lindle, Jane Clark
In 2008, due to increasing stakeholder dissatisfaction with assessment results and school report cards, South Carolina revised its 1998 Educational Accountability Act and required public engagement with stakeholders including parents/guardians, educators, business and community leaders, and taxpayers. The legislation created partnerships between…
Nguyen, Thi Dieu Phuong; Lund, Søren; Banta, Gary Thomas
The present report on stakeholder evaluation of highland aquatic resources provides an overview of completed research activities undertaken within the HighARCS project on the value ascribed by users, local communities and stakeholders to functions, goods and services (including non-use values) de...
Nast, Irina; Tal, Amir; Schmid, Stefan; Schoeb, Veronika; Rau, Barbara; Barbero, Marco; Kool, Jan
Research priorities, defined by multiple stakeholders, can proximally facilitate the coordination of research projects and national and international cooperation and distally further improve the quality of physiotherapy practice. The aim of this study was therefore to establish physiotherapy research priorities in Switzerland considering multiple stakeholders' opinions. A mixed methods design was chosen. For a qualitative identification of physiotherapy research topics, 18 focus group discussions and 23 semi-structured interviews/written commentaries were conducted. For the quantitative analysis, 420 participants prioritized research topics using a two-round Delphi questionnaire survey. The following stakeholder groups were surveyed in the German-speaking, French-speaking and Italian-speaking regions of Switzerland: physiotherapy researchers, practitioners and educators, representatives of patient organizations, public health organizations, health insurers, physicians, nurses, occupational therapists and other health professionals, as well as physical educators. The top five overall physiotherapy research priorities identified were as follows: physiotherapy treatment, physiotherapy assessment and diagnosis, prevention, physiotherapist-patient interaction and physiotherapy professional education at the bachelor level. With regard to diagnostic groups, the highest priorities were placed on musculoskeletal disorders, neurology, orthopaedics, geriatrics and ergonomics/occupational health. Consensus was moderate to high, and only few differences between stakeholder groups were revealed. Research directly related to physiotherapy treatment is of highest priority. It should focus on diagnostic groups related to chronicity in anticipation of demographic changes. Multidisciplinary networks for research and practice, alongside sound coordination of research projects, should increase the impact of physiotherapy research. An accurate dissemination of research priorities
Herbst, Franziska A; Heckel, Maria; Tiedtke, Johanna M; Adelhardt, Thomas; Sturm, Alexander; Stiel, Stephanie; Ostgathe, Christoph
There is a lack of research into how hospital staff and institutional stakeholders (i. e. institutional representatives from public health authorities, hospital hygiene, and the departments of microbiology, palliative care, and geriatrics) engage with patients who are carriers of multidrug-resistant organisms and receiving end-of-life care. Knowledge of their experiences, workload, and needs should be considered in dealing with hospitalized carriers of multidrug-resistant organisms as well as staff education. This study explored and compared staff members' and stakeholders' perspectives on multidrug-resistant organisms and on provision of end-of-life care to carrier patients. In this study four focus groups consisting of hospital staff members and institutional stakeholders were formed within a mixed-methods parent study in a palliative care unit at a university clinic and a geriatric ward of a Catholic and academic teaching hospital. Participants discussed results from staff and stakeholder interviews from a former study phase. Data were analyzed according to Grounded Theory and perspectives of staff members and institutional stakeholders were compared and contrasted. Key issues debated by staff members (N = 19) and institutional stakeholders (N = 10) were 1) the additional workload, 2) reasons for uncertainty about handling carrier patients, 3) the format of continuing education, and 4) the preferred management approach for dealing with multidrug-resistant organism carrier patients. Although similar barriers (e. g. colleagues' ambiguous opinions) were identified, both groups drew different conclusions concerning the management of these barriers. While institutional stakeholders recommended making decisions on hygiene measures under consideration of the specific patient situation, staff members preferred the use of standardized hygiene measures which should be applied uniformly to all patients. Staff members and institutional stakeholders
Jensen, Jakob D; Carcioppolo, Nick; King, Andy J; Bernat, Jennifer K; Davis, LaShara; Yale, Robert; Smith, Jessica
Past research has demonstrated that news coverage of cancer research, and scientific research generally, rarely contains discourse-based hedging, including caveats, limitations, and uncertainties. In a multiple message experiment (k = 4 news stories, N = 1082), the authors examined whether hedging shaped the perceptions of news consumers. The results revealed that participants were significantly less fatalistic about cancer (p = .039) and marginally less prone to nutritional backlash (p = .056) after exposure to hedged articles. Participants exposed to articles mentioning a second researcher (unaffiliated with the present study) exhibited greater trust in medical professions (p = .001). The findings provide additional support for the inclusion of discourse-based hedging in cancer news coverage and suggest that news consumers will use scientific uncertainty in illness representations.
Novoa, Ana; Shackleton, Ross; Canavan, Susan; Cybèle, Cathleen; Davies, Sarah J; Dehnen-Schmutz, Katharina; Fried, Jana; Gaertner, Mirijam; Geerts, Sjirk; Griffiths, Charles L; Kaplan, Haylee; Kumschick, Sabrina; Le Maitre, David C; Measey, G John; Nunes, Ana L; Richardson, David M; Robinson, Tamara B; Touza, Julia; Wilson, John R U
Alien species can have major ecological and socioeconomic impacts in their novel ranges and so effective management actions are needed. However, management can be contentious and create conflicts, especially when stakeholders who benefit from alien species are different from those who incur costs. Such conflicts of interests mean that management strategies can often not be implemented. There is, therefore, increasing interest in engaging stakeholders affected by alien species or by their management. Through a facilitated workshop and consultation process including academics and managers working on a variety of organisms and in different areas (urban and rural) and ecosystems (terrestrial and aquatic), we developed a framework for engaging stakeholders in the management of alien species. The proposed framework for stakeholder engagement consists of 12 steps: (1) identify stakeholders; (2) select key stakeholders for engagement; (3) explore key stakeholders' perceptions and develop initial aims for management; (4) engage key stakeholders in the development of a draft management strategy; (5) re-explore key stakeholders' perceptions and revise the aims of the strategy; (6) co-design general aims, management objectives and time frames with key stakeholders; (7) co-design a management strategy; (8) facilitate stakeholders' ownership of the strategy and adapt as required; and (9) implement the strategy and monitor management actions to evaluate the need for additional or future actions. In case additional management is needed after these actions take place, some extra steps should be taken: (10) identify any new stakeholders, benefits, and costs; (11) monitor engagement; and (12) revise management strategy. Overall, we believe that our framework provides an effective approach to minimize the impact of conflicts created by alien species management. Copyright © 2017 Elsevier Ltd. All rights reserved.
Directives and legislation on EIA and SEA need to provide more guidance on how and when public participation should be used. There are now several examples of how well public participation can be performed and the methods are becoming more proactive and innovative. By increasing the role of public participation within the Environmental Assessment process, plans, programmes and projects will become more publicly acceptable. There does need to be a balance as to where public participation is performed in the system, as too much can be a stress on resources and time, as well as producing ineffective results. Key stages such as scoping, preparing the environmental statement or report and decision-making need to be highlighted for the benefits public participation can have. The Aarhus Convention is certainly making a difference in the UK; however it is difficult to judge exactly how much difference yet. It was only fully implemented in the UK in 2005 although some Authorities were applying the three pillars prior to implementation. It is not clear how aware the general public are of the Convention and their rights. Empowering communities in the UK. will communities for decision-making in Environmental Assessments? Providing the public with resources to enable them to fully engage in the process will improve the participation and increase their confidence, but how will this increase their influence within the decision-making process? Ultimately, should the stakeholders and public just influence the incremental decisions made in Environmental Assessments or have more responsibility within the major decisions taken? It will be interesting to see how these issues are addressed over the coming years
Implementation and deployment of new and innovative environmental technologies is impossible without regulator, enduser and stakeholder support. Technologies being developed for different needs require different strategies to facilitate this endorsement. Areas addressed will include technologies developed to meet site specific cleanup needs and those developed for multiple site applications. A third area deals with using site specific technologies at previously unidentified locations. In order to expand the application of these technologies to other sites a plan to include potential site regulators and stakeholders early in the development process should be considered. The Subsurface Contaminant Focus Area has developed a Stakeholder Communication Plan. This plan, in addition to lessons learned from current technology development projects that have successfully obtained this type of support, will provide the basis for the information provided in this paper. The object of this paper is to suggest strategies that could facilitate the implementation and deployment of technologies at environmental sites by involving regulators and stakeholders at the proper time for various applications
Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: retrospective physician surveys including chart reviews at numerous centers.
Gossman, Michael S; Wilkinson, Jeffrey D; Mallick, Avishek
In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient׳s sex; patient׳s age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient׳s medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards. Copyright
Zwahlen, Diana; Tondorf, Theresa; Rothschild, Sacha; Koller, Michael T; Rochlitz, Christoph; Kiss, Alexander
International standards prioritize introducing routine emotional distress screening in cancer care to accurately identify patients who most need psycho-oncological treatment, and ensure that patients can access appropriate supportive care. However, only a moderate proportion of distressed patients accepts referrals to or uses psycho-oncological support services. Predictors and barriers to psycho-oncological support service utilization are under-studied. We know little about how patients and oncologists perceive the discussions when oncologists assess psychosocial distress with a screening instrument. We aim to 1) assess the barriers and predictors of uptake of in-house psycho-oncological support along the distress screening pathway in cancer patients treated at a University Oncology Outpatient Clinic and, 2) determine how patients and clinicians perceive communication about psychosocial distress after screening with the Distress Thermometer. This is a quantitative prospective observational study with qualitative aspects. We will examine medical and demographic variables, cancer patient self-reports of various psychological measures, and aspects of the patient-clinician communication as variables that potentially predict uptake of psycho-oncological support service. We will also assess the patients' reasons for accepting or refusing psycho-oncological support services. We assess at three points in time, based on paper-and-pencil questionnaires and two patient interviews during the study period. We will monitor outcomes (psycho-oncology service uptake) four months after study entry. The study will improve our understanding of characteristics of patients who accept or refuse psycho-oncological support, and help us understand how patients' and oncologists perceive communication about psychosocial distress, and referral to a psycho-oncologist. We believe this is the first study to focus on factors that affect uptake or rejection of psycho-oncological support services
Hanson, Heather M; Salmoni, Alan W; Volpe, Richard
Sustainability is a highly desired outcome of health promotion programs, yet it often eludes program planners looking to achieve it. This study aimed to uncover how the goal of program sustainability was interpreted by key stakeholders from three fall prevention program demonstration sites. Collected as part of a larger study on program sustainability that made use of a multiple case study methodology, semi-structured interviews were conducted with key informants involved in a wide range of program initiatives throughout the two-year funding period. Forty participants across the three sites provided definitions of sustainability. Most stakeholders reported that it was some version of the general fall prevention program that should be sustained. Fewer stakeholders reported that it was the successful elements or solutions to the program goals that should be sustained. The most common suggestions reported by stakeholders for how sustainability should be achieved were awareness raising and securing new funding sources. Although a number of key elements emerged, there were significant differences in stakeholders' definitions of sustainability, both within and between demonstration sites. This research provided insight into the unique meanings of sustainability held by different stakeholders during their involvement in a fall prevention program. The array of definitions held by stakeholders demonstrates how easily the efforts of those involved can become fragmented and, therefore, less effective in reaching the end goal of program sustainability when the project team is not working from the same definition of what that goal means.
Kumar, Y; Chaudhury, N R; Vasudev, N
This article presents the use of stakeholder analysis to examine the efficacy of health reform programs in India. Stakeholder analysis assists planners in identifying groups affected by proposed activities, their reactions to prospective changes, and the roles they might play in supporting or opposing them. Such information is then used to develop strategies involving national and local officials and communities in reform. Stakeholder analysis was used by the US Agency for International Development (USAID) for the proposed Women's and Children's Health (WACH) project. It involved interviews among major stakeholders regarding their views on the effectiveness of the current health system, the new roles that health care organizations and individuals would have after changes in service delivery under WACH, and their institutional capacity to handle new roles. In addition to stakeholder analysis, three other tools are available to policy managers and health sector reform teams to help them manage and influence the process of health sector reform: 1) institutional mapping, which involves identification and analysis of an organization's structure; 2) political mapping through graphic display of sources and degrees of political support and opposition; and 3) interest mapping, a combination of stakeholder analysis and political mapping. With the use of stakeholder analysis, USAID was provided with crucial information for the evaluation of community support and success capability of the WACH project.
Peltokorpi, Antti; Alho, Antti; Kujala, Jaakko; Aitamurto, Johanna; Parvinen, Petri
This paper aims to create a model for evaluating organizational change initiatives from a stakeholder resistance viewpoint. The paper presents a model to evaluate change projects and their expected benefits. Factors affecting the challenge to implement change were defined based on stakeholder theory literature. The authors test the model's practical validity for screening change initiatives to improve operating room productivity. Change initiatives can be evaluated using six factors: the effect of the planned intervention on stakeholders' actions and position; stakeholders' capability to influence the project's implementation; motivation to participate; capability to change; change complexity; and management capability. The presented model's generalizability should be explored by filtering presented factors through a larger number of historical cases operating in different healthcare contexts. The link between stakeholders, the change challenge and the outcomes of change projects needs to be empirically tested. The proposed model can be used to prioritize change projects, manage stakeholder resistance and establish a better organizational and professional competence for managing healthcare organization change projects. New insights into existing stakeholder-related understanding of change project successes are provided.
Suzuki, Satoru; Nakamura, Izumi; Suzuki, Satoshi; Ohkouchi, Chiyo; Mizunuma, Hiroshi; Midorikawa, Sanae; Fukushima, Toshihiko; Ito, Yuko; Shimura, Hiroki; Ohira, Tetsuya; Matsuzuka, Takashi; Ohtsuru, Akira; Abe, Masafumi; Yamashita, Shunichi; Suzuki, Shinichi
.583, respectively). TSH suppression can be present in response to illness, including thyroid nodules, in young subjects. Low TSH levels may be associated with the finding of papillary thyroid cancer as well as with thyroid nodules in children and adolescents.
Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry.
Jang, Ho-Jun; Park, Sang-Don; Park, Hyun Woo; Suh, Jon; Oh, Pyung Chun; Moon, Jeonggeun; Lee, Kyounghoon; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon
Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear. From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups. There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217). Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged elderly patients (aged ≥75 years).
Camden, Chantal; Shikako-Thomas, Keiko; Nguyen, Tram; Graham, Emma; Thomas, Aliki; Sprung, Jennifer; Morris, Christopher; Russell, Dianne J
To describe how stakeholder engagement has been undertaken and evaluated in rehabilitation research. A scoping review of the scientific literature using five search strategies. Quantitative and qualitative analyses using extracted data. Interpretation of results was iteratively discussed within the team, which included a parent stakeholder. Searches identified 101 candidate papers; 28 were read in full to assess eligibility and 19 were included in the review. People with disabilities and their families were more frequently involved compared to other stakeholders. Stakeholders were often involved in planning and evaluating service delivery. A key issue was identifying stakeholders; strategies used to support their involvement included creating committees, organizing meetings, clarifying roles and offering training. Communication, power sharing and resources influenced how stakeholders could be engaged in the research. Perceived outcomes of stakeholder engagement included the creation of partnerships, facilitating the research process and the application of the results, and empowering stakeholders. Stakeholder engagement outcomes were rarely formally evaluated. There is a great interest in rehabilitation to engage stakeholders in the research process. However, further evidence is needed to identify effective strategies for meaningful stakeholder engagement that leads to more useful research that positively impacts practice. Implications for Rehabilitation Using several strategies to engage various stakeholders throughout the research process is thought to increase the quality of the research and the rehabilitation process by developing proposals and programs responding better to their needs. Engagement strategies need to be better reported and evaluated in the literature. Engagement facilitate uptake of research findings by increasing stakeholders' awareness of the evidence, the resources available and their own ability to act upon a situation. Factors influencing
Full Text Available Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme.After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34% and 335 German (32% patients consented on participation (p = 0.46. General practitioners contributed significantly more of the Turkish (84% than of the German patients (16%, p<0.001. Contact attempts by programme staff were significantly less successful in Turkish (52% than in German patients (60%, p = 0.005 due to significantly higher rate of missing phone numbers (36% vs 25%, invalid address data (28% vs 7% and being unreachable by phone more frequently (39% vs 26%, all p<0.001. Consent rate was significantly higher in successfully contacted Turkish (63% compared to German patients (50%, p<0.001.The inclusion of Turkish minority patients into a heart failure management programme is feasible with higher consent rate than in Germans. However, effort is high due to inherent logistic adaptions and barriers in identification and contacting of patients.DRKS00007780.
Elam, Mark; Sundqvist, Goeran [Goeteborg Univ. (Sweden). Section for Science and Technology Studies
This report concerning Swedish nuclear waste management has been produced as part of a cross national research project: CARL - A Social Science Research Project into the Effects of Stakeholder involvement on Decision-Making in Radioactive Waste Management. Besides Sweden, the participating countries are Belgium, Canada, Finland, Slovenia and United Kingdom. A social science research team, working for three years, is in the first phase conducting research in their own countries in order to produce 6 country reports. During the next years the focus will shift to comparisons of stakeholder involvement practices in the participating countries. The report addresses current practices of Swedish nuclear waste management and their historical development. The main focus is on past, current and emerging patterns of stakeholder involvement in the siting of a deep repository for the final disposal of Sweden's spent nuclear fuel. The general questions attended to in the report are: Who are the main stakeholders, and how have they emerged and gained recognition as such? What are the issues currently subject to stakeholder involvement and how have these been decided upon? How is stakeholder involvement organized locally and nationally and how has this changed over time? How has stakeholder involvement gained acceptance as an activity of value in the siting of major waste facilities? The report have attempted to show the development of stakeholder involvement in the siting of a final repository for Sweden's spent nuclear fuel as resembling something other than a straightforward linear process of improvement and refinement. Stakeholder involvement has developed, over the past 15 years or so, into something more like a patchwork of different shapes and forms. Some of the forces that may well contribute to the further elaboration of the patchwork of stakeholder involvement have been pointed out, contingently modifying once more its overall colour and orientation. Questions
Elam, Mark; Sundqvist, Goeran
This report concerning Swedish nuclear waste management has been produced as part of a cross national research project: CARL - A Social Science Research Project into the Effects of Stakeholder involvement on Decision-Making in Radioactive Waste Management. Besides Sweden, the participating countries are Belgium, Canada, Finland, Slovenia and United Kingdom. A social science research team, working for three years, is in the first phase conducting research in their own countries in order to produce 6 country reports. During the next years the focus will shift to comparisons of stakeholder involvement practices in the participating countries. The report addresses current practices of Swedish nuclear waste management and their historical development. The main focus is on past, current and emerging patterns of stakeholder involvement in the siting of a deep repository for the final disposal of Sweden's spent nuclear fuel. The general questions attended to in the report are: Who are the main stakeholders, and how have they emerged and gained recognition as such? What are the issues currently subject to stakeholder involvement and how have these been decided upon? How is stakeholder involvement organized locally and nationally and how has this changed over time? How has stakeholder involvement gained acceptance as an activity of value in the siting of major waste facilities? The report have attempted to show the development of stakeholder involvement in the siting of a final repository for Sweden's spent nuclear fuel as resembling something other than a straightforward linear process of improvement and refinement. Stakeholder involvement has developed, over the past 15 years or so, into something more like a patchwork of different shapes and forms. Some of the forces that may well contribute to the further elaboration of the patchwork of stakeholder involvement have been pointed out, contingently modifying once more its overall colour and orientation. Questions have been
Bozec, Alexandre; Benezery, Karen; Chamorey, Emmanuel; Ettaiche, Marc; Vandersteen, Clair; Dassonville, Olivier; Poissonnet, Gilles; Riss, Jean-Christophe; Hannoun-Lévi, Jean-Michel; Chand, Marie-Eve; Leysalle, Axel; Saada, Esma; Sudaka, Anne; Haudebourg, Juliette; Hebert, Christophe; Falewee, Marie-Noelle; Demard, François; Santini, José; Peyrade, Frédéric
The objective of the study is to evaluate the nutritional status and determine its impact on clinical outcomes in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program without prophylactic feeding-tube placement. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngolaryngectomy, treated by docetaxel, cisplatin and 5-fluorouracil (TPF)-ICT for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Patients' nutritional status was closely monitored. Enteral nutrition was used if and when a patient was unable to sustain per-oral nutrition and hydration. The impact of nutritional status on clinical outcomes was investigated in univariate and multivariate analysis. A total of 53 patients (42 men and 11 women, mean age = 58.6 ± 8.2 years) were included in this study. Six (11.3 %) patients had lost more than 10 % of their usual body weight before therapy. Compared with patients' usual weight, the mean maximum patient weight loss during therapeutic management was 8.7 ± 4.5 kg. Enteral nutrition was required in 17 patients (32 %). We found no influence of the tested nutritional status-related factors on response to ICT, toxicity of ICT, overall, cause-specific and recurrence-free survival, and on post-therapeutic swallowing outcome. Maximum weight loss was significantly associated with a higher risk of enteral tube feeding during therapy (p = 0.03) and of complications (grade ≥3, p = 0.006) during RT. Without prophylactic feeding-tube placement, approximately one-third of the patients required enteral nutrition. There was no significant impact of nutritional status on oncologic or functional outcomes.
Bell, Carolyn Anne; Duncan, Gregory J; Eang, Rothmony; Saini, Bandana
Intensifying detection of tuberculosis (TB) symptomatic patients is a priority for Cambodia's National Tuberculosis Program, in a country where two-thirds of the population has latent TB infection. In 2005, the National Tuberculosis Program initiated a public-private mix (PPM) collaborative program with external and local stakeholders to identify and refer persons with TB symptoms from private sector pharmacies to public sector clinics for diagnosis and treatment. This qualitative study conducted in-depth interviews with organizational stakeholders to assess their perceptions of PPM program collaboration and its sustainability in the long term. Results showed that stakeholders perceived that collaboration and efficient management had contributed to positive program performance. However, stakeholders expressed anxiety over program sustainability should external resources be reduced. Recent developments in pharmacy undergraduate education and recognition of pharmacy providers' contribution to public health interventions may challenge PPM stakeholders to shift the paradigm from dependence on external agencies to confidence in local expertise and infrastructure. © 2013 APJPH.
Xie, Anping; Carayon, Pascale; Cartmill, Randi; Li, Yaqiong; Cox, Elizabeth D; Plotkin, Julie A; Kelly, Michelle M
A human factors approach to healthcare system redesign emphasizes the involvement of multiple healthcare stakeholders (e.g., patients and families, healthcare providers) in the redesign process. This study explores the experience of multiple stakeholders with collaboration in a healthcare system redesign project. Interviews were conducted with ten stakeholder representatives who participated in the redesign of the family-centered rounds process in a pediatric hospital. Qualitative interview data were analyzed using a phenomenological approach. A model of collaborative healthcare system redesign was developed, which defined four phases (i.e., setup of the redesign team, preparation for meetings, collaboration in meetings, follow-up after meetings) and two outcomes (i.e., team outcomes, redesign outcomes) of the collaborative process. Challenges to multi-stakeholder collaboration in healthcare system redesign, such as need to represent all relevant stakeholders, scheduling of meetings and managing different perspectives, were identified. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Weber, James R.; Word, Charlotte J.; Bilyard, Gordon R.
The purpose of this report is to help scientists communicate with stakeholders and the public (primarily nonscientists) about fundamental science research. The primary audience for this report is scientists involved in the Natural and Accelerated Bioremediation Research (NABIR) program of the U.S. Department of Energy. However, the information and insights in the report that are not program-specific should be helpful to scientists in other fundamental science research programs. The report first discusses why scientists should talk to stakeholders and the public, and the challenges associated with discussing the NABIR program. It is observed that communication initiatives can be characterized by three factors: relationships in the social environment, views of what constitutes communication, and accepted forms of communication practices and products. With a focus on informal science communication, recent efforts to gauge public understanding of science and the factors that affect public trust of science institutions are discussed. The social bases for scientist-nonscientist interactions are then examined, including possible sources of distrust and difficulties in transferring discussions of fundamental science from classrooms (where most of the public first learns about science) to public forums. Finally, the report contains specific suggestions for preparing, meeting, and following up on public interactions with stakeholders and the public, including themes common to public discussions of NABIR science and features of scientist-nonscientist interactions observed in interpersonal, small group, and large group interactions between NABIR scientists and stakeholders. A Quick Preparation Guide for Meeting NABIR Stakeholders is provided immediately following the Summary. It condenses some of the information and advice found in the text of the report.
Kaczynski, Andrew T; Stanis, Sonja A Wilhelm; Besenyi, Gina M
Parks are valuable community resources, and auditing park environments is important for understanding their influence on physical activity and health. However, few tools exist that engage citizens in this process. The purpose of this study was to develop a user-friendly tool that would enable diverse stakeholders to quickly and reliably audit community parks for their potential to promote physical activity. A secondary aim was to examine community stakeholders' reactions to the process of developing and using the new tool. The study employed a sequential, multiphase process including three workshops and field testing to ensure the new instrument was the product of input and feedback from a variety of potential stakeholders and was psychometrically sound. All study stages, including data collection and analysis, occurred in 2010. Stakeholder recommendations were combined with reviews of existing instruments to create the new Community Park Audit Tool (CPAT). The CPAT contains four sections titled Park Information, Access and Surrounding Neighborhood, Park Activity Areas, and Park Quality and Safety. Inter-rater analyses demonstrated strong reliability for the vast majority of the items in the tool. Further, stakeholders reported a range of positive reactions resulting from their engagement in the project. The CPAT provides a reliable and user-friendly means of auditing parks for their potential to promote physical activity. Future use of the CPAT can facilitate greater engagement of diverse groups in evaluating and advocating for improved parks and overall healthy community design. Copyright Â© 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Burns, Stephen G.
Mr Burns, Chairman of the United States Nuclear Regulatory Commission, delivered a keynote speech. He recognised there is a global movement towards broadening information flow and participation. He displayed the so-called Arnstein 'ladder' that can be applied to assess the degree of public involvement and influence achieved in any state or private decision making. The lower rungs depict non-participation and the middle rungs focus on education and information as well as consultation. Mr Burns suggested that the higher level of partnership was of most interest to the workshop. In his experience, partnership between stakeholders and regulatory organisations, as well as openness and transparency, are today seen as traits of a good regulator, and are increasingly set out as goals in regulatory strategic plans throughout the world. Mr Burns highlighted a broad definition of 'stakeholder' as 'one who is involved in or affected by a course of action'. Nuclear stakeholders thus include those who live near or work in nuclear facilities; own or run the facilities; govern at the national, regional or local level; manufacture the components or the fuel; regulate the output or use of the facility; benefit from the use of radiological material and nuclear installations; and those who might be adversely affected in any way by materials or facilities. Stakeholders also include the media who convey information to others, and the non-governmental organisations that represent the views of many individuals. Mr Burns focused on the concept of trust as enabling public confidence in technical calculations and risk management. He suggested that listening carefully to stakeholders is an important element of trust-building. He closed by affirming that regulators can maintain their independence while nonetheless considering others' opinions. Mr Burns emphasised that at the end of the day, the regulator holds sole responsibility for achieving its own
Stuart, Rhonda L; Cheng, Allen C; Marshall, Caroline L; Ferguson, John K
Standard and Droplet Precautions are considered adequate to control the transmission of influenza in most health care situations. Vaccination of health care staff, carers and vulnerable patients against seasonal and, eventually, pandemic influenza strains is an essential protective strategy. Management principles include: performance of hand hygiene before and after every patient contact or contact with the patient environment, in accord with the national 5 Moments for Hand Hygiene Standard; disinfection of the patient environment; early identification and isolation of patients with suspected or proven influenza; adoption of a greater minimum distance of patient separation (2 metres) than previously recommended; use of a surgical mask and eye protection for personal protection on entry to infectious areas or within 2 metres of an infectious patient; contact tracing for patient and health care staff and restriction of prophylactic antivirals mainly to those at high risk of severe disease; in high aerosol-risk settings, use of particulate mask, eye protection, impervious long-sleeved gown, and gloves donned in that sequence and removed in reverse sequence, avoiding self-contamination; exclusion of symptomatic staff from the workplace until criteria for non-infectious status are met; reserving negative-pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation; ensuring that infectious postpartum women wear surgical masks when caring for their newborn infants and practise strict hand hygiene; and implementation of special arrangements for potentially infected newborns who require nursery or intensive care.
Vaz, M; Diffey, B; Jacob, A J; Vaz, M
Because of the large numbers of leprosy patients with disability and the limited resources available, it is important that socio-economic rehabilitation (SER) is targeted towards those who are most in need. Towards this purpose, current assessments of leprosy patients prior to initiating SER include the evaluation of income, assets and household possessions. Conspicuously absent is the nutritional assessment of the patient. In the absence of weight loss associated with illness, population studies indicate that undernutrition reflects poor socio-economic conditions. In this study of 151 cured leprosy patients with disability, 57% of the patients were found to be undernourished using body mass index (kg/m2) derived from body weight and height, and 10% of the patients were severely undernourished (grade III). Undernutrition in the patients was poorly though significantly correlated with personal income (r = 0.18, P nutritional status evaluation by anthropometry as part of the initial screening of leprosy patients prior to instituting SER. We believe that this simple and objective evaluation can add to the assessment of 'threat' of economic deprivation or actual economic 'dislocation', and thus help in the prioritization of leprosy patients for SER.
Full Text Available Abstract Background Kabuki syndrome (KS is a multiple congenital anomaly syndrome characterized by specific facial features, mild to moderate mental retardation, postnatal growth delay, skeletal abnormalities, and unusual dermatoglyphic patterns with prominent fingertip pads. A 3.5 Mb duplication at 8p23.1-p22 was once reported as a specific alteration in KS but has not been confirmed in other patients. The molecular basis of KS remains unknown. Methods We have studied 16 Spanish patients with a clinical diagnosis of KS or KS-like to search for genomic imbalances using genome-wide array technologies. All putative rearrangements were confirmed by FISH, microsatellite markers and/or MLPA assays, which also determined whether the imbalance was de novo or inherited. Results No duplication at 8p23.1-p22 was observed in our patients. We detected complex rearrangements involving 2q in two patients with Kabuki-like features: 1 a de novo inverted duplication of 11 Mb with a 4.5 Mb terminal deletion, and 2 a de novo 7.2 Mb-terminal deletion in a patient with an additional de novo 0.5 Mb interstitial deletion in 16p. Additional copy number variations (CNV, either inherited or reported in normal controls, were identified and interpreted as polymorphic variants. No specific CNV was significantly increased in the KS group. Conclusion Our results further confirmed that genomic duplications of 8p23 region are not a common cause of KS and failed to detect other recurrent rearrangement causing this disorder. The detection of two patients with 2q37 deletions suggests that there is a phenotypic overlap between the two conditions, and screening this region in the Kabuki-like patients should be considered.
Uzuka, Takeo; Takahashi, Hideaki; Aoki, Hiroshi; Natsumeda, Manabu; Fujii, Yukihiko
Elderly and low Karnofsky performance status (KPS) patients have been excluded from most prospective trials. This retrospective study investigated glioblastoma treatment outcomes, including those of elderly and low KPS patients, and analyzed the prognostic factors using the medical records of 107 consecutive patients, 59 men and 48 women aged from 21 to 85 years (median 65 years), with newly diagnosed glioblastoma treated at our institute. There were 71 high-risk patients with age >70 years and/or KPS 6 -methylguanine-deoxyribonucleic acid methyltransferase-negative (p=0.027), and more than subtotal removal (p=0.003) were significant prognostic factors. The median postoperative KPS score tended to be better than the preoperative score, even in the high-risk group. We recommend maximal safe resection for glioblastoma patients, even those with advanced age and/or with low KPS scores. (author)
This project developed a conceptual model of private-sector freight stakeholder decisions and interactions for : forecasting freight demands in response to key policy variables. Using East Central Wisconsin as a study area, empirical : models were de...
Lauesen, Linne Marie
Stakeholder management has for the last three decades been concerned either with strategic business management or business ethics, values and quality. Many models have been developed, but recently the literature asks for more dynamic models instead of the staticism that characterizes some models....... management models does – for the sake of the wider social responsibilities of the businesses and its stakeholders.......Stakeholder management has for the last three decades been concerned either with strategic business management or business ethics, values and quality. Many models have been developed, but recently the literature asks for more dynamic models instead of the staticism that characterizes some models...... evidence from hybrid organizations as Publicly Owned Enterprises (POEs) mixed of private corporations and political administration. The model offers a new way of combining risk management with ethical decisionmaking processes by the inclusion of multiple stakeholders. Not only does the model apply...
Ravazzani, Silvia; Mormino, Sara
of competitive pressures and stakeholder demands (Harrison, St. John, 1996) require organizations, and in particular HR, to take on a more strategic role aimed to build new capability and support the overarching business strategy (Ulrich, Beatty 2001). This study draws on Strategic Human Resource Management......, Strategic Human Resource Development and Stakeholder Management studies and, on this basis, investigates the case of an Italian bank to understand the nature and characteristics of collaborative learning activities towards external stakeholders. The investigation supports the proposition that HR development...... and corporate learning in a stakeholder-oriented perspective can play a strategic role in supporting business strategy, providing organizations the resources to meet internal and external needs (Wilson, 2005) and to interconnect with their value network....
Dentoni, D.; Veldhuizen, M.G.
Managers of Unilever discuss the processes that led the company to develop and implement a corporate sustainability strategy working with multiple stakeholders. Major learning points include: 1) interactions with stakeholders are crucial to secure strategic resources in developing countries; 2)
Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: Retrospective physician surveys including chart reviews at numerous centers
Gossman, Michael S., E-mail: MGossman@TSRCC.com [Regulation Directive Medical Physics, Russell, KY (United States); Wilkinson, Jeffrey D. [Medtronic, Inc., Mounds View, MN (United States); Mallick, Avishek [Department of Mathematics, Marshall University, Huntington, WV (United States)
In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient's sex; patient's age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient's medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards.
Full Text Available Companies’ strategies and values must be in accordance to stakeholders’ expectations and needs because their role and influences on companies’ activity are decisive for companies future development. Corporate Social Responsibility is a meaningful way through which companies can pursue sustainable development by having a coherent economical, social and environmental perspective on how the business should be managed. CSR must become an integral part of corporate management system, because it has a major role in distressing the relation between company and major stakeholders, both internally and externally. CSR is a global phenomenon, which draws the attention of a growing number of partisans, from public private and social sector. To demonstrate the applicability of the theoretical approaches deduced from the existing literature, the authors recourse to an empirical qualitative research, conducted through a questionnaire implemented to top managers, HR managers and heads of CSR departments within large companies that operate in Romania. The research is based on the analysis of a number of 87 questionnaires and aims to highlight major stakeholders and finding how companies’ responsible activities can influence stakeholders. This study is designed to highlight how prioritization of stakeholders influences CSR initiatives within large companies that operate in Romania, and to present a perspective of company’s approach towards shared value influence major stakeholders. The conclusions drawn have a greater relevance both theoretically and especially practically because provides insights on how large companies perceive CSR and how stakeholders influence responsible initiatives in emergent country like Romania where stereotypes are difficult to manage.
B A Laway
Full Text Available Introduction: Hypothyroidism is a known consequence of external-beam radiotherapy to the neck encompassing a part or whole of the thyroid gland. In this non-randomized prospective study, we have tried to evaluate the response of the thyroid gland to radiation by assessing thyroid function before irradiation and at regular intervals after irradiation. Aims and Objectives: The aim of this study were to assess in the cancer patients, who were exposed to the therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland: the incidence of primary hypothyroidism, the time required to become hypothyroid, any relation between the total dose for the development of hypothyroidism, and whether there are any patient or treatment-related factors that are predictive for the development of hypothyroidism, including the use of concurrent chemotherapy. Materials and Methods: This non-randomized, prospective study was conducted for a period of 2 years in which thyroid function was assessed in 59 patients (cases of head and neck cancer, breast cancer, lymphoma patients and other malignancies, who had received radiotherapy to the neck region. 59 euthyroid healthy patients (controls were also taken, who had not received the neck irradiation. These patients/controls were assessed periodically for 2 years. Results: The incidence of hypothyroidism after external beam radiation therapy (EBRT to neck where radiation portals include part or whole of the thyroid gland was 16.94%, seven cases had subclinical hypothyroidism (11.86% and three cases had clinical hypothyroidism (5.08%. Mean time for development of hypothyroidism was 4.5 months. There was no effect of age, gender, primary tumor site, radiation dose and chemotherapy, whether neoadjuvant or concurrent with the development of hypothyroidism. Conclusion: In summary, we found that thyroid dysfunction is a prevalent, yet easily treatable source of morbidity in patients
Full Text Available In order to analyze functional connectivity in untreated and treated patients with schizophrenia, resting-state fMRI data were obtained for whole-brain functional connectivity analysis from 22 first-episode neuroleptic-naïve schizophrenia (NNS, 61 first-episode neuroleptic-treated schizophrenia (NTS patients, and 60 healthy controls (HC. Reductions were found in untreated and treated patients in the functional connectivity between the posterior cingulate gyrus and precuneus, and this was correlated with the reduction in volition from the Positive and Negative Symptoms Scale (PANSS, that is in the willful initiation, sustenance, and control of thoughts, behavior, movements, and speech, and with the general and negative symptoms. In addition in both patient groups interhemispheric functional connectivity was weaker between the orbitofrontal cortex, amygdala and temporal pole. These functional connectivity changes and the related symptoms were not treated by the neuroleptics. Differences between the patient groups were that there were more strong functional connectivity links in the NNS patients (including in hippocampal, frontal, and striatal circuits than in the NTS patients. These findings with a whole brain analysis in untreated and treated patients with schizophrenia provide evidence on some of the brain regions implicated in the volitional, other general, and negative symptoms, of schizophrenia that are not treated by neuroleptics so have implications for the development of other treatments; and provide evidence on some brain systems in which neuroleptics do alter the functional connectivity.
Lindson, Nicola; Richards-Doran, Dan; Heath, Laura; Hartmann-Boyce, Jamie
The Cochrane Tobacco Addiction Group (TAG) conducts systematic reviews of the evidence for tobacco cessation and prevention interventions. In 2016 TAG conducted a priority-setting, stakeholder engagement project to identify where further research is needed in the areas of tobacco control and smoking cessation. The project comprised two surveys and a workshop. A range of stakeholders participated, including members of the public (smokers and ex-smokers), clinicians, researchers, research funders, health-care commissioners and public health organizations. The first survey phase identified unanswered research questions in the field of tobacco control. The second phase asked participants to rank these, with overall rankings calculated by combining scores across participants. The workshop allowed attendees to discuss prioritization of topics and questions in more depth. Workshop discussions were transcribed and analysed thematically, and a final voting activity at the close of the workshop allowed participants to choose topics to prioritize and to de-prioritize. A total of 304 stakeholders (researchers, health professionals, smokers and ex-smokers, guideline developers, research funders and policymakers, representing 28 countries) identified 183 unanswered research questions. These were categorized into 15 research categories. A total of 175 participants prioritized categories and questions in the second survey phase, with 'electronic cigarettes'; 'addressing inequalities'; and 'mental health and other substance abuse' prioritized as the top three categories. Forty-three stakeholders attended the workshop and discussed reasons for and against category prioritization. Prioritized research categories largely mirrored those in the survey stage, although 'treatment delivery' also emerged as a key category. Five cross-cutting themes emerged: efficacy; relative efficacy; cost effectiveness; addressing inequalities; and different types of evidence. There are many unanswered
The way in which members of the public perceive a contamination situation and an approach to the remediation of contaminated land will influence the decision making process in a variety of ways. Through communication between experts, decision makers and members of stakeholder communities, participatory processes and negotiation between different interest groups can sometimes be used effectively as mechanisms for improving the overall decision making process. The intention is to ensure a technically sound and socially acceptable decision that meets norms of adequacy or satisfactory performance in relation to a whole range of different concerns. Good communication strategies will encourage cooperation and understanding between different interested parties in remediation projects. Involvement of affected or interested persons can prevent fear driven reactions, which potentially damage public response and create undue expectations or unnecessary anxiety. For all environmental remediation (ER) cases, there is a risk that the process will fail if it does not respect social, environmental, political and economic dimensions. This requires open, clear and mutually agreed lines of communication among stakeholders within a well defined legal framework. A general recommendation is to involve them from a very early point in the process. This publication presents ER in plain language in such a way that implementers and regulators can communicate the motives and objectives of remediation projects to a variety of stakeholder communities in order to improve mutual understanding and facilitate dialogue between interested parties. ER is considered from two perspectives: technical and non-technical. A section that gives general ideas on the strategies to deal with stakeholder involvement and which discusses different aspects of the communication approaches in ER is then included. It is recognized that social, cultural and political situations are very diverse in different countries in
Siirola, John; Tidwell, Vincent Carroll; Benz, Zachary O.; Stansbury, Melanie; Richards, Elizabeth H.; Turnley, Jessica Glicken (Galisteo Consulting); Warrender, Christina E.; Morrow, James Dan
Participatory modeling has become an important tool in facilitating resource decision making and dispute resolution. Approaches to modeling that are commonly used in this context often do not adequately account for important human factors. Current techniques provide insights into how certain human activities and variables affect resource outcomes; however, they do not directly simulate the complex variables that shape how, why, and under what conditions different human agents behave in ways that affect resources and human interactions related to them. Current approaches also do not adequately reveal how the effects of individual decisions scale up to have systemic level effects in complex resource systems. This lack of integration prevents the development of more robust models to support decision making and dispute resolution processes. Development of integrated tools is further hampered by the fact that collection of primary data for decision-making modeling is costly and time consuming. This project seeks to develop a new approach to resource modeling that incorporates both technical and behavioral modeling techniques into a single decision-making architecture. The modeling platform is enhanced by use of traditional and advanced processes and tools for expedited data capture. Specific objectives of the project are: (1) Develop a proof of concept for a new technical approach to resource modeling that combines the computational techniques of system dynamics and agent based modeling, (2) Develop an iterative, participatory modeling process supported with traditional and advance data capture techniques that may be utilized to facilitate decision making, dispute resolution, and collaborative learning processes, and (3) Examine potential applications of this technology and process. The development of this decision support architecture included both the engineering of the technology and the development of a participatory method to build and apply the technology
Full Text Available The idea of this paper is to determine the mental models of actors in the firm with respect to the stakeholder approach of corporate governance. The use of the cognitive map to view these diagrams to show the ways of thinking and conceptualization of the stakeholder approach. The paper takes a corporate governance perspective, discusses stakeholder model. It takes also a cognitive mapping technique.
The issue of corporate responsibility in terms of societal, economic and environmental matters within the petrochemical sector and the role played in this area by the Council on Economic Priorities (CEP) was discussed. CEP is a non-profit research organization whose mission is to analyse the social and environmental records of corporations in an effort to influence corporate behaviour. CEP campaigns for more communication, more social disclosure and environmentally cleaner corporations. The campaign for cleaner corporations, (C-3), began in 1992 as a public awareness campaign to list the worst environmental performers in the U.S. In the C-3 process, CEP provides recommendations to listed companies and de-lists those which have improved their environmental and social performance. The focus in 1997 was on the petrochemical industry. The overall ranking of 15 major petrochemical companies was provided, along with two case histories illustrating the C-3 process from 'listing' to 'delisting'. Measures used in determining environmental performance for a company include their environmental management policy, environmental impact, environmental reporting and communications, product stewardship and stakeholder relations
Franco-Trigo, L; Tudball, J; Fam, D; Benrimoj, S I; Sabater-Hernández, D
Collaboration between relevant stakeholders in health service planning enables service contextualization and facilitates its success and integration into practice. Although community pharmacy services (CPSs) aim to improve patients' health and quality of life, their integration in primary care is far from ideal. Key stakeholders for the development of a CPS intended at preventing cardiovascular disease were identified in a previous stakeholder analysis. Engaging these stakeholders to create a shared vision is the subsequent step to focus planning directions and lay sound foundations for future work. This study aims to develop a stakeholder-shared vision of a cardiovascular care model which integrates community pharmacists and to identify initiatives to achieve this vision. A participatory visioning exercise involving 13 stakeholders across the healthcare system was performed. A facilitated workshop, structured in three parts (i.e., introduction; developing the vision; defining the initiatives towards the vision), was designed. The Chronic Care Model inspired the questions that guided the development of the vision. Workshop transcripts, researchers' notes and materials produced by participants were analyzed using qualitative content analysis. Stakeholders broadened the objective of the vision to focus on the management of chronic diseases. Their vision yielded 7 principles for advanced chronic care: patient-centered care; multidisciplinary team approach; shared goals; long-term care relationships; evidence-based practice; ease of access to healthcare settings and services by patients; and good communication and coordination. Stakeholders also delineated six environmental factors that can influence their implementation. Twenty-four initiatives to achieve the developed vision were defined. The principles and factors identified as part of the stakeholder shared-vision were combined in a preliminary model for chronic care. This model and initiatives can guide policy
Implications of Public Reporting of Risk-Adjusted Mortality Following Percutaneous Coronary Intervention: Misperceptions and Potential Consequences for High-Risk Patients Including Nonsurgical Patients.
Gupta, Anuj; Yeh, Robert W; Tamis-Holland, Jacqueline E; Patel, Shalin H; Guyton, Robert A; Klein, Lloyd W; Rab, Tanveer; Kirtane, Ajay J
Assessment of clinical outcomes such as 30-day mortality following coronary revascularization procedures has historically been used to spur quality improvement programs. Public reporting of risk-adjusted outcomes is already mandated in several states, and proposals to further expand public reporting have been put forward as a means of increasing transparency and potentially incentivizing high quality care. However, for public reporting of outcomes to be considered a useful surrogate of procedural quality of care, several prerequisites must be met. First, the reporting measure must be truly representative of the quality of the procedure itself, rather than be dominated by other underlying factors, such as the overall level of illness of a patient. Second, to foster comparisons among physicians and institutions, the metric requires accurate ascertainment of and adjustment for differences in patient risk profiles. This is particularly relevant for high-risk clinical patient scenarios. Finally, the potential deleterious consequences of public reporting of a quality metric should be considered prior to expanding the use of public reporting more broadly. In this viewpoint, the authors review in particular the characterization of high-risk patients currently treated by percutaneous coronary interventional procedures, assessing the adequacy of clinical risk models used in this population. They then expand upon the limitations of 30-day mortality as a quality metric for percutaneous coronary intervention, addressing the strengths and limitations of this metric, as well as offering suggestions to enhance its future use in public reporting. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
João Paulo Lara de Siqueira
Full Text Available Whereas an initial step in the management of stakeholders is the identification and classification of these actors, this study sought to answer the research question: how managers of Brazilian professional soccer clubs identify and classify their stakeholders? The theoretical framework used was the Stakeholder Theory, developed by Freeman (1984 and other researchers. The method used was proposed by Almeida et al. (2000, which assesses the saliency through the concepts power, legitimacy and urgency, that were proposed in the study of Mitchell et al. (1997. There were two propositions concerning the context of Brazilian soccer clubs: first, that the urgency perceived by managers in the demands of a stakeholder is high when his legitimacy is high and other one is that the most salient stakeholders for the managers are those with high degrees of legitimacy. Stakeholders were surveyed as perceived by the managers of Sociedade Esportiva Palmeiras. Three types of stakeholders were classified as demanding (sponsors, partners and the partner for the construction of the new stadium and three as dependents (members, athletes of professional soccer team and the media. Other stakeholders identified were classified as irrelevant, including the fans and and the organized groups of fans. It can be said that in the specific case of these managers of this particular football club, the trend was the acceptance of both propositions.
Shalimar; Midha, Shallu; Hasan, Ajmal; Dhingra, Rajan; Garg, Pramod Kumar
Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P pain free at those follow-up periods. Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Corbett, Jennie; d'Angelo, Camilla; Gangitano, Lorenzo; Freeman, Jon
This article presents findings from a survey conducted by RAND Europe at the request of the National Institute for Health Research (NIHR) to gather and synthesise stakeholder views on the future of health and healthcare in England in 20 to 30 years' time. The aim of the research was to generate an evidenced-based picture of the future health and healthcare needs, and how it might differ from today, in order to inform strategic discussions about the future priorities of the NIHR and the health and social care research communities more broadly. The survey provided a rich and varied dataset based on responses from 300 stakeholders in total. A wide range of fields were represented, including public health, social care, primary care, cancer, genomics, mental health, geriatrics, child health, patient advocacy and health policy. The respondent group also included a number of professional and private stakeholder categories, such as clinicians, policy experts, academics and patient and public representatives. The study findings validate a number of prominent health research priorities currently visible in England, such as antimicrobial resistance, the burden of dementia and age-related multi-morbidity, digital health and genomics. Interest in these areas and other themes, such as mental health, health inequalities and transforming health service models, cut across multiple disciplinary boundaries. However, it is clear that there are a variety of views among stakeholders on the relative importance of these areas of focus, and the best approach to manage their emergence in the coming decades. The full dataset of survey responses, for which permission to share was given, is a useful resource for those seeking to engage with a particular issue in more depth. The dataset can be found on NIHR's website at: http://nihr.ac.uk/news-and-events/documents/quotes.xls.
Bairstow, B M; Burke, V; Beilin, L J; Deutscher, C
The records of 62 men and 43 women, 14-88 years old, admitted to general medical wards in a public teaching hospital during 1991 were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in 22.9% and 21.9% of patients respectively. Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; 10.5% of the patients had interactions involving alcohol and 2.9% tobacco. Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two beta-blockers. The drugs prescribed indicated that some patients had conditions such as gastro-oesophageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed. This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.
USDA and EPA released a comprehensive scientific report on honey bee health in May 2013. The report points to multiple factors playing a role in honey bee colony declines, including parasites and disease, genetics, poor nutrition, and pesticide exposure.
Dupont, Danielle; Beresniak, Ariel; Sundgren, Mats; Schmidt, Andreas; Ainsworth, John; Coorevits, Pascal; Kalra, Dipak; Dewispelaere, Marc; De Moor, Georges
The Electronic Health Records for Clinical Research (EHR4CR) technological platform has been developed to enable the trustworthy reuse of hospital electronic health records data for clinical research. The EHR4CR platform can enhance and speed up clinical research scenarios: protocol feasibility assessment, patient identification for recruitment in clinical trials, and clinical data exchange, including for reporting serious adverse events. Our objective was to seed a multi-stakeholder ecosystem to enable the scalable exploitation of the EHR4CR platform in Europe, and to assess its economic sustainability. Market analyses were conducted by a multidisciplinary task force to define an EHR4CR emerging ecosystem and multi-stakeholder value chain. This involved mapping stakeholder groups and defining their unmet needs, incentives, potential barriers for adopting innovative solutions, roles and interdependencies. A comprehensive business model, value propositions, and sustainability strategies were developed accordingly. Using simulation modelling (including Monte Carlo simulations) and a 5-year horizon, the potential financial outcomes of the business model were forecasted from the perspective of an EHR4CR service provider. A business ecosystem was defined to leverage the EHR4CR multi-stakeholder value chain. Value propositions were developed describing the expected benefits of EHR4CR solutions for all stakeholders. From an EHR4CR service provider's viewpoint, the business model simulation estimated that a profitability ratio of up to 1.8 could be achieved at year 1, with potential for growth in subsequent years depending on projected market uptake. By enhancing and speeding up existing processes, EHR4CR solutions promise to transform the clinical research landscape. The ecosystem defined provides the organisational framework for optimising the value and benefits for all stakeholders involved, in a sustainable manner. Our study suggests that the exploitation of EHR4CR
Tada, Toshifumi; Kumada, Takashi; Toyoda, Hidenori; Kiriyama, Seiki; Tanikawa, Makoto; Hisanaga, Yasuhiro; Kanamori, Akira; Kitabatake, Shusuke; Yama, Tsuyoki; Tanaka, Junko
Eradication of hepatitis C virus (HCV) with interferon (IFN)-based therapy has been reported to reduce all-cause mortality in patients with chronic HCV infection. However, the impact of HCV eradication on non-liver-related mortality and causes of death has not been sufficiently investigated in patients with progressive HCV-related fibrosis. We enrolled 784 chronic HCV patients with progressive liver fibrosis (aspartate aminotransferase to platelet ratio index >1). Cause of death, incidence of hepatocellular carcinoma, and all-cause mortality including non-liver-related mortality were analyzed. Of these 784 patients, 170 achieved sustained virological response (SVR) (eradication of HCV) with IFN-based therapy (IFN-SVR), and 614 did not receive IFN-based therapy (non-IFN patients, chronic HCV infection). The median follow-up duration was 10.3 years. Two hundred seventy-three patients died during follow-up (liver-related death, n = 171; non-liver-related death, n = 102). The mortality rate from non-liver-related disease was 63.6% (7/11) in IFN-SVR patients and 36.3% (95/262) in non-IFN patients, respectively. In multivariate analysis, the eradication of HCV associated with not only hepatocellular carcinoma incidence (hazard ratio (HR), 0.162; 95% confidence interval (CI), 0.092-0.284), and all-cause mortality (HR, 0.094; 95% CI, 0.047-0.187), but non-liver-related mortality (HR, 0.286; 95% CI, 0.127-0.644) as well. Eradication of HCV reduced both liver-related and non-liver-related mortality in patients with progressive HCV-related fibrosis. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Jesús-Silva, Miriam América; Fernández-Martínez, Ramón; Roldán-Marín, Rodrigo; Arenas, Roberto
Onychomycosis is the most common nail disease, representing 50% of cases affecting the nail apparatus. The diagnosis is made by clinical examination along with the KOH exam of the nail and culture of the sample. However, not all dermatologists have access to a mycology lab. To determine the correlation between KOH examination and dermoscopic patterns in patients with clinical diagnosis of onychomycosis. A descriptive, open, observational, prospective, cross-sectional study of 178 patients with clinical suspicion of onychomycosis was conducted. All patients underwent clinical examination, dermoscopy with a DermLite PHOTO dermatoscope (3Gen, San Juan Capistrano, CA, USA), KOH assessment and culture analysis. The most frequent dermoscopic patterns were identified and their correlation with the clinical subtype of onychomycosis was analyzed. The study included 178 patients with clinical suspicion of onychomycosis. Of these, 155 (87.1%) had positive direct KOH examination for onychomycosis. Eighty-seven patients (56.13%) presented with clinical onychomycosis pattern of total dystrophic onychomycosis (TDO), 67 (43.23%) with distal lateral subungual onychomycosis (DLSO), 1 (0.65%) with trachyonychia). Dermoscopic patterns of onychomycosis showed the following frequencies: the spiked pattern was present in 22 patients (14.19%), longitudinal striae pattern in 51 patients (32.9%) and linear edge pattern in 21 patients (13.55%). We identified a pattern described as "distal irregular termination" in 41 patients with TDO and 26 with DLSO. This is the fist study conducted in a Mexican population that uses dermoscopy as a diagnostic tool along with the KOH examination for the diagnosis of onychomycosis. Dermoscopy may be used as an important diagnostic tool when evaluating nail disease. However, it should not be used as the only diagnostic criteria for onychomycosis.
Fact sheet showing the metrics from calendar year 2016 from Building America's various outreach activities, including website, webinars, publications, etc. Metrics report on data for outreach and stakeholder engagement.
Rothgeb, Stacey K [National Renewable Energy Laboratory (NREL), Golden, CO (United States)
Fact sheet showing the metrics from calendar year 2016 from Building America's various outreach activities, including website, webinars, publications, etc. Metrics report on data for outreach and stakeholder engagement.
Shikhova, E V; Guliaeva, S F; Tsarev, Iu K; Chervotkina, L A
The objective of the present study was to evaluate clinical and cost effectiveness of rehabilitation programs including long-term physical training of moderate intensity intended for the management of patients with coronary heart disease (CHD) who had undergone acute coronary events; the programs were adapted to the treatment under conditions of spa resorts, dispensaries, and outpatient clinics. It was shown that rehabilitation of patients presenting with CDH with the use of moderately intensive physical exercises during a long period enhances the effectiveness of application of the available funds due to improved clinical course of coronary heart disease, tolerance of physical load, and quality of life.
Markhorst, Joekie; Martirosyan, Liana; Calsbeek, Hiske; Braspenning, Jozé
Transparency in diabetes care requires quality indicators that are of interest to stakeholders in order to optimise their usage. Indicator development is often focused on consensus, and little is known about stakeholders' preferences for information on quality. To explore the preferences of consumers, providers, purchasers and policy makers for different quality domains and indicators in relation to the intended use of quality indicators. Between June and December 2009, 14 semi-structured interviews were held with stakeholders who have a decisive vote in the selection of the national indicator set for diabetes care in the Netherlands. The following subjects were explored: (1) the aims of using information on quality; (2) the interpretation of and preferences for the quality domains of safety, timeliness, effectiveness and patient-centredness in relation to the user aims; and (3) the preferences for structure, process or outcome indicators. Content analysis was used to analyse qualitative data. Stakeholders had similar and different aims according to their roles. The interpretations of quality domains varied greatly between the stakeholders. Besides differences in interpretation, their preferences were similar. Most stakeholders prioritised patient-centredness above the other domains of quality, ranked in order of priority as safety, effectiveness and timeliness, whereas purchasers also prioritised efficiency. All stakeholders preferred to use process indicators or a mix of process and outcome indicators. The preferences of the stakeholders for quality indicators seem to be neither well-refined nor congruent. The implementation of an indicator set can probably be improved if the stakeholders' definitions and preferences for quality domains become more explicit during the selection process for indicators.
Jacob, Louis; Kostev, Karel
The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK. This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016. The following drugs were included in the analysis: anti-inflammatory and antirheumatic products, non-steroids and analgesics including opioids, antimigraine preparations, and other analgesics and antipyretics. Demographic variables included age and gender. This study included 4,270,142 patients. The prevalences of pain medication prescriptions were 57.3% in France, 29.6% in Germany, and 21.7% in the UK. Although this prevalence generally remained consistent between age groups in France (54.3%-60.3%), it increased with age in Germany (18-30 years: 23.8%; >70 years: 35.8%) and in the UK (18-30 years: 9.3%; >70 years: 43.8%). Finally, the prevalence of pain medication prescriptions was higher in women than in men in all three countries. Paracetamol was prescribed to 82.3% and 60.1% of patients receiving pain medication in France and the UK, respectively, whereas ibuprofen was prescribed to 46.5% of individuals in Germany. The prevalence of pain medication prescriptions was higher in France than in Germany and the UK. Further research is needed to gain a better understanding of the differences in the prescription patterns between these three European countries.
T.M. Jones; W.A. Felps (William); G. Bigley
textabstractWe use convergent elements of major ethical theories to create a typology of corporate stakeholder cultures—the aspects of organizational culture consisting of the beliefs, values, and practices that have evolved for solving problems and otherwise managing stakeholder relationships. We
Gooyert, V. de; Rouwette, E.A.J.A.; Kranenburg, H.L. van; Freeman, R.E.
The role of stakeholders in organizational decision-making is gaining more and more attention. Managers find that in order to create value sustainably and ethically, it is necessary to balance the interests of various stakeholders. This trend is reflected in the management literature, where much
P. Vishwanathan (Pushpika)
markdownabstractThis PhD thesis lies at the intersection of stakeholder theory and corporate governance research. Stakeholder theory proposes that firms are best understood as a set of relationships among groups that have a stake in the activities of the firm. Corporate governance research, on the
Donna M. Carlon
Full Text Available As firms are creating and recreating themselves as stakeholder corporations, tensions mount between a firm’s fiduciary duties to its shareholders and the broader responsibilities inherent in a stakeholder focus. Firms have employed several techniques to help resolve this tension with limited success. We suggest that the next step in reducing this tension is formally accounting for stakeholder value through changes in financial reporting. We contend that stakeholders have a financial value to the firm that can and should be accounted for through the firm’s financial reporting system. We propose a three-step process we call stakeholder valuing (SV to begin a conversation regarding how such a method can be created. SV begins with codifying the firm’s identity as a stakeholder entity, moves to assessing stakeholder value that’s consistent with that identity, and concludes with accounting for and reporting that value. What we are suggesting will be seen by some as a radical change in accounting practices but we believe it is necessary as we move toward a consistent, reliable, verifiable, transparent, and comparable means of accounting for the true value of a stakeholder corporation.
Brouwer, J.H.; Hiemstra, W.; Vugt, van S.M.; Walters, H.
This paper examines different practical methods for stakeholders to analyse power dynamics in multi-stakeholders processes (MSPs), taking into account the ambiguous and uncertain nature of complex adaptive systems. It reflects on an action learning programme which focused on 12 cases in Africa and
Kronborg, Gitte; Weis, Nina; Madsen, Hans O
for pneumococcal infections. To assess the influence of MBL genotypes on the course and outcome of invasive pneumococcal disease, clinical data for 141 adult patients were collected prospectively and their genotypes were determined. All patients included had positive blood cultures for Streptococcus pneumoniae....... The distribution of variant MBL alleles related to low MBL serum concentrations was similar among the patients and healthy individuals, and MBL genotype was not associated with infection outcome. Thus, in a random adult population with invasive pneumococcal infection, MBL does not seem to play a role......Invasive pneumococcal disease is a serious infection that primarily affects very young children and elderly or immunocompromised individuals but also affects previously healthy people. Variant mannose-binding lectin (MBL) alleles are associated with recurrent infections and may be a risk factor...
Full Text Available This paper examines different perceptions on climate change management and disclosuresfrom the viewpoint of stakeholders in Indian Corporations. The paper shows how climatechange strategies and disclosures at different organizational levels can be linked to thesocietal and competitive contexts that companies face, embedded in a stakeholder view.Companies are divided according to certain attributes - location, geographical spread,industry, degree of vertical integration and diversification, companies prioritizing particularstakeholder groups, and their climate change strategies and disclosures including internalmeasures, supply-chain measures and/or market-based measures that move beyond the supplychain are analyzed.This paper attempts to illustrate how institutional, resource-based, supply chain andstakeholder views are all important to characterize and understand corporate strategicresponses to a sustainability issue.
This report resents evaluations, recommendations, and requirements concerning Tunable Hybrid Plasma (THP) derived from a three-year program of stake holder involvement. THP destroys volatile organic compounds by directing a moderate energy electron beam into a flow of air containing organic contaminants. This report is for technology developers and for those responsible for making decisions about the use of technology to remediate contamination by volatile organic compounds. Stakeholders' perspectives help those responsible for technology deployment make good decisions concerning the acceptability and applicability of THP to the remediation problems the face. In addition, this report presents data requirements for the technology's field demonstration defined by stakeholders associated with the Hanford site in Washington State, as well as detailed comments on THP from stakeholders from four other sites throughout the western United States
Edward Nicodemus Lontah
Donaldson and Peterson studies have shown that stakeholder theory has a more solid foundation than the epistemology of shareholder theory to analyze the performance of business ethics and moral duty of a company. This article discussed the business activities of Oskar Schindler, an industrialist war-profiteer during World War II. Schindler's business which was originally run by the government under the Nazi regime, eventually opposed the mission of economic and legal liability imposed by the regime. Schindler's transformation of vision and business mission in this article demonstrate the characteristics and connection of layers in descriptive, instrumental and normative stakeholder theory in the concept of "normative, instrumental and descriptive stakeholder theory" according to Donaldson and Peterson.
Ishiyama, Mitsutomi; Soine, Laurie A; Vesselle, Hubert J
Cardiac sarcoidosis is associated with major adverse cardiac events including cardiac arrest, for which anti-inflammatory treatment is indicated. Oral corticosteroid is the mainstay among treatment options; however, adverse effects are a major concern with long-term use. It would be beneficial for providers to predict treatment response and prognosis for proper management strategy of sarcoidosis, though it remains challenging. Fluorine (F)-18 fluorodeoxyglucose (FDG)-positron emission tomography(PET)/computed tomography(CT) has an advantage over anatomical imaging in providing semi-quantitative functional parameters such as standard uptake value (SUV), metabolic volume, and total lesion glycolysis (TLG), which are well-established biomarkers in oncology. However, the relationship between these parameters and treatment response has not been fully investigated in cardiac sarcoidosis. Also, the prognostic value of extracardiac active inflammation noted on FDG-PET/CT in the setting of cardiac sarcoidosis is unclear. The aim of this retrospective study was to investigate the prognostic value of semi-quantitative values of both cardiac and extracardiac disease sites derived from FDG-PET/CT in predicting treatment course in cardiac sarcoidosis. Sixteen consecutive patients with suspected cardiac sarcoidosis, who demonstrated abnormal myocardial activity on cardiac-inflammation FDG-PET/CT encompassing the entire chest/upper abdomen and subsequently underwent corticosteroid therapy for diagnosis of active cardiac sarcoidosis, were included. Semi-quantitative values of hypermetabolic lesions were derived from all visualized organ system and were compared to daily corticosteroid dose at 6 months. Of the 16 patients, 81.3% (13/16) of the patients showed extracardiac involvement. The lesion with the greatest SUV was identified in the heart in 11 patients (68.7%), in the liver in 1 patient (6.3%), and in lymph nodes in 4 patients (25%). The maximum SUV across all visualized
M. V. Surovtseva
Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm.
M. V. Surovtseva
Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm.
Full Text Available Including stakeholder perspectives in environmental decision making is in many countries a legal requirement and is widely seen as beneficial as it can help increase decision legitimacy, likelihood of implementation, and quality of the outcome. Whereas the theoretical literature on stakeholder engagement is large, less attention has been devoted to comparing and discussing different methodological approaches. Here, we compare three approaches—multi-criteria analysis, plural rationality theory, and scenario construction—that include stakeholders’ perspectives in environmental decision making. We find differences between the approaches concerning the assumptions about stakeholder rationality and whether experts and/or stakeholders are in charge of framing the problem. Further differences concern the type of data input from stakeholders and how it is used by the experts, as well as the role of stakeholders and whether they are involved early—already for identifying options—or later in the process, for evaluating or ranking alternatives analyzed by the experts. The choice of approach thus predetermines the type and depth of stakeholder engagement. No approach is “better” than another, but they are suited for different problems and research aims: the choice of the approach, however, has a large impact on the results.
Full Text Available Climate change is one of the defining challenges facing the planet. Voluntary forest carbon offset project which has the potential to boost forest carbon storage and mitigate global warming has aroused the global concern. The objective of this paper is to model the game situation and analyze the game behaviors of stakeholders of voluntary forest carbon offset projects in China. A stakeholder model and a Power-Benefit Matrix are constructed to analyze the roles, behaviors, and conflicts of stakeholders including farmers, planting entities, communities, government, and China Green Carbon Foundation. The empirical analysis results show that although the stakeholders have diverse interests and different goals, a win-win solution is still possible through their joint participation and compromise in the voluntary forest carbon offset project. A wide governance structure laying emphasis on benefit balance, equality, and information exchanges and being regulated by all stakeholders has been constructed. It facilitates the agreement among the stakeholders with conflicting or different interests. The joint participation of stakeholders in voluntary forest carbon offset projects might change the government-dominated afforestation/reforestation into a market, where all participators including government are encouraged to cooperate with each other to improve the condition of fund shortage and low efficiency.
Fanari, Zaher; Barekatain, Armin; Kerzner, Roger; Hammami, Sumaya; Weintraub, William S; Maheshwari, Vinay
To investigate the impact of integrating a medical intensivist into a cardiac care unit (CCU) multidisciplinary team on the outcomes of CCU patients. We conducted a retrospective cohort study of 2239 CCU admissions between July 1, 2011, and July 1, 2013, which constituted patients admitted in the 12 months before and 12 months after the introduction of intensivists into the CCU multidisciplinary team. This team included a cardiologist, a medical intensivist, medical house staff, nurses, a pharmacist, a dietitian, and physical and respiratory therapists. The primary outcome was CCU mortality. Secondary outcomes included hospital mortality, CCU length of stay, hospital length of stay, and duration of mechanical ventilation. After the implementation of a multidisciplinary team approach, there was a significant decrease in both adjusted CCU mortality (3.5% vs 5.9%; P=.01) and hospital mortality (4.4% vs 11.1%; Pmultidisciplinary team approach in which an intensivist and a cardiologist comanage the critical care of CCU patients is feasible and may result in better patient outcomes. Copyright Â© 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
van Berkel, Jantien; Meershoek, Agnes; Janssens, Rien M J P A; Boot, Cécile R L; Proper, Karin I; van der Beek, Allard J
Developing, implementing and evaluating worksite health promotion requires dealing with all stakeholders involved, such as employers, employees, occupational physicians, insurance companies, providers, labour unions and research and knowledge institutes. Although worksite health promotion is becoming more common, empirical research on ethical considerations of worksite health promotion is scarce. We explored the views of stakeholders involved in worksite health promotion in focus group discussions and we described the ethical considerations that result from differences between these views. The focus group discussions were organised per stakeholder group. Data were analysed according to the constant comparison method. Our analyses show that although the definition of occupational health is the same for all stakeholders, namely 'being able to perform your job', there seem to be important differences in the views on what constitutes a risk factor to occupational health. According to the employees, risk factors to occupational health are prevailingly job-related. Labour unions agree with them, but other stakeholders, including the employer, particularly see employee-related issues such as lifestyle behaviour as risk factors to occupational health. The difference in definition of occupational health risk factors translates into the same categorisation of worksite health promotion; employee-related activities and work-related activities. The difference in conceptualisation of occupational health risk factors and worksite health promotion resonates in the way stakeholders understand 'responsibility' for lifestyle behaviour. Even though all stakeholders agree on whose responsibility lifestyle behaviour is, namely that of the employee, the meaning of 'responsibility' differs between employees, and employers. For employees, responsibility means autonomy, while for employers and other stakeholders, responsibility equals duty. This difference may in turn contribute to
From the view of stakeholder theory, not only the enterprises should provide services to shareholders, but also take care of the demands of stakeholders. Stakeholders for the enterprise crisis are the organizations and individuals, which cause crisis, respond to the crisis and affected by the enterprise crisis. In this paper, first of all, to comb the development of stakeholder theory systematically; secondly, with the help of the enterprise crisis stakeholder analysis model, analyze the concept of stakeholders for the enterprise crisis and membership, and with the example of Shuanghui Group for further analysis; finally, we put forward relevant proposals for the enterprise crisis from the view of stakeholders.
Governments are particularly salient stakeholders for business ethics. They act on societal needs and social expectations, and have the political and legal powers to restrict or expand the economic freedoms of business as well as the legitimacy and often urgency to do so. We draw on two examples......: the Business & Human Rights regime from a UN Global Compact perspective; and mandatory CSR reporting. Supplying integrated teaching notes and generalising on the examples, we explain how legal method may help students of business ethics, organisation and management – future managers – in their analysis...... to the business ethics literature by explaining how legal method complements stakeholder theory for organisational practice....
Kaupanger, R.M.; Kostelnik, K.M.; Milam, L.M.
The Buried Waste Integrated Demonstration (BWID) is a program funded by the US Department of Energy (DOE) Office of Technology Development. BWID supports the applied research, development, demonstration, and evaluation of a suite of advanced technologies that together form a comprehensive remediation system for the effective and efficient remediation of buried waste. Stakeholder participation in the DOE Environmental Management decision-making process is critical to remediation efforts. Appropriate mechanisms for communication with the public, private sector, regulators, elected officials, and others are being aggressively pursued by BWID to permit informed participation. This document summarizes public outreach efforts during FY-93 and presents a strategy for expanded stakeholder involvement during FY-94
Malard, Julien; Inam Baig, Azhar; Rojas Díaz, Marcela; Hassanzadeh, Elmira; Adamowski, Jan; Tuy, Héctor; Melgar-Quiñonez, Hugo
Model coupling is increasingly used as a method of combining the best of two models when representing socio-environmental systems, though barriers to successful model adoption by stakeholders are particularly present with the use of coupled models, due to their high complexity and typically low implementation flexibility. Coupled system dynamics - physically-based modelling is a promising method to improve stakeholder participation in environmental modelling while retaining a high level of complexity for physical process representation, as the system dynamics components are readily understandable and can be built by stakeholders themselves. However, this method is not without limitations in practice, including 1) inflexible and complicated coupling methods, 2) difficult model maintenance after the end of the project, and 3) a wide variety of end-user cultures and languages. We have developed the open-source Python-language software tool Tinamit to overcome some of these limitations to the adoption of stakeholder-based coupled system dynamics - physically-based modelling. The software is unique in 1) its inclusion of both a graphical user interface (GUI) and a library of available commands (API) that allow users with little or no coding abilities to rapidly, effectively, and flexibly couple models, 2) its multilingual support for the GUI, allowing users to couple models in their preferred language (and to add new languages as necessary for their community work), and 3) its modular structure allowing for very easy model coupling and modification without the direct use of code, and to which programming-savvy users can easily add support for new types of physically-based models. We discuss how the use of Tinamit for model coupling can greatly increase the accessibility of coupled models to stakeholders, using an example of a stakeholder-built system dynamics model of soil salinity issues in Pakistan coupled with the physically-based soil salinity and water flow model
van Duijn, Jacqueline; van Duijn, Arie J; Nitsch, Wanda
It has been reported that in Western society as many as 16% of individuals experience cervicogenic headache, which can lead to significant amounts of pain and perceived disability. Cervicogenic headache is characterized by unilateral occipital-temporal pain that is increased by neck movement; it is accompanied by cervical hypomobility, postural changes, and/or increased cervical muscle tone. This case report describes the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic headache. The patient was a 40-year-old woman referred by her physiatrist with complaints of cervical pain and ipsilateral temporal headache. The patient presented with increased muscle tone, multiple-level joint hypomobility in the cervical and thoracic spine, muscle weakness, and postural changes. Self-report outcome measures included the Visual Analog Scale for headache pain intensity and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations, soft tissue mobilizations, postural re-education, and exercise to address postural deficits and cervical and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically meaningful improvements with regard to pain, disability, and headache. This case report indicates that a multimodal physical therapy treatment program may be effective in the management of a patient diagnosed with cervicogenic headache.
Pescatore, C.; Vari, A.
Site selection for radioactive waste management (RWM) facilities draws considerable attention from implementers, government bodies, local communities and the public at large. Facility siting processes have generally tended to be marred by conflicts, disagreements and delays. In response, efforts have been made to shift from a more traditional 'decide, announce and defend' model to one of 'engage, interact and co-operate'. The essence of the new approach is co-operation or partnership between the implementer and the affected communities, involving dialogue between experts and citizens, mutual learning and public participation in the decision-making process. National ministries and authorities have also been called to and do play a more visible role. The intensity and degree of partnering can vary from country to country and in different phases of project development. Important changes have taken place in citizen participation in radioactive waste management over the past decade. These changes can be summarised as follows: - shift from information and consultation towards partnership, i.e. from token involvement to citizen influence and power; - shift from a passive to an active role of local communities: from resigned acceptance to collaboration, volunteering and veto; - development of a great variety of administrative formats for collaboration; - recognition of the need for, and legitimacy of, community empowerment measures and socio-economic benefits; - emergence of new ideals and bases for collaboration including mutual learning, adding values to the host community/region and sustainable development. Involving local actors in the design of the facility and community benefits are likely to result in solutions that will add value to the host region. In all cases, social capital is augmented as local stakeholders develop new skills and increase their knowledge about the interests and ideals of their community. Implementers and other institutional players also
I contribute in this article to descriptive stakeholder engagement theory by conceptualising a number of new internal influence strategies that engaged secondary stakeholders can use in their new face-to-face interactions with the corporations. These internal stakeholder influence strategies should...... be seen as adding to the list of external stakeholder influence strategies (e.g. Frooman, 1999) that secondary stakeholders can use in their traditional role of operating from the outside....
Ihugba, Bethel Uzoma; Osuji, Onyeka K.
This paper proposes an engagement oriented corporation-stakeholder relationship in Corporate Social Responsibility (CSR) programmes. It is a proposition which poses the two connected questions of how to move from solely public relation driven stakeholder management to social development oriented stakeholder participation (engagement) and how Stakeholder Engagement can be measured. On the backdrop of Arnstein’s (1969) citizenship participation model and reasons for Stakeholder Engagement frame...
Full Text Available Background: Evolution of individualized radiosurgical therapeutic methods for brain metastasis as an ominous prognostic finding may encourage a more extensive application of neuroimaging in patients with extracerebral cancer. The aim of the present study was to investigate the added value of brain-included 18 F FDG PET/CT acquisition protocol based on primary cancer type and clinical indication.Materials and Methods: A retrospective review was performed on 3945 18 F FDG PET/CT reports of patients with extra-cerebral cancer underwent brain-included PET/CT study. Cerebral lesions suggestive of brain metastasis were subsequently verified by MRI, MRI+MRS, surgical pathology and a 1-year clinical formal follow up. The detection rate of new brain metastasis and related impact on disease status were then investigated in each cancer type based on clinical indication.Results: Of a total 3933 eligible patients, 44 (1.12% were finally verified to have new cerebral metastasis. The most common primary sources were lung cancer (19/385, 4.93%, cancer of unknown primary (CUP (5/168, 2.97% and breast cancer (8/468, 1.71%. The most common clinical indications were initial staging (17/44, 43.1% and restaging (19/44, 36.4%. Change in disease status occurred in 12 out of 44 patients (27.3%, more frequently occurred in lung cancer (n=4, in all indications and breast (n=3 cancers at restaging (n=7, 43.8%.Conclusion: PET/CT acquisition protocol study may be best optimized based on the type of primary cancer and timing of evaluation. Brain-included field of view may be recommended for lung cancer regardless the clinical indication, cancer of unknown primary and breast cancer at restaging.
Jabbari, Alireza; Ferdosi, Masoud; Keyvanara, Mahmoud; Agharahimi, Zahra
Policy makers and decision makers must identify the stakeholders in medical tourism, who will be affected by and/or affect this industry, and determine their status for partnership. The aim of this study was to identify the main stakeholders in Isfahan's medical tourism, analyze them, and provide strategies for developing this industry. A qualitative study was conducted in 2011. At first, the key stakeholders in medical tourism were identified in accordance with the experts' idea and literature review. Then we interviewed the key stakeholders. Data analysis was conducted using the stakeholders' analyses, which helped in developing strategies. The result showed that the key stakeholders were made up of nine groups. They included the provincial governance of Isfahan, the Cultural Heritage and Tourism Organization of Isfahan, the Chamber of Commerce, the Medical Council, the Isfahan University of Medical Sciences, health service providers, tourism services providers, investors, and the Tosea Saderat Bank. The rate of knowledge of the Cultural Heritage and Tourism Organization of Isfahan, clinic and international relationship of Isfahan University of Medical Sciences from government policy about medical tourism were very much. Private Hospitals, the Medical Council, investors, and the University of Medical Sciences had great power. Private hospitals, clinics, the Cultural Heritage and Tourism Organization of Isfahan, and the University of Medical Sciences were in the supporter position. The effected strategies were the included strategies, focused on increasing power; increasing support, and on maintaining the position. There are different stakeholders in the medical tourism industry. Thus, policy makers can plan, make a policy and decision, and use effective strategies to develop medical tourism by designing a medical tourism stakeholders' network, a medical tourism provincial council, and clarify the roles and responsibilities of stakeholders.
Hanson, H M; Salmoni, A W
Sustainability of health promotion and injury prevention programmes is a goal of practitioners and an increasingly common requirement of funding bodies. However, less is known about the views held by individual stakeholders involved in such programmes regarding their perceptions of facilitators and barriers to achieving sustainability. This paper aims to share the perceptions of programme sustainability held by key stakeholders involved in a community-based fall prevention programme in three Ontario demonstration communities in Canada. A qualitative case study research design. A holistic multiple case study method was employed. In total, 45 stakeholders involved in various aspects of the project participated from three demonstration sites. Stakeholders' perceptions were gathered on the individual actions they took in an effort to promote sustainability, and the barriers they perceived as preventing or limiting sustainability. Stakeholders reported taking a number of actions to aid programme sustainability, with some actions deemed to be more functional in aiding sustainability than others. Common actions reported by stakeholders included partnership formation, networking and increasing community capacity. Stakeholders also perceived a number of barriers to achieving sustainability, including insufficient human and financial resources, lack of co-ordination and buy-in, heavy reliance on volunteers and an inability to mobilize physicians. Stakeholders' perceptions of sustainability were used to develop recommendations for sustainability for both communities and funding bodies. The views and experiences shared by the stakeholders in this project can serve as lessons learnt to aid in the sustainability of other health promotion and injury prevention programmes in the future. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.
Launay, Manon; Roux, Antoine; Beaumont, Laurence; Douvry, Benoit; Lecuyer, Lucien; Douez, Emmanuel; Picard, Clément; Grenet, Dominique; Jullien, Vincent; Boussaud, Véronique; Guillemain, Romain; Billaud, Eliane M
Appropriate exposure to posaconazole (PSZ) has been limited until the recent approval of the delayed-release oral tablet formulation. Our goal was to determine the exposure obtained by using the standard dose of 300 mg once a day in lung transplant (LT) patients, including patients with cystic fibrosis (CF). PSZ trough concentrations ( C 0 ) were determined using a liquid chromatography-tandem mass spectrometry assay. Indicative thresholds of interest were asterisk means that statistical test is significant]), and the PSZ C 0 exposures for these patients were 1.9 ± 1.5, 1.1 ± 0.8, and 2.4 ± 1.8 mg/liter, respectively ( P < 0.00001*). More than 60% of the concentrations were in the therapeutic range. In CFLT patients, the administration of one 300-mg PSZ tablet quickly achieved an exposure similar to that achieved with the PSZ oral suspension formulation (OSF) administered 3 or 4 times a day for several months. The TRL C 0 /dose ratio ( C 0 / D ) was 7.4 ± 4.4 mg/liter with PSZ tablets, whereas it was 4.6 ± 0.8 mg/liter with the PSZ oral solution ( P = 0.034*). The ERL C 0 / D was similar with both formulations. PPI had no impact on the PSZ concentration (1.49 ± 1.07 mg/liter without PPI versus 1.33 ± 1.17 mg/liter with PPI; P = 0.4134*). Despite the high levels of exposure, PSZ remained well tolerated (one case of diarrhea and one case of fatigue were reported). PSZ tablet administration allows satisfactory exposure, even in CFLT patients, with a dosage lower than that of the PSZ OSF. This once-a-day formulation was not impacted by PPI, which are extensively used in CF patients. Copyright © 2018 American Society for Microbiology.
Ernecoff, Natalie C; Witteman, Holly O; Chon, Kristen; Chen, Yanquan Iris; Buddadhumaruk, Praewpannarai; Chiarchiaro, Jared; Shotsberger, Kaitlin J; Shields, Anne-Marie; Myers, Brad A; Hough, Catherine L; Carson, Shannon S; Lo, Bernard; Matthay, Michael A; Anderson, Wendy G; Peterson, Michael W; Steingrub, Jay S; Arnold, Robert M; White, Douglas B
Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs. We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews. Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy. There is
Bostick, Thomas P; Holzer, Thomas H; Sarkani, Shahryar
Coastal hazards including storm surge, sea-level rise, and cyclone winds continue to have devastating effects on infrastructure systems and communities despite costly investments in risk management. Risk management has generally not been sufficiently focused on coastal resilience, with community stakeholders involved in the process of making their coastline, as a system, more resilient to coastal storms. Thus, without stakeholder earlier involvement in coastal resilience planning for their community, they are frustrated after disasters occur. The U.S. National Academies has defined resilience as "the ability to prepare and plan for, absorb, recover from, and more successfully adapt to adverse events"(National Research Council). This article introduces a methodology for enabling stakeholder-involved resilience discussions across physical, information, cognitive, and social domains. The methodology addresses the stages of resilience-prepare, absorb, recover, and adapt-and integrates performance assessment with scenario analysis to characterize disruptions of risk-management priorities. The methodology is illustrated through a case study at Mobile Bay, Alabama, USA. © 2016 Society for Risk Analysis.
Lute, Michelle L; Bump, Adam; Gore, Meredith L
Whereas past wolf management in the United States was restricted to recovery, managers must now contend with publicly contentious post-recovery issues including regulated hunting seasons. Understanding stakeholder concerns associated with hunting can inform stakeholder engagement, communication, and policy development and evaluation. Social identity theory (SIT) has been used to understand how groups interact, why they conflict, and how collaboration may be achieved. Applying SIT to stakeholder conflicts about wolf hunting may help delineate groups according to their concern about, support for or opposition to the policy choice of hunting wolves. Our objective was to assess concerns about hunting as a tool to resolve conflict in Michigan, using SIT as a framework. We used a mixed-modal sampling approach (e.g., paper, Internet) with wolf hunting-related public meeting participants in March 2013. Survey questions focused on 12 concerns previously identified as associated with hunting as a management tool to resolve conflict. Respondents (n = 666) cared greatly about wolves but were divided over hunting wolves. Wolf conflicts, use of science in policy decisions, and maintaining a wolf population were the highest ranked concerns. Principle components analysis reduced concerns into three factors that explained 50.7% of total variance; concerns crystallized over justifications for hunting. General linear models revealed a lack of geographic influence on care, fear and support for hunting related to wolves. These findings challenge assumptions about regional differences and suggest a strong role for social identity in driving dichotomized public perceptions in wildlife management.
Some insight is provided for IPPSO members into the IMO Technical Panel (TP), its scope, modus operandi, and stakeholdering process. The TP is one of 3 panels recommended by the MDC and defined in the IMP bylaws. Its role is to consider rule changes and make recommendations to the IMO board. The aims of the Technical Panel are listed. The priority issues with significant direct impact on generators are: import and export transmission, including access to the inter-ties, and the Financial Transmission Rights associated with inter-ties, procedures governing new investment in transmission, participation and prudential requirements, and residual risk location, facility aggregation rules, local market power migration, must-run contracts; principles and forms of agreement, penalties for non-compliance with rules, and transitional provisions around market opening. The excluded major market design principles to be resolved by others are covered, as well as how it is decided what issues need attention. The TP does its work by: work planning, policy consultation, rule guidance and direction requests, and proposed rule amendments. Further points are listed concerning: how the TP secures stakeholder input, how the IPPSO stakeholder consultation process works, import and export transmission issues, and accreditation and prudential requirements
Asyraf Mahyuddin, Izzat; Rahim, Zaiton Abdul; Nawawi, Norwina Mohd
Masjids or mosques were built across the Malay Archipelago or the Nusantara, as a statement on the rise and strengths of the Islamic community since the arrival of Islam in the 1300s. As the latest religion to the South-East Asia after Hindu-Buddhist, the mass often discusses the form and make of the masjid but seldom question who’s who constitutes the design and the rigmarole of masjids. This paper aim at identifying the stakeholders of masjid architecture of Nusantara through analysing the involvement of stakeholders from historical and primary data, covering the process of initiation, through masjid construction including the conceptions and perceptions on the factors influencing the architecture of the masjid. The paper intents to demystify the sole responsibility of the architect in designing masjid of Nusantara region and places the will of Islam as the religion of initiation and stakeholders, whom are the rulers, scholars and common Muslims, as the Ummah, the reason of its make and form it is today.
Full Text Available Achim Benditz,1 Felix Greimel,1 Patrick Auer,2 Florian Zeman,3 Antje Göttermann,4 Joachim Grifka,1 Winfried Meissner,4 Frederik von Kunow1 1Department of Orthopedics, University Medical Center Regensburg, 2Clinic for anesthesia, Asklepios Klinikum Bad Abbach, Bad Abbach, 3Centre for Clinical Studies, University Medical Center Regensburg, Regensburg, 4Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany Background: The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking.Methods: All patients included in the study had undergone total hip arthroplasty (THA. Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS. A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward.Results: From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0 on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2. Over time, the maximum pain score decreased (mean 3.0, ±2.0, whereas patient satisfaction
Enduring Contestations: Stakeholder Strategic Action in Water Resource Management in the Save Catchment Area, Eastern Zimbabwe. ... The data presented in this article was collected in the Save Catchment Council area in the eastern part of Zimbabwe between August 2001 and April 2002. Eastern Africa Social Science ...
This article analyzes how Danish listed firms comply with the Danish Corporate Governance Code's recommendations regarding the categories: Role of shareholders, role of stakeholders and transparency. It is shown that the number of recommendations can be explained by six different underlying facto...
This paper considers why stakeholder institutions mandated to manage water resources in Zimbabwe in a participatory manner, have failed to perform according to expectations. A central argument of the paper is that this failure is because of the absence of a clear development agenda, which can facilitate effective ...
Ideen er at vise at en virksomhed, som samtidigt skal tilgode ledelsen og forbrugerne, må have en monopollignende stilling på markedet og benytte en bizar prisdiskriminering, hvilket vises men en Nash forhandlingsligevægt. Desuden inddrages en ekstensiv diskussion af stakeholder-begrebet....
Elizabeth Kyoko Wada
Full Text Available Means of accommodation involve a wide range of social actors and agents, as well as different business models. Management strategies in this sector have been increasingly important for long-term sustainability and competitiveness of business organizations. This study aims to analyze the interactions between apart-hotels and their stakeholders to foster an improvement of services provided, aligning the interface of strategic management from the point of view of managers and their key stakeholders. It is an exploratory study, with qualitative chacter, along with multiple case studies of the following establishments: Travel Inn, Hotels Slaviero and Etoile george v. Brazilian enterprises, which manage lodging facilities with apart-hotel concepts, combining features that enable comparative analysis of the study. For conceptual understanding, this study was based on literature about stakeholders, taking the work of Freeman (1984 and Freeman et al (2010 as main references. The research was conducted through semi-structured interviews with managers of lodging facilities and their key stakeholders and through direct observation and documentation. We found that not all groups of influence are considered in the planning of service flats. However, the organizations surveyed indicated that the market has realized the importance of the groups that exert influence and are influenced by their goals, and are therefore increasingly alert for integration of such groups in their strategic planning.
Full Text Available In recent years, knowledge, the human capital, and learning organizations have become the key determinants of current global progress. Higher educational sector has been faced with globalization and strong competition. Therefore, the need has arisen for professional management structures and more entrepreneurial style of leadership. Organizations have been transformed to learning organizations by the life long learning concept, while the knowledge management has become the leading tool in building competitive advantages. High education organizations are being pushed forward by competitiveness. That pressure requires continuous improvement emphasizing the need for measuring outcomes and building excellence. The paradigm of stakeholder analysis, applied to specific determinations of the system of higher education institutions, could be a good way for comprehending and predicting interests, needs and requirements of all key players in the environment. The purpose of this paper is to enhance the possibility of understanding the connection between higher education institutions and its environment in context of stakeholder analysis. The paper uses literature as a basis in identifying critical parameters for stakeholder analysis and its implementation to higher education sector. The findings of the paper reveal that the concept of stakeholders is critical and difficult to implement everywhere and to everything. There is a clear attempt of all organizations, especially those that create and encourage knowledge, to understand the actions of all participants and predictions of interests and requirements of the changing environment.
Anne E. Black
This report presents complete results of a 2011 stakeholder feedback effort conducted for the National Wildfire Coordination Group (NWCG) Executive Board concerning how best to organize and manage national wildland fire Incident Management Teams in the future to meet the needs of the public, agencies, fire service and Team members. Feedback was collected from 858...
Rosewater, David Martin [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Conover, David [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)
The objective of this document is to set out a strategy to reach all stakeholders that can impact the timely deployment of safe stationary energy storage systems in the built environment with information on ESS technology and safety that is relevant to their role in deployment of the technology.
Kinash, Shelley; Crane, Linda; Judd, Madelaine-Marie; Knight, Cecily
A literature review identified 12 strategies that have been empirically linked to improvements in graduate employability. A survey methodology was used to investigate self-reported use and/or perspectives on these strategies among four stakeholder groups. The following questions were asked: to students--What strategies are you using to improve…
... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Stakeholder participation. 50.4 Section 50.4 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION... county throughout the project area, either in paper or electronic format; and (ii) Complete copies of all...
Oct 2, 2016 ... The need for the appreciation of values and knowledge diversity has contributed to the increasing ... Outcome Perception Index (OPI) was developed to assess stakeholders' perception of the extent to which the ..... Consumer Price Index of Bryan and Cecchetti (1993); the Economic Security Index designed ...
The need for the appreciation of values and knowledge diversity has contributed to the increasing relevance of stakeholder participation in the monitoring and evaluation (M&E) of development projects. Using mixed methods research design and indicators, this paper assesses the outcomes of the participatory monitoring ...
Lago, Patricia; Avgeriou, Paris; Hilliard, Rich
As noted earlier, some stakeholder concerns are well-served today by available architecture viewpoints, frameworks, or ADLs, while others aren't expressible with available, off-the-shelf approaches. Hence the theme of this special issue: exploring the space of architecting in the face of multiple
: the Business & Human Rights regime from a UN Global Compact perspective; and mandatory CSR reporting. Supplying integrated teaching notes and generalising on the examples, we explain how legal method may help students of business ethics, organisation and management – future managers – in their analysis...... to the business ethics literature by explaining how legal method complements stakeholder theory for organisational practice....
Leisyte, Liudvika; Westerheijden, Donald F.; Eggins, Heather
The various changes in post-bureaucratic organising, which are moving towards network approaches, coupled with the managerial agenda of corporate governance, have redefined the roles of various internal and external stakeholders in the governance of higher education institutions (Leisyte and Dee,
McCaughin, Keith; Derosa, Joseph
An enterprise is a complex adaptive social system that should maximize stakeholder, not shareholder, value — value to employees, customers, shareholders and others. We expand upon Russell Ackoff s direction to distribute value among stakeholders, to propose a schema of rules that guide the interactions among autonomous agents in the transactional environment of an enterprise. We define an enterprise as an organization and its transactional environment interacting with and adapting to each other. Enterprise behavior can only be understood in the context of this transactional environment where everything depends on everything else and interactions cannot be controlled, but can be influenced if they are guided by an understanding of the internal rules of the autonomous agents. The schema has four complementary rules (control, autonomy, return and value) derived from the work of Russell Ackoff and Michael Porter. The basic rules are applied in combination to eight stakeholder types derived from Richard Hopeman and Raymond McLeod (Leaders, Competitors, Customers, Public, Workers, Collaborators, Suppliers and Regulators). An enterprise can use this schema and rules in a process of stakeholder analysis to develop and continually refine strategies to encourage behaviors that benefit the enterprise and discourage behaviors that harm the enterprise. These strategies are implemented in a relationship management program in support of enterprise strategic management to consciously and explicitly shape the environment to reduce risks and increase opportunities for success.
ABSTRACT. This study was undertaken with the objective of evaluating the extent of convergence on the part of key stakeholders in the cocoa sector on the problems of cocoa extension and how to address it. The study was carried out in the Atwima Mponua and Amansie West districts of the Ashanti re- gion in 2008 ...
This study was undertaken with the objective of evaluating the extent of convergence on the part of key stakeholders in the cocoa sector on the problems of cocoa extension and how to address it. The study was carried out in the Atwima Mponua and Amansie West districts of the Ashanti region in 2008 although some of the ...
Kuzmyn, Zenon J.; Collet, Leverne S.
The intent of this paper is to illustrate the use of stakeholder information in evaluating a school program. The material presented is part of a comprehensive formative evaluation of a crisis intervention program operated by a suburban school district situated near a large industrial city in the Midwest. The crisis intervention program provided…
van Gorp, B.; van der Goot, M.J.
Despite its importance, the notion of sustainability is open for discursive struggle. This article's primary objective is to acquire insight into the manner in which the principal stakeholders strategically use frames in their public communication about sustainable food and agriculture. A framing
The main concern of the stakeholders is the problem of who to hold accountable for fund disbursement and execution of educational programs. The second concern is the degree of transparency in financial dealings with a view to check irregularity and ultimately enhances efficiency. Using the 'Perception Survey' method, ...
Pettigrew, Simone; Pescud, Melanie; Donovan, Robert J.
The aim of this study was to assess the extent to which parents and school-based stakeholders (principals, teachers, canteen managers and Parents & Citizen Committee presidents) are supportive of potential expansions to a new school food policy. Eight additional policy components elicited in preliminary focus groups with parents and 19 additional…
THIS STUDY WAS UNDERTAKEN TO IDENTIFY AND EVALUATE CRITERIA BY WHICH THE PUBLIC, AND CERTAIN STAKEHOLDER GROUPS WITHIN THE PUBLIC, WILL JUDGE THE MERITS OF THE FAST-TRAC SYSTEM. OVER A PERIOD OF TWO YEARS, THREE SURVEYS WERE CONDUCTED TO OBTAIN SPECI...
Mark G. Rickenbach; Paul H. Gobster
Parcelization, the process by which relatively large forest ownerships become subdivided into smaller ones, is often related to changes in ownership and can bring changes to the use of the land. Landowners, resource professionals, and others interested in Wisconsin's Northwoods were asked their views on parcelization in a series of stakeholder forums. We analyzed...
Full Text Available The present research is aimed at analyzing and evaluating the influence of key stakeholders on sustainability marketing strategies (SMSs of multi-industry Indian companies. The study objective is achieved in several phases, including development of typology of SMS of Indian companies, identification and classification of stakeholders, and evaluation of influence of various stakeholders on SMS of Indian companies. To achieve these objectives, data were collected from Business Standard 1,000 companies through email survey, and 153 complete responses were received. Empirical evidence shows that most of the Indian companies are either undecided about or uninterested in adopting sustainability marketing (SM practices, or are not showing their interest in adopting sustainability. Findings further reveal that stakeholders exert environmental, social, and economic pressures on Indian companies; managers of Indian companies feel considerable pressure from environmental stakeholders for adopting SMS, while the pressure from social and economic stakeholders is comparatively less. The study will help managers manage stakeholders effectively while formulating SMSs.
Rashid, F. I. A.; Zolkaffly, M. Z.; Jamal, N.
In order to keep abreast on issues related to CTBT in Malaysia, Malaysian Nuclear Agency (Nuklear Malaysia), as the CTBT National Authority in Malaysia, has collaborated with local partners to implement various stakeholder engagement programme. This paper aims at highlighting Malaysia’s approach in promoting CTBT through stakeholder engagement programme targeted at multilevel stakeholders, both national and international. Such programmes includes participation in the international forums, inter-agency meetings, awareness seminars, training courses, technical visits to IMS station, promoting civil and scientific application of International Monitoring System (IMS) data and International Data Centre (IDC) products using Virtual Data Exploitation Center (vDEC), inviting youth groups to participate in the CTBTO Youth Group, and publications of CTBT-related topics. This approach has successfully fortify Malaysia’s commitments at the international level, enhanced national awareness of global multilateral framework, increased stakeholders awareness and their roles related to CTBT, as well as building domestic capacity on CTBT matters. In conclusion, stakeholder engagement is crucial in promoting and enhancing stakeholders understanding on CTBT. Continuous engagement with relevant stakeholders will enable effective dissemination and smooth implementation of CTBT related matters that will eventually support global universalization of CTBT.
Full Text Available Chronic nonsurgical skin wounds such as venous stasis and diabetic ulcers have been associated with a number of comorbid conditions; however, the strength of these associations has not been compared. We utilized the Stanford Translational Research Integrated Database Environment (STRIDE system to identify a cohort of 637 patients with chronic skin ulcers. Preliminary analysis ( showed that 49.7% of the patients had a poor prognosis such as amputation or a nonhealing ulcer for at least a year. Factors significantly associated ( with these outcomes included diabetes mellitus, chronic kidney disease, peripheral neuropathy, peripheral arterial disease, and need for systemic antibiotics. Patients with poor outcomes also tended to have lower hemoglobin levels (, higher WBC levels (, and lower albumin levels (. On multivariate analysis, however, only diabetes mellitus (OR 5.87, 1.36–25.3, need for systemic antibiotics (OR 3.88, 1.06–14.2, and albumin levels (0.20 per unit, 0.07–0.60 remained significant independent predictors of poor wound-healing outcomes. These data identify patients at the highest risk for poor wound-healing and who may benefit the most from more aggressive wound care and treatment.
Sekula, Peggy; Liss, Yvonne; Davidovici, Batya; Dunant, Ariane; Roujeau, Jean-Claude; Kardaun, Sylvia; Naldi, Luigi; Schumacher, Martin; Mockenhaupt, Maja
The purpose of this study was to evaluate the severity-of-illness score called SCORTEN with respect to its predictive ability and by using data obtained in the RegiSCAR study, the most comprehensive European registry of patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). For advanced comparisons, an auxiliary score (AS) was defined using data obtained in a previous study. Three hundred sixty-nine patients with SJS/TEN were included in RegiSCAR between 2003 and 2005. The data needed for calculation of SCORTEN were available for 45% of patients. The score revealed a moderate predictive ability with a slight underestimation of the total number of in-hospital deaths by 11%, an area under the receiver operating characteristic curve of 0.75, and a Brier score of 0.14. Problems could be seen by analyzing subgroups such as patients with TEN. The AS was better calibrated but discriminated worse (area under the receiver operating characteristic curve: 0.72; Brier score: 0.14). With the help of a refined score derived from SCORTEN and AS, potential for a possible improvement could be demonstrated. The authors were able to show that the predictive ability of SCORTEN is acceptable. Although improvement might be possible, SCORTEN remains the tool of choice, whereas AS might be an alternative in retrospective settings with missing laboratory data.
Elam, Mark; Sundqvist, Goeran
The focus in this paper is on past, current and emerging patterns of stakeholder involvement in the siting of a deep repository for final disposal of Sweden's spent nuclear fuel. In particular, we concentrate on how the two municipalities of Oskarshamn and Oesthammar have acted as engaged stakeholders, and have gained recognition as such, in the siting process. In general: How has stakeholder involvement gained acceptance as an activity of value in the siting of major waste facilities? What are the issues currently subject to stakeholder involvement and how have these been decided upon? An effect of the history of nuclear activity in Oskarshamn and Oesthammar is that stakeholder involvement over a final repository can be divided into social and technical issues. Both municipalities have out of tradition, as part of their social acceptance of a new repository, been prepared to surrender extended involvement in key safety issues. They have been prepared to do this because they also see themselves being able to delegate these safety issues to the government authorities SSI and SKI. These two authorities have been acceptable to the two municipalities as their legitimate 'technological guardians'. As physical geology re-enters the siting process for a deep repository, Oskarshamn appear more prepared to break with tradition than Oesthammar. Oskarshamn are currently demanding transparency from SKB in relation to the exact technical and geological criteria they will use to choose between them and Oesthammar as a repository site. In contrast to Oesthammar, Oskarshamn are preparing with the expected help of SKI and SSI to dispute their geology and its relation to nuclear safety with SKB if they consider it necessary. If Oskarshamn act to draw safety issues in relation to alternative methods and sitings into the EIA process where might this lead? As environmental groups now enter the process (three groups were granted funding in the first round - 2005) the character of site
Gupta, Adyya; Dhillon, Preet K; Govil, Jyotsna; Bumb, Dipika; Dey, Subhojit; Krishnan, Suneeta
Cancer is a leading cause of death worldwide. A large proportion of cancer deaths are preventable through early detection but there are a range of social, emotional, cultural and financial dimensions that hinder the effectiveness of cancer prevention and treatment efforts. Cancer stigma is one such barrier and is increasingly recognized as an important factor influencing health awareness and promotion, and hence, disease prevention and control. The impact and extent of stigma on the cancer early detection and care continuum is poorly understood in India. To evaluate cancer awareness and stigma from multiple stakeholder perspectives in North India, including men and women from the general population, health care professionals and educators, and cancer survivors. A qualitative study was conducted with in-depth interviews (IDIs) and focus group discussions (FGDs) among 39 individuals over a period of 3 months in 2014. Three groups of participants were chosen purposively - 1) men and women who attended cancer screening camps held by the Indian Cancer Society, Delhi; 2) health care providers and 3) cancer survivors. Most participants were unaware of what cancers are in general, their causes and ways of prevention. Attitudes of families towards cancer patients were observed to be positive and caring. Nevertheless, stigma and its impact emerged as a cross cutting theme across all groups. Cost of treatment, lack of awarenes and beliefs in alternate medicines were identified as some of the major barriers to seeking care. This study suggests a need for spreading awareness, knowledge about cancers and assessing associated impact among the people. Also Future research is recommended to help eradicate stigma from the society and reduce cancer-related stigma in the Indian context.
Seithikurippu R. Pandi-Perumal
Full Text Available This review introduces a conceptual framework for understanding stakeholder management in the clinical and community-based research environment. In recent years, an evolution in practice has occurred in which many applicants for public and non-governmental funding of public health research in hospital settings. Community health research projects are inherently complex, have sought to involve patients and other stakeholders in the center of the research process. Substantial evidence has now been provided that stakeholder involvement is essential for management effectiveness in clinical research. Feedback from stakeholders has critical value for research managers inasmuch as it alerts them to the social, environmental and ethical implications of research activities. Additionally those who are directly affected by program development and clinical research, the patients, their families, and others, almost universally have a strong motivation to be involved in the planning and execution of new program changes. The current overview introduces a conceptual framework for stakeholder management in the clinical research environment and offers practical suggestions for fostering meaningful stakeholder engagement. The fifth edition of PMBOK® of the Project Management Institute (PMI, has served as basis for many of the suggested guidelines that are put forward in this article.
Stewart, Kimberly D.; Martinez, Alvaro A.; Weiner, Sheldon; Podratz, Karl; Stromberg, Jannifer S.; Schray, Mark; Mitchell, Christina; Sherman, Alfred; Chen, Peter; Brabbins, Donald A.
Purpose: To evaluate the long-term results of treatment using adjuvant whole abdominal irradiation (WAPI) with a pelvic/vaginal boost in patients with Stage I-III endometrial carcinoma at high risk of intra-abdominopelvic recurrence, including clear cell (CC) and serous-papillary (SP) histologic features. Methods and Materials: In a prospective nonrandomized trial, 119 patients were treated with adjuvant WAPI between November 1981 and April 2000. All patients were analyzed, including those who did not complete therapy. The mean age at diagnosis was 66 years (range 39-88). Thirty-eight patients (32%) had 1989 FIGO Stage I-II disease and 81 (68%) had Stage III. The pathologic features included the following: 64 (54%) with deep myometrial invasion, 48 (40%) with positive peritoneal cytologic findings, 69 (58%) with high-grade lesions, 21 (18%) with positive pelvic/para-aortic lymph nodes, and 44 (37%) with SP or CC histologic findings. Results: The mean follow-up was 5.8 years (range 0.2-14.7). For the entire group, the 5- and 10-year cause-specific survival (CSS) rate was 75% and 69% and the disease-free survival (DFS) rate was 58% and 48%, respectively. When stratified by histologic features, the 5- and 10-year CSS rate for adenocarcinoma was 76% and 71%, and for serous papillary/CC subtypes, it was 74% and 63%, respectively (p=0.917). The 5- and 10-year DFS rate for adenocarcinoma was 60% and 50% and was 54% and 37% serous papillary/CC subtypes, respectively (p=0.498). For surgical Stage I-II, the 5-year CSS rate was 82% for adenocarcinoma and 87% for SP/CC features (p=0.480). For Stage III, it was 75% and 57%, respectively (p=0.129). Thirty-seven patients had a relapse, with the first site of failure the abdomen/pelvis in 14 (38%), lung in 8 (22%), extraabdominal lymph nodes in 7 (19%), vagina in 6 (16%), and other in 2 (5%). When stratified by histologic variant, 32% of patients with adenocarcinoma and 30% with the SP/CC subtype developed recurrent disease. Most
G Pitman, Alexander
Referral to a clinical radiologist is the prime means of communication between the referrer and the radiologist. Current Australian and New Zealand government regulations do not prescribe what clinical information should be included in a referral. This work presents a qualitative compilation of clinical radiologist opinion, relevant professional recommendations, governmental regulatory positions and prior work on diagnostic error to synthesise recommendations on what clinical information should be included in a referral. Recommended requirements on what clinical information should be included in a referral to a clinical radiologist are as follows: an unambiguous referral; identity of the patient; identity of the referrer; and sufficient clinical detail to justify performance of the diagnostic imaging examination and to confirm appropriate choice of the examination and modality. Recommended guideline on the content of clinical detail clarifies when the information provided in a referral meets these requirements. High-quality information provided in a referral allows the clinical radiologist to ensure that exposure of patients to medical radiation is justified. It also minimises the incidence of perceptual and interpretational diagnostic error. Recommended requirements and guideline on the clinical detail to be provided in a referral to a clinical radiologist have been formulated for professional debate and adoption. © 2017 The Royal Australian and New Zealand College of Radiologists.
Penserga, Ester G; Natividad, Therese Aileen L; Salido, Evelyn S
To describe Filipino patients with rheumatoid arthritis (RA) entered in the Rheumatoid arthritis database and registry (RADAR) of the Philippine General Hospital. Cases entered to RADAR from 2010-2012 were included. All fulfilled the 1987 American College of Rheumatology criteria for classification of RA. Included cases gave written infomed consent. Data extracted were demographics, clinical presentation, laboratory tests, treatment and disease course. Means and proportions were used for population characteristics. Two hundred and sixty-six cases were included. Mean age was 44 years, with 9 : 1 female preponderance and mean diagnosis time of 5 years. There was symmetrical polyarthritis with high tender and swollen joint count and mean Disease Activity Score of 28 joints, erythrocyte sedimentation rate of 5.27 (3.39, 8.13). Rheumatoid factor was positive in 2/3 of cases. Hypertension, tuberculosis and diabetes were important co-morbidities. Treatment included prednisone, non-steroidal anti-inflammatory drugs and methotrexate. At 12 months of treatment, evaluable cases (< 20%) showed improvement from high to moderate disease activity. Methotrexate average dose was 8.6 mg/week. Nine cases received biologic agents. Factors affecting treatment included access to rheumatology centers, low socioeconomic status, presence of co-morbid diseases and treatment adverse events. This study reports a cohort of Filipino RA patients seen in a government arthritis unit whose disease characteristics are similar to what is reported worldwide. This cohort differs from most studies in having a high female to male ratio, a long delay in diagnosis, and high attrition rate. Mean methotrexate dose was low and there was less access to biologic disease-modifying anti-rheumatic drugs. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Full text of publication follows: The Swedish speaker made clear that giving information to stakeholders is not enough; we need to ensure real participation in our decision making process. Where possible, this should be part of existing democratic structures. The Canadian presentation raised a number of important issues, including who leads the process and how to build public confidence in a waste disposal site. In terms of leadership it is clear that there are various options, central and local. However, what is important is that there is some form of legal agreement that legitimises this leadership role. This helps to ensure buy-in of all groups and also helps local democratic bodies to recognize the decisions made. Public confidence in waste disposal sites (or decommissioned sites for that matter) is improved by finding some open public use for the sites, for example sports facilities. The Canadians also raised the issue of independent peer review. It is important that local stakeholders have a source of independent advice on whether what they are being told by the central government and regulators is reasonable. The Canadian regulator mentioned that nuclear operators have a requirement in their licence to communicate with stakeholders. If I have understood this correctly it seems a very positive development. He also mentioned staff confidence and credibility, illustrating this by his amusing joke on the difference between introvert and extrovert engineers. This is something that the FSC has also taken an interest in. It is vital that the nuclear industry and regulators recruit, develop and reward staff who have strong communication skills. Historically, our business has placed more emphasis on pure technical ability than on communicating simply the outcome of technical work. But the public does not see it this way. Indeed, we could go further and question the value of a safety case that cannot be understood by any intelligent person. Simplicity and clarity is
Health research database security issues abound. Issues include subject confidentiality, data ownership, data integrity and data accessibility. There are also various stakeholders in database security. Each of these stakeholders has a different set of concerns and responsibilities when dealing with security issues. There is an obvious need for training in security issues, so that these issues may be addressed and health research will move on without added obstacles based on misunderstanding s...
Dogra, Nisha; Wass, Val
Personal attitudes of doctors towards cultural diversity may influence the delivery of clinical care. Yet whether medical schools should assess a student's cultural awareness and if so, how, has not been specifically debated. To establish the views of key stakeholders in medical education on the assessment of awareness of cultural diversity within the undergraduate curriculum. Semi-structured interviews were undertaken, using sampling and snowballing, with 61 stakeholders, including policymakers, teachers of diversity, students, service users and carers. The data were analysed qualitatively using quasi-statistical and template approaches and themes identified. Three main themes emerged. The first was ambivalence over the need to assess students. Most felt students should be assessed to ensure the subject was taken seriously. Some were concerned that assessment might encourage false attitudes. The second theme was uncertainty over the best methodology. Objective structured clinical examinations (OSCEs) were the most favoured method. Significant concern was expressed that this alone was sufficient. The third theme was concern that current assessment methods do not identify students with inappropriate attitudes that are potentially detrimental to patient care. Assessment of cultural awareness should be attempted but it needs to be multifaceted. The OSCE alone is inadequate. Other tools, such as reflective portfolios, need evaluation.
Stopper, Andrea; Raddatz, Agnieszka; Grassmann, Aileen; Stuard, Stefano; Menzer, Marcus; Possnien, Gernot; Scatizzi, Laura; Marcelli, Daniele
National healthcare systems worldwide face growing challenges to reconcile interests of patients for high-quality medical care and of payers for sustainable and affordable funding. Advances in the provision of renal replacement therapy can only be made by developing and implementing appropriate sophisticated and state-of-the-art business models that include reimbursement schemes for comprehensive care packages. Such business models must succeed in integrating and reconciling the interests of all stakeholders. NephroCare as dialysis provider has adopted and tailored recognized management techniques, i.e. Balanced Scorecard and Kaizen, to achieve these goals. Success of the complete business model package is tangible - strategies initiated to improve treatment quality even at the cost of providers have been translated into win-win scenarios for the complete stakeholder community. Room for improvement exists: the possibility to extend the portfolio of service offerings within the comprehensive care frame, as well as the challenge for achieving a balance between the stability of targets while keeping these up to date concerning new insights. Copyright © 2011 S. Karger AG, Basel.
Dunlop, William C N; Staufer, Alexandra; Levy, Pierre; Edwards, Guy J
Innovative pricing agreements for medicines have been used in European markets for more than 20 years, and offer an opportunity for payers and pharmaceutical companies to align on value, optimise speed to patients, and share risk. Developing successful agreements requires alignment between key stakeholders, yet there is a lack of summative data on how current innovative agreements are used in the real-world (e.g. the level of realised access to medicines, and rebates and discounts, which are often non-transparent). This research used a web-based survey of payer stakeholders to determine what kinds of innovative agreements are currently used, anticipated future usage, attitudes, and drivers of adoption. Participants included national and regional payers (or former payers) and hospital-level decision makers. Sixty-six payers completed the survey. Respondents expected that the use of innovative pricing agreements will remain the same or increase in the future. Overall, they felt there is a positive attitude towards new schemes, and that innovative agreements are likely to be used when they reduce total costs or reduce uncertainty. Given payer expectations, pharmaceutical companies should continue to take a role in ensuring that they have sufficient capacity to support payers in the design and implementation of innovative pricing agreements. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.
Full Text Available Abstract Background Mutations in OTOF gene, encoding otoferlin, cause DFNB9 deafness and non-syndromic auditory neuropathy (AN. The aim of this study is to identify OTOF mutations in Chinese patients with non-syndromic auditory neuropathy. Methods 73 unrelated Chinese Han patients with AN, including one case of temperature sensitive non-syndromic auditory neuropathy (TS-NSRAN and 92 ethnicity-matched controls with normal hearing were screened. Forty-five pairs of PCR primers were designed to amplify all of the exons and their flanking regions of the OTOF gene. The PCR products were sequenced and analyzed for mutation identification. Results Five novel possibly pathogenic variants (c.1740delC, c.2975_2978delAG, c.1194T>A, c.1780G>A, c.4819C > T were identified in the group of 73 AN patients, in which two novel mutant alleles (c.2975_2978delAG + c.4819C > T were identified in one Chinese TS-NSRAN case. Besides, 10 non-pathogenic variants of the OTOF gene were found in AN patients and controls. Conclusions Screening revealed that mutations in the OTOF gene account for AN in 4 of 73(5.5% sporadic AN patients, which shows a lower genetic load of that gene in contrast to the previous studies based on other populations. Notably, we found two novel mutant alleles related to temperature sensitive non-syndromic auditory neuropathy. This mutation screening study further confirms that the OTOF gene contributes to ANs and to TS-NSRAN.
Cullen, Anne E.; Coryn, Chris L. S.; Rugh, Jim
Participatory evaluation approaches have a relatively long history of advocacy and application in the international development evaluation community. Despite widespread use and apparent resonance with practitioners and donors alike, very little empirical research exists on why and how participatory evaluation approaches are used in international…
Murtagh, Madeleine J; Minion, Joel T; Turner, Andrew; Wilson, Rebecca C; Blell, Mwenza; Ochieng, Cynthia; Murtagh, Barnaby; Roberts, Stephanie; Butters, Oliver W; Burton, Paul R
Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes (as a patient or member of the public). Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others (the many 'publics' of engagement) brings them closer to the research but also brings the research closer to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. In practice, engagement faces numerous challenges and is often time-consuming, expensive and 'thorny' work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER (Employing COnceptUal schema for policy and Translation Engagement in Research) methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, "How could it be otherwise?" ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of 'keeping open' the possible considerations that might emerge and including reflexive use of qualitative analytic methods. This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to 'open up' engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER
Full Text Available The financial position of an economic entity is a concept that can have different meanings, depending on the stakeholder category that make its analysis. In energy sector, which is considered of high importance in the national economy, we consider that the most important category of stakeholder is the state (government, because ensuring the functionality of this sector is an crucial condition for development of others sectors from national economy. For this reason, we can look at the informational needs of other stakeholder categories trough the state’s “sine qua non” condition to ensure the optimal functionality of this sector, which manifests itself like this: the functioning of the sector involves the attraction of investors, the functioning of the sector involves the existence of human resources, the functioning of the sector cannot be ensured without the existence of commercial relations that involves suppliers and clients and for insuring the functioning of the sector it is often require various financing sources. All those aspects are giving raise to some categories of stakeholder interested over the parameters in which the energy sector entities are functioning, one of the interest domain being the financial position of the companies activating in its field. Over the present study we had in view to highlight the main present approaches regarding the concept of financial position, but also the main issues fallowed by the main stakeholder categories in their attempt to appreciate the financial position of the entities activating in energy sector which are listed to Bucharest Stock Exchange. The results of this study have showed that there is some base requirements regarding the informational needs of stakeholder regarding the financial position of the companies activating in energy sector, and those are related to the concepts of going concern, overall solvency ratio, general liquidity ratio and indebtedness degree. After this study
von Wallpach, Sylvia; Hemetsberger, Andrea; Kornum, Niels
The new “stakeholder-focus brand era” (Merz, He, & Vargo 2009, p.337) puts stakeholders and their role in brand co-creation center stage. Yet, insights into the dynamics of multi-stakeholder brand co-creation are still sparse. Applying a network theory approach, this article advances stakeholder......-oriented branding theory by investigating into discursive strategies multiple stakeholders use to engage in and mobilize brand networks on social media sites. An empirical investigation into two prominent online LEGO sites uncovers the role of social media sites as actors, and the interests and respective...... discursive strategies of stakeholders involved in co-creating the brand LEGO....
Ahring, Kirsten K; Lund, Allan M; Jensen, Erik; Jensen, Thomas G; Brøndum-Nielsen, Karen; Pedersen, Michael; Bardow, Allan; Holst, Jens Juul; Rehfeld, Jens F; Møller, Lisbeth B
Management of phenylketonuria (PKU) is achieved through low-phenylalanine (Phe) diet, supplemented with low-protein food and mixture of free-synthetic (FS) amino acid (AA). Casein glycomacropeptide (CGMP) is a natural peptide released in whey during cheese-making and does not contain Phe. Lacprodan® CGMP-20 used in this study contained a small amount of Phe due to minor presence of other proteins/peptides. The purpose of this study was to compare absorption of CGMP-20 to FSAA with the aim of evaluating short-term effects on plasma AAs as well as biomarkers related to food intake. This study included 8 patients, who had four visits and tested four drink mixtures (DM1-4), consisting of CGMP, FSAA, or a combination. Plasma blood samples were collected at baseline, 15, 30, 60, 120, and 240 minutes (min) after the meal. AA profiles and ghrelin were determined 6 times, while surrogate biomarkers were determined at baseline and 240 min. A visual analogue scale (VAS) was used for evaluation of taste and satiety. The surrogate biomarker concentrations and VAS scores for satiety and taste were nonsignificant between the four DMs, and there were only few significant results for AA profiles (not Phe). CGMP and FSAA had the overall same nonsignificant short-term effect on biomarkers, including Phe. This combination of FSAA and CGMP is a suitable supplement for PKU patients.
Kirsten K. Ahring
Full Text Available Introduction. Management of phenylketonuria (PKU is achieved through low-phenylalanine (Phe diet, supplemented with low-protein food and mixture of free-synthetic (FS amino acid (AA. Casein glycomacropeptide (CGMP is a natural peptide released in whey during cheese-making and does not contain Phe. Lacprodan® CGMP-20 used in this study contained a small amount of Phe due to minor presence of other proteins/peptides. Objective. The purpose of this study was to compare absorption of CGMP-20 to FSAA with the aim of evaluating short-term effects on plasma AAs as well as biomarkers related to food intake. Methods. This study included 8 patients, who had four visits and tested four drink mixtures (DM1–4, consisting of CGMP, FSAA, or a combination. Plasma blood samples were collected at baseline, 15, 30, 60, 120, and 240 minutes (min after the meal. AA profiles and ghrelin were determined 6 times, while surrogate biomarkers were determined at baseline and 240 min. A visual analogue scale (VAS was used for evaluation of taste and satiety. Results. The surrogate biomarker concentrations and VAS scores for satiety and taste were nonsignificant between the four DMs, and there were only few significant results for AA profiles (not Phe. Conclusion. CGMP and FSAA had the overall same nonsignificant short-term effect on biomarkers, including Phe. This combination of FSAA and CGMP is a suitable supplement for PKU patients.
Cornachione, Edgard B., Jr.; Trombetta, Maria R.; Casa Nova, Silvia P. C.
To what extent does the intense and direct involvement of internal stakeholders, such as program managers and staff members, play a significant role toward evaluation use? Stakeholder involvement is a key element in evaluation and evaluation use is considered within a broader sense that includes organizational knowledge, individual skills, and…
Tyszkiewicz, Bogumila; Labor, Bea
based on a proper understanding of the values and value functions of younger citizens. Such information must thus be an integral part of the knowledge base to be used when plans and processes are being developed for dismantling and decommissioning of nuclear power plants and other older nuclear facilities. In the present project, empirical data have been collected and compiled in a survey of the values of younger citizens with regard to decommissioning and dismantling of older nuclear facilities. The survey constitutes a stratified sample from three towns in Poland. They are Lublin, Olsztyn and Gdansk. A total of 780 students in the age group 14-19 years participated in the Survey. The results are compared to those from a similar study in the County of Kalmar in Sweden in the year 2006. The results include some major lesson learned. These may be summarised as follows: - Younger citizens tend to base their values regarding decommissioning on safety, and environmental aspects. Aspects like future economic growth and technological processes are less influential on the values. - Younger citizens tend to express a lack of information and debate as a basis of their value functions. Likewise, they tend to express interest in the topic and are open to become more included in the processes. - Younger citizens have suggestions on how more information can be made accessible to the general public. - Younger citizens need to be better included in the stakeholder process. This can be achieved by allowances from the Swedish Nuclear Waste Fund to support groups of younger citizens to follow the Swedish process of research, development and demonstration of a concept for the management of spent nuclear fuel. Less than fully accessible information campaigns about nuclear power and associated nuclear waste may result in differences in confidence levels between different groups of stakeholders. By finding out more about the values of different stakeholders it will be possible for the
Arabi, Yaseen M; Al-Dorzi, Hasan M; Alamry, Ahmed; Hijazi, Ra'ed; Alsolamy, Sami; Al Salamah, Majid; Tamim, Hani M; Al-Qahtani, Saad; Al-Dawood, Abdulaziz; Marini, Abdellatif M; Al Ehnidi, Fatimah H; Mundekkadan, Shihab; Matroud, Amal; Mohamed, Mohamed S; Taher, Saadi
Compliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department. This was a pre-post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011-September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012-March 03, 2013) and intervention phase II when SRT was added (March 04, 2013-October 30, 2013) in a 900-bed tertiary-care academic hospital. We recorded baseline characteristics and processes of care in adult patients presenting with sepsis or septic shock. The primary outcome measures were hospital mortality. Secondary outcomes were the need for mechanical ventilation and length of stay in the intensive unit and in the hospital. After implementing the multifaceted intervention including e-alert and SRT, cases were identified with less severe clinical and laboratory abnormalities and the processes of care improved. When adjusted to propensity score, the interventions were associated with reduction in hospital mortality [for intervention phase II compared to pre-intervention: adjusted odds ratio (aOR) 0.71, 95% CI 0.58-0.85, p = 0.003], reduction in the need for mechanical ventilation (aOR 0.45, 95% CI 0.37-0.55, p mechanical ventilation and reduction in hospital mortality and LOS.
Wisell, Kristin; Winblad, Ulrika; Sporrong, Sofia Kälvemark
BACKGROUND: Reforms in the health-care sector, including the pharmacy sector, can have different rationales. The Swedish pharmacies were prior to 2009 organized in a state-owned monopoly. In 2009, a liberalization of the ownership took place, in which a majority of the pharmacies were sold...... in the Swedish pharmacy sector, and also to compare the expectations with the perceived outcomes. METHODS: Semi-structured interviews were conducted with representatives from key stakeholder organizations; i.e., political, patient, and professional organizations. The analysis was performed in steps, and themes...... were developed in an inductive manner. RESULTS: One expectation among the political organization participants was that the ownership liberalization would create opportunities for ideas. The competition introduced in the market was supposed to lead to a more diversified pharmacy sector. After...
von Wallpach, Sylvia; Koll, Oliver
may show substantial overlap and divergence at the same time. When relating these stakeholders’ reputations to management-intended brand reputation, we find that some reputation elements have permeated to none, one or both groups, but also that the two stakeholder groups may agree about reputation...... elements which are not intended. We discuss how brand management can and why it should use such results in their brand-building efforts.......Marketing science and practice acknowledge that a brand’s reputation amongst consumers is essential for success. However, brand reputation may also affect other stakeholders’ exchange relationships with a brand. We discuss (1) the relevance of a multi-stakeholder approach to brand management, (2...
Kraeger, Patsy; Robichau, Robbie
Philanthropic organizations contribute to important work that solves complex problems to strengthen communities. Many of these organizations are moving toward engaging in public policy work, in addition to funding programs. This paper raises questions of legitimacy for foundations, as well as issues of transparency and accountability in a pluralistic democracy. Measures of civic health also inform how philanthropic organizations can be accountable to stakeholders. We propose a holistic model for philanthropic accountability that combines elements of transparency and performance accountability, as well as practices associated with the American pluralistic model for democratic accountability. We argue that philanthropic institutions should seek stakeholder and public input when shaping any public policy agenda. This paper suggests a new paradigm, called philanthropic accountability that can be used for legitimacy and democratic governance of private foundations engaged in policy work. The Philanthropic Accountability Model can be empirically tested and used as a governance tool.
This report presents evaluations, recommendations, and requirements concerning ResonantSonic Drilling (Sonic Drilling), derived from a three-year program of stakeholder involvement. Sonic Drilling is an innovative method to reach contamination in soil and groundwater. The resonant sonic drill rig uses counter-rotating weights to generate energy, which causes the drill pipe to vibrate elastically along its entire length. In the resonant condition, forces of up to 200,000 pounds are transmitted to the drill bit face to create a cutting action. The resonant energy causes subsurface materials to move back into the adjacent formation, permitting the drill pipe to advance. This report is for technology developers and those responsible for making decisions about the use of technology to remediate contamination by volatile organic compounds. Stakeholders' perspectives help those responsible for technology deployment to make good decisions concerning the acceptability and applicability of sonic drilling to the remediation problems they face
Chambwera, Muyeye; Zou, Ye; Boughlala, Mohamed
Across the developing world, decision makers understand the need to adapt to climate change — particularly in agriculture, which supports a large proportion of low-income groups who are especially vulnerable to impacts such as increasing water scarcity or more erratic weather. But policymakers are often less clear about what adaptation action to take. Cost-benefit analyses can provide information on the financial feasibility and economic efficiency of a given policy. But such methods fail to capture the non-monetary benefits of adaptation, which can be even more important than the monetary ones. Ongoing work in Morocco shows how combining cost-benefit analysis with a more participatory stakeholder analysis can support effective decision making by identifying cross-sector benefits, highlighting areas of mutual interest among different stakeholders and more effectively assessing impacts on adaptive capacity.
Gordon, Melissa; Lockwood, Michael; Vanclay, Frank; Hanson, Dallas; Schirmer, Jacki
Although the Australian forest plantation industry acknowledges that there is a role for corporate social responsibility (CSR) in forest management, there is confusion as to what this constitutes in practice. This paper describes the conflicts between internal and external stakeholder views on CSR in plantation forestry. We conducted in-depth interviews with key informants across three plantation management regions in Australia: Tasmania, the Green Triangle and south-west Western Australia. We interviewed a range of stakeholders including forest company employees, local councils, Indigenous representatives, and environmental non-government organisations. CSR-related initiatives that stakeholders believed were important for plantation management included the need for community engagement, accountability towards stakeholders, and contribution to community development and well-being. Although there was wide support for these initiatives, some stakeholders were not satisfied that forest companies were actively implementing them. Due to the perception that forest companies are not committed to CSR initiatives such as community engagement, some stakeholder expectations are not being satisfied. Copyright © 2012 Elsevier Ltd. All rights reserved.
Ferrero, I. (Ignacio); Hoffman, W. M. (W. Michael); McNulty, R. E. (Robert E.)
Milton Friedman famously stated that the only social responsibility of business is to increase its profits, a position now known as the shareholder model of business. Subsequently, the stakeholder model, associated with Edward Freeman, has been widely seen as a heuristically stronger theory of the responsibilities of the firm to the society in which it is situated. Friedman's position, nevertheless, has retained currency among many business thinkers. In this paper we argue that Friedman's eco...
Abuzeinab, Amal; Arif, Mohammed
PhD study This is an Open Access article and is freely available via the publisher's webpage. Follow the DOI link for full text. Green business models have the potential to deliver a much better performance compared to the conventional business models in this age of sustainability. Stakeholder engagement is considered one of the key elements to help facilitate an increased uptake of green business models. There is limited research available on principles and mechanisms to enhance stakeh...
Isaksson, Raine; Hallencreutz, Jacob; Turner, Dawn-Marie; Garvare, Rickard
With the ever increasing rate of change the pressure continues to rise on all types of organisations for quicker and more effective change. Companies of today face multiple requirements which have caused a shift from shareholder focus to a more balanced stakeholder focus. In the 80s and 90s the Japan originated quality movement with its focus on customers was by many seen as the solution for effective change. Change program focus has since shifted from Total Quality Management (TQM) and Busin...
Weaver, W.J.; Brownell, L.F.
The Secretary of Energy has defined the mission for the Department. Her vision for the Department of Energy (DOE) is to promote environmental excellence, economic growth, and leadership in science and technology. The Office of Environmental Restoration and Waste Management (EM), which is responsible for implementing an emergency management system for EM facilities and the transport of non-weapons-related radioactive materials, has addressed this mission through the establishment of six goals. This paper specifically discusses efforts to accomplish the last goal: Develop a stronger partnership between the DOE and its stakeholders. EM's Emergency Management Program supports strong partnerships with all interested parties. The EM Emergency Management Program provides the capability for preparedness in the event of an operational emergency at EM facilities, and it gives DOE the capability for preparedness in the event of an operational emergency involving DOE shipments of non-weapons-related radioactive and hazardous materials in transit. The Program is committed to plan, train, and provide material resources for the protection and safety of DOE workers, the public, and the environment. A great deal of stakeholder interaction is associated with the transport of DOE radioactive materials. To assure a communication link to other DOE program areas and interested stakeholders outside the DOE, the Emergency Management Program has committed extensive resources within the transportation program to promote and support EM's commitment to stakeholder involvement. The Transportation Emergency Preparedness Program (TEPP) develops and enhances integrated emergency preparedness in the area of transportation. TEPP coordinates programs across the DOE complex and supplies a DOE-wide unified approach to the public
Agaimy, Abbas; Märkl, Bruno; Kitz, Julia; Wünsch, Peter H; Arnholdt, Hans; Füzesi, Laszlo; Hartmann, Arndt; Chetty, Runjan
The frequency and morphological spectrum of gastrointestinal peripheral nerve sheath tumors (PNSTs) from consecutive case material has not been studied in the c-KIT era. We reviewed all mesenchymal gastrointestinal (GI) lesions at our departments according to current diagnostic criteria. PNSTs formed the third commonest group of mesenchymal GI tumors with a lower frequency (schwannomas (n = 22) were the most common types of PNSTs encountered. Rare tumors included neurofibromatosis 1 (NF1)-associated PNSTs (n = 5) and gastric perineurioma (n = 1). Thirteen schwannomas (including also some recent cases) were initially diagnosed as GIST, leiomyoma, or neurofibroma. Unusual histological variants included sigmoid GCT with prominent lipomatous component (n = 1), reticular-microcystic schwannoma of small (n = 1) and large (n = 1) bowel, NF1-associated gastric schwannoma (the first case to date), and psammomatous melanotic colonic schwannoma unrelated to Carney complex (n = 1). PNSTs coexisted with GIST in four patients (three had definite NF1). In conclusion, PNSTs of the GI tract are rare uniformly benign neoplasms that may show schwannian, perineurial, fibroblastic, or mixed differentiation. Most of them (92%) occurred sporadically unassociated with NF1 or NF2. Gastrointestinal PNSTs are still underrecognized by general pathologists. Awareness of their diverse morphology will help to avoid confusing them with smooth muscle neoplasms and GIST that they may closely mimic.
Full Text Available The study analyzes the state of coppice forestry in Bulgaria during last 18 years. Stakeholders and their interests and preferences in coppice forests are explored and assessed. Forests restitution process in Bulgaria started in 1997 and has not been finished yet. Nevertheless, significant further changes of the current ownershipdistribution are not expected. By the end of 2007, the state was the biggest coppice forest owner/stakeholder in Bulgaria with 71.3% of all coppice forests being state property. The other two important stakeholders are the municipalities (14.0% and private owners (12.0%. Currently, forest owners' number in Bulgaria exceeds 1million, the average holding area being smaller than 1 ha. Only 150 individual plots are larger than 50 ha. The majority of private owners aim at taking maximum and immediate profit from their recently restituted forest properties. In most cases that reflects in clearcuts. Coppice forests management has been one of the problematicissues of Bulgarian forestry for decades. Despite of forest authorities significant efforts, the area of coppice forests in Bulgaria (1.78 million ha in 2007 remained unchanged for a period of 50 years. The official forest policy is still aimed at conversionof coppice forests into seed ones through different silvicultural methods. That policy is applied to almost all coppice forests regardless of their ownership.
Full Text Available Qing-Tao Zhao,1 Yong Yang,2 Shun Xu,3 Xiao-Peng Zhang,1 Hui-En Wang,1 Hua Zhang,1 Zhi-Kang Wang,1 Zheng Yuan,1 Guo-Chen Duan11Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, 2Department of General Surgery, Sujiatun Central Hospital, 3Department of Thoracic Surgery, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, People’s Republic of ChinaBackground: Neutrophil to lymphocyte ratio (NLR has recently been reported to be a poor prognostic indicator in lung cancer. However, the prognostic value of the NLR in patients with lung cancer still remains controversial. We performed a meta-analysis to evaluate the prognostic value of NLR in patients with lung cancer.Methods: We performed a comprehensive literature search in PubMed, Ovid, the Cochrane Library, and Web of Science databa