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2.
J Environ Manage ; 254: 109721, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31726283

RESUMO

Responsible sourcing refers to the compliance of suppliers with environmental and social standards. In today's supply chains, buyers and external stakeholders use auditing mechanisms to induce responsible sourcing. For the first time, this paper investigates the effect of a buyer's audits on the tactical decisions of supply chains. We address a repeated game with one buyer and one critical supplier. At the strategic stage, the buyer chooses the optimal auditing efforts to induce responsible sourcing. At the tactical stages, the buyer and supplier compete with each other for their profit margins, while the buyer also determines the quantity of production. Moreover, the supplier chooses between responsible and irresponsible production. Two auditing mechanisms are defined for the buyer: strong incentive compatibility (SIC) and weak incentive compatibility (WIC). The effectiveness and backfiring conditions for these auditing mechanisms are identified. The former denotes that the mechanism can induce responsible sourcing, while the latter denotes the conflict between supply chain transparency and responsible sourcing. The results show that the supplier requires an efficiency wage for compliance with responsible sourcing standards. We find that auditing mechanisms in supply chains face an unintended consequence. Higher auditing efforts by the buyer reduce the supplier's wholesale price. This reduction may offset the greater potential for discovery obtained by higher auditing efforts. We also show that the effect of consumer awareness on responsible sourcing is not straightforward and depends strongly on the buyer's auditing mechanism. If the buyer chooses the SIC (WIC) auditing mechanism, consumer awareness always favors (threatens) responsible sourcing. Finally, this research suggests that coordination between buyers and external stakeholders contributes greatly to responsible sourcing.


Assuntos
Comércio , Políticas , Tomada de Decisões
3.
J Environ Manage ; 254: 109820, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31733471

RESUMO

Co-management is widely seen as a way of improving environmental governance and empowering communities. When successful, co-management enhances the validity and legitimacy of decision-making, while providing stakeholders with influence over processes and outcomes that directly impact them. However, our research with participants in co-management across several cases leads us to argue that many of the individuals who contribute to co-management are subject to significant personal stress arising from both the logistical and social/emotional demands of participation in these processes. We argue that the literature on co-management has touched on this only indirectly, and that personal stress is a major challenge for participants that ought to be integrated into research agendas and addressed by policy-makers. In this article, we review the contours of the personal stress issue as it has appeared in our observations of co-management events and interviews with participants. While these findings are partial and preliminary, we argue that personal stress has theoretical and practical significance to the broader literature and process design. We conclude the article with recommendations for participants, researchers and policy-makers about how to consider and respond to problems of personal stress.


Assuntos
Conservação dos Recursos Naturais , Política Ambiental , Tomada de Decisões , Humanos , Encaminhamento e Consulta
4.
Sports Biomech ; 19(1): 76-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29902127

RESUMO

A potential challenge associated with sports is that athletes must often perform the cognitive processing associated with decision-making (i.e., movement selection) when fatigued. The purpose of this systematic review was to summarise studies that have analysed the extent to which fatigue influences the effects of decision-making on lower extremity mechanics during execution of common sports manoeuvres. We specifically focused on mechanics associated with ACL injury risk. Reviewers searched the PubMed, SPORTDiscus, CINAHL and Web of Science databases. The search identified 183 unique articles. Five of these articles met our eligibility criteria. Two of the studies incorporated fatigue protocols where athletes progressed to exhaustion and found that the effects of decision-making on mechanics were more pronounced with fatigue. The nature of the results appears to indicate that fatigue may compromise an athlete's cognitive processing in a manner that diminishes their ability to control movement when rapid decision-making is required. However, three subsequent studies utilised fatigue protocols designed to mimic sports participation and found that fatigue did not influence the effects of decision-making on mechanics. In general, these findings appear to indicate that fatigue may only affect the cognitive processing associated with decision-making when athletes approach a state of exhaustion.


Assuntos
Atletas/psicologia , Tomada de Decisões , Fadiga/psicologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Antecipação Psicológica , Traumatismos em Atletas/fisiopatologia , Humanos , Extremidade Inferior/fisiologia , Movimento/fisiologia , Fadiga Muscular/fisiologia , Fatores de Risco
5.
J Urol ; 203(1): 159-163, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31441673

RESUMO

PURPOSE: Patients who undergo cystectomy due to bladder cancer can elect an ileal conduit or a neobladder for urinary diversion. Decision regret related to this choice is an important and undesirable patient reported outcome. Our objective was to compare the severity of decision regret experienced by patients with a neobladder vs an ileal conduit. MATERIALS AND METHODS: We analyzed data from a longitudinal cohort study of patients who underwent cystectomy from 2013 to 2015. We applied multivariable linear regression to examine associations of the urinary diversion method (neobladder vs ileal conduit) with decision regret measured with the DRS (Decision Regret Scale) 6 and 18 months after cystectomy. Covariates included demographic and clinical characteristics, health care utilization and complications after cystectomy, quality of life and factors related to the decision making process, including informed and shared decision making, and goal concordance. RESULTS: Of the 192 patients in our cohort 141 received an ileal conduit and 51 received a neobladder. We observed no significant difference in the DRS score in patients with a neobladder vs an ileal conduit at 6 or 18 months (b=-1.28, 95% CI -9.07-6.53, vs b=-1.55, 95% CI -12.48-9.38). However, informed decision making was negatively related to decision regret at 6 and 18 months (b=-13.08, 95% CI -17.05--9.11, and b=-8.54, 95% CI -4.26--2.63, respectively). Quality of life was negatively associated with decision regret at 18 months (b=-5.50, 95% CI -8.95--2.03). CONCLUSIONS: Patients treated with cystectomy who were more informed about bladder reconstruction options experienced less regret independent of the method selected. Efforts to inform and prepare patients for the bladder reconstruction decision may help prevent decision regret.


Assuntos
Cistectomia , Tomada de Decisões , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Qualidade de Vida , Neoplasias da Bexiga Urinária/patologia
6.
Einstein (Sao Paulo) ; 18: eRW4852, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618287

RESUMO

The objective of this study was to identify the variables that influence physicians to implement Advance Directives and assess their impact on end-of-life care. It is a narrative literature review of 25 articles published between 1997 and 2018, in the following databases: CAPES, EBSCOhost, BDTD, VHL, Google Scholar, MEDLINE®/PubMed. The keywords utilized were: "advance directives", "living wills", "physicians", "attitude", "decision making", "advance care planning". The main factors that influenced physicians to implemente the directives were patients prognosis, medical paternalism, and patients understanding of their medical condition. Respect for autonomy, lack of knowledge and experience with directives, legal concerns, family influence, cultural and religious factors also contributed to medical decision. Most studies (86%) showed that having a directive led to lower rates of invasive interventions in the last days of patient´s life. Physicians were interested in respecting their patients' autonomy and agreed that having an advance directive helped in the decision-making process; however, they stated other factors were also taken into account, mainly prognosis and reversibility conditions. Having directives contributed to reducing the use of life support therapies and adoption of comfort measures.


Assuntos
Adesão a Diretivas Antecipadas/psicologia , Médicos/psicologia , Assistência Terminal , Diretivas Antecipadas , Atitude do Pessoal de Saúde , Tomada de Decisões , Humanos , Paternalismo , Autonomia Pessoal
7.
Nurs Educ Perspect ; 41(1): 59-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31860493

RESUMO

Creating simulation-based learning experiences is a process. With tools such as the 2016 INACSL Standards of Best Practice: Simulation Simulation Design and theories to guide development, nurse faculty have the opportunity to create rich simulation-based learning experiences that promote student learning. The purpose of this article is to describe an innovative simulation-based experience that applies simulation design criteria in a non-manikin experience. Using a ShadowBox approach, novice nursing students were exposed to expert decision-making in a simulated environment. We describe this approach and how the simulation design criteria are applied.


Assuntos
Bacharelado em Enfermagem , Treinamento por Simulação , Estudantes de Enfermagem , Tomada de Decisões , Humanos , Aprendizagem
8.
Ned Tijdschr Tandheelkd ; 126(12): 687-695, 2019 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-31840681

RESUMO

Vurnerable older people often need intensive preventive and curative oral health care. However, their physical and cognitive decline does not always allow for lege artis implementation of dental treatments. This causes practical problems often with related moral issues. Including these moral issues in planning and implementation will make oral healthcare more effective and will also alleviate moral pressure on oral healthcare providers. Mostly the moral issues relate to every day ethics, which can be solved by all persons involved collectively, in open consultation and with an ethics of care approach. This means aiming at 'doing the right thing in the right way', including all the relevant aspects of the person of the patient and his/her environment. To achieve this, oral health care should be embedded in the overall care process for the elderly and care providers should feel involved with the older person and have reflective skills.


Assuntos
Tomada de Decisões , Idoso Fragilizado , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica , Feminino , Humanos , Masculino , Princípios Morais , Saúde Bucal
9.
Br Dent J ; 227(11): 967-974, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31844224

RESUMO

This paper is the final in a four-part series outlining treatment planning at periodontal reassessment. The first article (part 1) focused on the information that should be gathered at the reassessment appointment. Parts 2 and 3 discussed systemic and local factors that can relate to residual periodontal probing depths. Treatment can involve a range of non-surgical and surgical approaches. A variety of general, practical and local site factors can affect the choice of one option over another in choosing the most predictable treatment option. Decision-making can be challenging and this paper aims to aid this process by discussing the assessment of prognosis, factors that need to be considered in decision-making and treatment options available. A flow chart to summarise this process is presented.


Assuntos
Periodontite , Tomada de Decisões , Humanos , Planejamento de Assistência ao Paciente , Bolsa Periodontal , Prognóstico
10.
J Water Health ; 17(6): 896-909, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31850897

RESUMO

Sanitation planners make complex decisions in the delivery of sanitation services to achieve health outcomes. We present findings from a stakeholder engagement workshop held in Kampala, Uganda, to educate, interact with, and solicit feedback from participants on how the relevant scientific literature on pathogens can be made more accessible to practitioners to support decision-making. We targeted Water, Sanitation and Hygiene (WASH) practitioners involved in different levels of service delivery. Practitioners revealed that different sanitation planning tools are used to inform decision-making; however, most of these tools are not user-friendly or adapted to meet their needs. Most stakeholders (68%) expressed familiarity with pathogens, yet less than half (46%) understood that fecal coliforms were bacteria and used as indicators for fecal pollution. A number of stakeholders were unaware that fecal indicator bacteria do not behave and persist the same as helminths, protozoa, or viruses, making fecal indicator bacteria inadequate for assessing pathogen reductions for all pathogen groups. This suggests a need for awareness and capacity development around pathogens found in excreta. The findings underscore the importance to engage stakeholders in the development of support tools for sanitation planning and highlighted broader opportunities to bridge science with practice in the WASH sector.


Assuntos
Tomada de Decisões , Higiene , Saneamento/normas , Microbiologia da Água , Qualidade da Água/normas , Abastecimento de Água/normas , Animais , Conhecimentos, Atitudes e Prática em Saúde , Uganda , Água
11.
J Clin Ethics ; 30(4): 331-337, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851624

RESUMO

Situations in which patients lack medical decision-making (MDM) capacity raise ethical challenges, especially when the patients decline care that their surrogate decision makers and/or clinicians agree is indicated. These patients are a vulnerable population and should receive treatment that is the standard of care, in line with their the values of their authentic self, just as any other patient would. But forcing treatment on patients who refuse it, even though they lack capacity, carries medical and psychological risks to the patients and the hospital staff. It is also often impractical to force some treatments, especially in the long term. For example, independent of the ethical "should" question, how would one force hemodialysis for the rest of a patient's life, or force a surgery that requires weeks of post-operative physical therapy? In this article we present a novel algorithm that can help clinicians with ethical and practical decision making, with the goals of achieving the best outcomes for patients and reducing moral distress for their caretakers and clinicians.


Assuntos
Tomada de Decisão Clínica/ética , Tomada de Decisões , Ética Clínica , Recusa do Paciente ao Tratamento , Humanos , Competência Mental , Participação do Paciente , Diálise Renal , Recusa do Paciente ao Tratamento/ética
12.
J Opioid Manag ; 15(6): 479-485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850509

RESUMO

INTRODUCTION: In response to the US opioid epidemic, the Centers for Disease Control and Prevention issued a guideline (CDCG) for prescribing opioids for chronic pain. Successful implementation of the CDCG requires identification of the information, skills, and support physicians need to carry out its recommendations. However, such data are currently lacking. METHODS: The authors performed one-on-one interviews with nine practicing physicians regarding their needs and perspectives for successful CDCG implementation, including the perceived barriers, focusing on communication strategies. Interviews were audio recorded, transcribed, and a thematic qualitative analysis was performed. FINDINGS: Three major themes were identified: communication, knowledge, and information technology (IT). Physicians reported that open communication with patients about opioids was difficult and burdensome, but essential; they shared their communication strategies. Knowledge gaps included patient-specific topics (eg, availability of/insurance coverage for non-opioid treatments) and more general areas (eg, opioid dosing/equivalencies, prescribing naloxone). Finally, physicians discussed the importance of innovation in IT, focusing on the electronic medical record for decision support and to allow safer opioid prescribing within the time constraints of clinical practice. DISCUSSION: These qualitative data document practical issues that should be considered in the development of implementation plans for safer opioid prescribing practices. Specifically, healthcare systems may need to provide opioid-relevant communication strategies and training, education on key topics such as naloxone prescribing, resources for referrals to appropriate nonpharmacologic treatments, and innovative IT solutions. Future research is needed to establish that such measures will be effective in producing better outcomes for patients on opioids for chronic pain.


Assuntos
Analgésicos Opioides , Comunicação , Registros Eletrônicos de Saúde , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Tomada de Decisões , Humanos , Naloxona , Médicos , Pesquisa Qualitativa
14.
J Law Med ; 27(1): 164-177, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682348

RESUMO

A doctor may make a unilateral decision to withdraw or withhold life-sustaining treatment from a patient. Recent cases involving critically ill children in Australia, England and Wales have demonstrated how doctors may determine a child's life is not worth maintaining despite parental demands for treatment. The breadth of a doctor's discretion to not provide treatment is ambiguous though, and the extent to which a doctor may make unilateral quality of life judgments is not clear. The ambiguity arises because of different framing of a doctor's obligations, a lack of clear role delineation between relevant decision-makers and differences in opinion about the appropriate scope of inquiry when applying concepts like "futility" and "best interests". This ambiguity is likely to cause confusion in practice and may be the difference between a child receiving life-sustaining treatment.


Assuntos
Qualidade de Vida , Suspensão de Tratamento , Austrália , Criança , Tomada de Decisões , Inglaterra , Humanos , País de Gales
15.
J Law Med ; 27(1): 192-210, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682350

RESUMO

Courts in England and Wales, Australia, and New Zealand have insisted the question of when it is acceptable to withdraw or withhold life-sustaining medical treatment from a child must be considered on a case-by-case basis. Over the last 40 years a number of cases have considered whether treatment is objectively in the child's best interests. This article seeks to identify whether there are factors identified and weighed in a consistent manner across cases. Thirty cases involving decisions about the provision of life-sustaining medical treatment to children three years old or younger were identified. Judges regularly refer to the need to weigh benefits and burdens and these factors were identified and assigned scores. Eight key factors were identified, and a scoring range was assigned to each. The factors focus on the condition and position of the child and the burdens of invasive medical treatment. The review demonstrates there are factors consistently identified and despite criticisms of the indeterminacy of the best interests test, there may be a broadly consistent approach to decision-making. Cognitive capacity and unavoidably imminent death appear to be the two most influential factors in determining whether life-sustaining treatment should be provided.


Assuntos
Tomada de Decisões , Suspensão de Tratamento , Austrália , Criança , Pré-Escolar , Inglaterra , Humanos , Nova Zelândia , País de Gales
16.
J Law Med ; 26(4): 874-895, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682365

RESUMO

Internationally, profoundly disabled children have received growth attenuation treatment to allow their parents to continue to care for them as they mature into adulthood. This article considers how the Family Court of Australia might approach this topic. It assumes that parents wishing to attenuate the linear growth of their child require an order from the Family Court under its welfare jurisdiction. This assumption is made because of the parents' conflict of interests; the treatment's irreversible nature; and the fact that it is sought for non-Gillick competent children. This article highlights the view that there are concerns about how the Court, given its adversarial nature and current approach to medical decisions, will determine whether this treatment is in a child's best interests. It concludes that a federally funded interdisciplinary administrative panel is better positioned to assess and decide each application on a case-by-case basis.


Assuntos
Crianças com Deficiência , Seguridade Social/legislação & jurisprudência , Adulto , Austrália , Criança , Tomada de Decisões , Humanos , Pais
17.
J Law Med ; 26(4): 896-921, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682366

RESUMO

This article examines the evolution of advance care planning (ACP) in Singapore through the development of a less-formal, communications-based model - the Living Matters program - and its experience with local cultural and community responses to the process and its outcomes. Living Matters is, in practice, arguably a communitarian approach to ACP. The article then examines the challenges Living Matters poses to the overarching legal framework for ACP and suggests improvements to the proxy decision-making framework under the Mental Capacity Act (Singapore, cap 177A, 2010 rev ed), offering more flexible legal tools for ACP, and more regulatory support for the means to implement ACP outcomes effectively.


Assuntos
Planejamento Antecipado de Cuidados , Diretivas Antecipadas , Tomada de Decisões , Humanos , Procurador , Singapura
18.
J Law Med ; 26(4): 943-948, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682368

RESUMO

New Zealand courts are increasingly finding people unfit to stand trial. It is therefore important that the topic is carefully explored. For instance, should an assessment of fitness to stand trial include an assessment of a person's ability to make autonomous decisions about how to conduct their defence? This ability is referred to as "decisional competence". A pivotal case on this issue is Solicitor-General v Dougherty [2012] NZCA 405. In this case, the Court of Appeal decided that an assessment of decisional competence should not be part of an assessment of fitness to stand trial, but in doing so, appeared to misunderstand the concept. This article aims to discuss a correct understanding of decisional competence, in particular by contrasting it with the notion of "acting in one's best interests". This will aid further discussion on this important and relevant issue.


Assuntos
Tomada de Decisões , Competência Mental , Nova Zelândia
19.
Pan Afr Med J ; 33: 289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692808

RESUMO

Introduction: This study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest. Methods: We conducted a prospective, observational study in pre hospital emergency services. We included adults' patients, with a suspicion of non-traumatic cardiac arrest (CA) in an out of hospital environment, who received or not cardiopulmonary resuscitation (CPR) by our mobile emergency medical service teams. An analytic study was conducted in order to identify independent factors that could influence the decision to resuscitate OHCA. Results: During study, 228 patients were enrolled, the mean age was 64 +/- 14 years and 59% were men. Eighteen patients (8%) received bystander CPR by witnesses. The median time elapsed to arrive at the scene was 13 [8-25] min. The median "noflow" was 22 [10-34] min. The resuscitation decision was taken by the mobile EMS staff for 106 patients (46.5%). For other patients, the decision not to resuscitate was motivated solely by the finding of a confirmed state of death in an elderly patient (p = 0.045). The predictive decision factor for resuscitation was the no flow time less than 18.5 min, Odds Ratio adjusted with 95% confidence interval to: 1.38 (1.24 - 3.55) (p <0.001). Overall out of hospital survival rate was 17% of resuscitated patients. Conclusion: The decision to resuscitate a cardiac arrest outside of the hospital depends more on the "no flow" time than on the presumed etiologies.


Assuntos
Reanimação Cardiopulmonar/métodos , Tomada de Decisões , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo
20.
Nurs Res ; 68(6): E8-E12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693558

RESUMO

BACKGROUND: Scarce and differing reasons for including closing questions in qualitative research exist, but how data generated from these questions are used remains uncertain. OBJECTIVES: The purpose of the study was to understand if and how researchers use closing questions in qualitative research, specifically the research questions were: (a) "Why do qualitative researchers include or exclude closing questions during interviews?" and (b) "How do qualitative researchers use data from closing questions?" METHODS: A qualitative descriptive design using a single, asynchronous, web-based, investigator-designed survey containing 14 items was used to collect data. Convenience and snowball sampling were used to recruit participants. Data were analyzed using descriptive statistics and qualitative content analysis. Codes were developed from the qualitative data. Subcategories were derived from similar codes, and these subcategories were further scrutinized and were used to create broad categories. RESULTS: The number of respondents per question ranged from 76 to 99; most identified nursing and sociology as their academic disciplines, lived in the United States, and were involved in qualitative research for 1-10 years. Data, the interview, the interviewee, and the interviewer were broad categories to emerge as reasons for including closing questions. Only one respondent reported a reason for excluding closing questions. The uses of closing question data were described in four broad categories: analysis, data, the interview guide, and inquiry. DISCUSSION: Researchers frequently included closing questions in qualitative studies. The reasons for including these questions and how data are used vary, and support limited previously published literature. One unique reason, adding "new breath" to the interview, emerged. Study findings can aid qualitative researchers in deciding whether to include closing questions.


Assuntos
Internet , Entrevistas como Assunto , Pesquisa Qualitativa , Inquéritos e Questionários , Tomada de Decisões , Humanos
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