Movatterモバイル変換

BackgroundDecisions about limitations of life sustaining treatments are made for end-of-life patients in intensive care units. The aim of this research was to explore the professional and ethical attitudes and experiences of medical professionals on treatment of end-of-life patients in ICUs in the Republic of Croatia.MethodsA cross-sectional study was conducted among physicians and nurses working in surgical, medical, neurological, and multidisciplinary ICUs in the total of 9 hospitals throughout Croatia using a questionnaire with closed and open type questions. Exploratory factor (...) analysis was conducted to reduce data to a smaller set of summary variables. Mann–Whitney U test was used to analyse the differences between two groups and Kruskal–Wallis tests were used to analyse the differences between more than two groups.ResultsLess than third of participants stated they were included in the decision-making process, and physicians are much more included than nurses. Sixty two percent of participants stated that the decision-making process took place between physicians. Eighteen percent of participants stated that ‘do-not-attempt cardiopulmonary resuscitations’ orders were frequently made in their ICUs. A decision to withdraw inotropes and antibiotics was frequently made as stated by 22.4% and 19.9% of participants, respectively. Withholding/withdrawing of LST were ethically acceptable to 64.2% of participants. Thirty seven percent of participants thought there was a significant difference between withholding and withdrawing LST from an ethical standpoint. Seventy-nine percent of participants stated that a verbal or written decision made by a capable patient should be respected. Physicians were more inclined to respect patient’s wishes then nurses with high school education. Nurses were more included in the decision-making process in neurological than in surgical, medical, or multidisciplinary ICUs. Male participants in comparison to female, and physicians in comparison to nurses with high school and college education displayed more liberal attitudes about LST limitation.ConclusionsDNACPR orders are not commonly made in Croatian ICUs, even though limitations of LST were found ethically acceptable by most of the participants. Attitudes of paternalistic and conservative nature were expected considering Croatia’s geographical location in Southern Europe. (shrink)

No categories

Direct download(3 more)   Export citation   Bookmark  

Healthcare professionals working in intensive care units are often involved in end-of-life decision-making. No research has been done so far about these processes taking place in Croatian ICUs. The aim of this study was to investigate the perceptions, experiences, and challenges healthcare professionals face when dealing with end-of-life decisions in ICUs in Croatia. A qualitative study was performed using professionally homogenous focus groups of ICU nurses and physicians of diverse professional and clinical backgrounds at three research sites. In total, six (...) institutions at the tertiary level of healthcare were included. The constant comparative analysis method was used in the analysis of the data. Differences were found between the perceptions and experiences of nurses and physicians in relation to end-of-life decisions. Nurses’ perceptions were more focused on the context and features of immediate care, while physicians’ perceptions also included the wider sociocultural context. However, the critical issues these specific professional groups face when dealing with end-of-life decisions seem to overlap. A high variability of practices, both between individual practitioners and between different organizational units, was omnipresent. The lack of adequate legal, professional, and clinical guidelines was commonly expressed as one of the most critical source of difficulties. (shrink)

Direct download(3 more)   Export citation   Bookmark   1 citation  

No categories

Export citation   Bookmark  

No categories

Direct download   Export citation   Bookmark  

No categories

Direct download(2 more)   Export citation   Bookmark  

No categories

Export citation   Bookmark  

When encountering a set of alternatives displayed in the form of a list, the decision maker usually determines a particular alternative, after which she stops checking the remaining ones, and chooses an alternative from those observed so far. We present a framework in which both decision problems are explicitly modeled, and axiomatically characterize a ‘divide-and-choose’ rule which unifies successive choice and satisficing choice.

Direct download(2 more)   Export citation   Bookmark  

Direct download(4 more)   Export citation   Bookmark   2 citations  

Protection motivation theory is a theoretical framework informative for understanding behavioral intentions and choices during exceptional and uncommon circumstances, such as a pandemic of respiratory infectious disease. PMT postulates both the threat appraisal and the coping appraisal as predictors of health behaviors. Recent advances in the field of behavioral immune system research suggest that humans are equipped with a set of psychological adaptations enabling them to detect the disease-threat and activate behavioral avoidance of pathogens. The present study, set within PMT (...) framework and informed by the BIS research, aimed to explain and predict voluntary adherence to COVID-19 guidelines by perceived personal risk and vulnerability to disease as threat appraisal variables, and trust in science as the response efficacy element of coping appraisal. Gender, age, belief in the second wave, perceived personal risk, germ aversion, and trust in science were all found to be significant positive predictors of the intent to adhere to non-pharmacological COVID-19 recommendations, with the belief in the second wave, germ aversion, and trust in science being the most important ones. On the other hand, only the belief in the second wave and trust in science were significant positive predictors of the intent to adhere to pharmacological COVID-19 recommendations. Interventions aimed at enhancing preventative measures adherence should take into account that the psychological mechanisms underlying adherence to these two types of recommendations are not identical. (shrink)

Direct download(2 more)   Export citation   Bookmark   1 citation  

Direct download   Export citation   Bookmark  

Optimal shelflisting invites profit maximization to become sensitive to the ways in which purchasing decisions are order-dependent. We study the computational complexity of the corresponding product arrangement problem when consumers are either rational maximizers, use a satisficing procedure, or apply successive choice. The complexity results we report are shown to crucially depend on the size of the top cycle in consumers’ preferences over products and on the direction in which alternatives on the shelf are encountered.

No categories

Direct download(2 more)   Export citation   Bookmark  

No categories

Direct download(2 more)   Export citation   Bookmark  

We present a unified look at myopic stability concepts for hedonic games, and discuss the status of the existence problems of stable coalition structures. In particular, we show that contractual strictly core stable coalition structures always exist, and present a sufficient condition for the existence of contractually Nash stable coalition structures on the class of separable games.

No categories

Direct download(3 more)   Export citation   Bookmark   3 citations  

This volume of Eurasian Studies in Business and Economics includes selected papers from the 24th Eurasia Business and Economics Society (EBES) Conference, held in Bangkok. The theoretical and empirical papers gathered here cover diverse areas of business and management from different geographic regions; yet the main focus is on the latest findings on evolving marketing methods, analytics, communication standards, and their effects on customer value and engagement. The volume also includes related studies that analyze sustainable consumer behavior, and business strategy-related (...) topics such as cross-border restructuring, quality management standards, and the internationalization of SMEs. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark