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American Journal of Diseases of... Oct 1975Medical ethics has increased in importance in medical education and practice as a consequence of advances in definitive treatment of patients. Most problems in ethics... (Review)
Review
Medical ethics has increased in importance in medical education and practice as a consequence of advances in definitive treatment of patients. Most problems in ethics related to medicine have certain common denominators. Medical scientists and practitioners frequently disclaim any ethical absolutes or consider as important only nonmoral consequences rather than ethical principles such as justice, noninjury, truth-telling, etc. Failure to differentiate moral from nonmoral decisions as well as differences in level of moral reasoning also account for substantial differences in analyzing a given clinical problem. Finally, individual moral policy may be rendered ineffective because of institutional policies that result from purely pragmatic considerations.
Topics: Attitude of Health Personnel; Bioethical Issues; Bioethics; Cost-Benefit Analysis; Decision Making; Ethical Analysis; Ethical Relativism; Ethical Theory; Ethics; Ethics, Institutional; Ethics, Medical; Hospitals; Human Development; Humans; Medicine; Moral Obligations; Morals; Pediatrics; Physicians; Social Responsibility
PubMed: 12085869
DOI: 10.1001/archpedi.1975.02120470013004 -
BMJ (Clinical Research Ed.) Jun 2011
Topics: Humans; Male; Prostatic Neoplasms
PubMed: 21672980
DOI: 10.1136/bmj.d3702 -
European Journal on Criminal Policy and... 2021This Special Issue is a collection of seven papers that seek to better our understanding of how urban mobility relates to crime patterns, and how day to day movement of...
This Special Issue is a collection of seven papers that seek to better our understanding of how urban mobility relates to crime patterns, and how day to day movement of people in urban spaces (urban mobility) is related to spatio-temporal patterns of crime. It focusses on urban mobility, or the dynamic movement of people in relation to crime risk. Moreover, it questions how to best measure this risk using an appropriate crime denominator. Building on the work of Sarah Boggs, this special issue contends that we need more than an appropriate denominator related to the type of crime we are measuring, for example violence based on the number of potential victims present (the exposed or ambient population), or the number of burglaries per households in an area, or the number of shoplifting offences per number of shops present. It argues that this denominator needs to be both 'crime type' appropriate, and to be spatially and temporally appropriate. When considering urban mobility as flows of people, the challenge is that the denominator can not be considered as a fixed or static concept, and that we need to consider the 'dynamic denominator' challenge. Indeed, crime hot spots which do not account for dynamic denominators may be misleading for resource prioritisation. This special issue explores a range of potential solutions to this including mobile/cell phone data, transportation data, land use data, and other possible measures to address this.
PubMed: 34803232
DOI: 10.1007/s10610-021-09501-7 -
American Journal of Industrial Medicine Feb 1998The U.S. government currently publishes workplace fatality rates, using employment as the denominator. However, employment may not be a good proxy for worker exposure to...
The U.S. government currently publishes workplace fatality rates, using employment as the denominator. However, employment may not be a good proxy for worker exposure to risk if groups of workers differ in their hours worked. Using micro data from the Census of Fatal Occupational Injuries and Current Population Survey, this paper presents alternative fatality rates calculated using employment and hours worked. Rates are compared for worker groups defined by gender, age, occupation, and industry. In general, both measures identify the same groups of workers as facing especially high and low fatality risks. The rank correlation of the employment- and hours-based fatality rates for 222 detailed occupations is very high, with a value of 0.99. However, for a few groups, the hours- and employment-based rates may differ more than 10%. Most notably, workers below age 20 and above age 64 have rates that are 60% and 37% higher, respectively, when hours is used in the denominator. This suggests that hours--the conceptually preferable denominator--should be used when possible to calculate workplace fatality rates.
Topics: Accidents, Occupational; Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Models, Statistical; Risk Assessment; Time Factors; United States; Workplace
PubMed: 9438047
DOI: 10.1002/(sici)1097-0274(199802)33:2<151::aid-ajim6>3.0.co;2-0 -
Cognition May 2015This study examines how numeracy and probability denominator (a direct-ratio probability, a relative frequency with denominator 100, a relative frequency with...
This study examines how numeracy and probability denominator (a direct-ratio probability, a relative frequency with denominator 100, a relative frequency with denominator 10,000) affect the evaluation of prospects in an expected-value based pricing task. We expected that numeracy would affect the results due to differences in the linearity of number perception and the susceptibility to denominator neglect with different probability formats. An analysis with functional measurement verified that participants integrated value and probability into an expected value. However, a significant interaction between numeracy and probability format and subsequent analyses of the parameters of cumulative prospect theory showed that the manipulation of probability denominator changed participants' psychophysical response to probability and value. Standard methods in decision research may thus confound people's genuine risk attitude with their numerical capacities and the probability format used.
Topics: Adolescent; Adult; Aged; Cognition; Decision Making; Female; Humans; Male; Middle Aged; Probability; Psychological Theory; Young Adult
PubMed: 25704578
DOI: 10.1016/j.cognition.2015.01.014 -
Current Opinion in Dentistry Oct 1991Risk management continues to define itself as an integral element in quality dental care. Issues reviewed range from periodontal record keeping to assessment of... (Review)
Review
Risk management continues to define itself as an integral element in quality dental care. Issues reviewed range from periodontal record keeping to assessment of temporomandibular joint dysfunction and from cosmetic patients to after-hours emergency care. Two common denominators emerge throughout the articles reviewed. First, thorough and accurate documentation of all phases of patient contact and treatment remains at the heart of risk management. Communication, as a system of relationships between physician, staff, and patients, ensures understanding and agreement toward a common goal. Risk management remains a unifying principle that joins legal responsibilities with sound clinical practice.
Topics: Dental Records; Humans; Informed Consent; Practice Management, Dental; Risk Management
PubMed: 1807467
DOI: No ID Found -
Health Promotion and Chronic Disease... Oct 2016Chronic disease rates are produced from the Public Health Agency of Canada's Canadian Chronic Disease Surveillance System (CCDSS) using administrative health data from...
INTRODUCTION
Chronic disease rates are produced from the Public Health Agency of Canada's Canadian Chronic Disease Surveillance System (CCDSS) using administrative health data from provincial/territorial health ministries. Denominators for these rates are based on estimates of populations derived from health insurance files. However, these data may not be accessible to all researchers. Another source for population size estimates is the Statistics Canada census. The purpose of our study was to calculate the major differences between the CCDSS and Statistics Canada's population denominators and to identify the sources or reasons for the potential differences between these data sources.
METHODS
We compared the 2009 denominators from the CCDSS and Statistics Canada. The CCDSS denominator was adjusted for the growth components (births, deaths, emigration and immigration) from Statistics Canada's census data.
RESULTS
The unadjusted CCDSS denominator was 34 429 804, 3.2% higher than Statistics Canada's estimate of population in 2009. After the CCDSS denominator was adjusted for the growth components, the difference between the two estimates was reduced to 431 323 people, a difference of 1.3%. The CCDSS overestimates the population relative to Statistics Canada overall. The largest difference between the two estimates was from the migrant growth component, while the smallest was from the emigrant component.
CONCLUSION
By using data descriptions by data source, researchers can make decisions about which population to use in their calculations of disease frequency.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Canada; Cause of Death; Censuses; Child; Child, Preschool; Chronic Disease; Databases, Factual; Diabetes Mellitus; Humans; Incidence; Infant; Infant, Newborn; Insurance, Health; Middle Aged; Population; Prevalence; Young Adult
PubMed: 27768559
DOI: 10.24095/hpcdp.36.10.03 -
Hepatobiliary Surgery and Nutrition Apr 2023
PubMed: 37124701
DOI: 10.21037/hbsn-23-47 -
BMC Pregnancy and Childbirth Mar 2021Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in... (Observational Study)
Observational Study
BACKGROUND
Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage.
METHODS
The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017-2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation.
RESULTS
Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5-40.8%, specificity 66.8-99.5%), BMV accuracy was higher (sensitivity 12.4-48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure.
CONCLUSIONS
Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies.
Topics: Adolescent; Adult; Bangladesh; Data Accuracy; Female; Humans; Infant, Newborn; Live Birth; Male; Masks; Nepal; Perinatal Death; Positive-Pressure Respiration; Pregnancy; Registries; Resuscitation; Stillbirth; Surveys and Questionnaires; Tanzania; Young Adult
PubMed: 33765958
DOI: 10.1186/s12884-020-03422-9 -
TheScientificWorldJournal 2012Recent research has shown that patients frequently experience difficulties understanding health-relevant numerical concepts. A prominent example is denominator neglect,... (Review)
Review
Recent research has shown that patients frequently experience difficulties understanding health-relevant numerical concepts. A prominent example is denominator neglect, or the tendency to pay too much attention to numerators in ratios (e.g., number of treated patients who died) with insufficient attention to denominators (e.g., overall number of treated patients). Denominator neglect can lead to inaccurate assessments of treatment risk reduction and thus can have important consequences for decisions about health. Here, we reviewed a series of studies investigating (1) different factors that can influence patients' susceptibility to denominator neglect in medical decision making--including numerical or language-related abilities; (2) the extent to which denominator neglect can be attenuated by using visual aids; and (3) a factor that moderates the effectiveness of such aids (i.e., graph literacy). The review spans probabilistic national U.S. and German samples, as well as immigrant (i.e., Polish people living in the United Kingdom) and undergraduate samples in Spain. Theoretical and prescriptive implications are discussed.
Topics: Audiovisual Aids; Communication; Decision Support Techniques; Germany; Informed Consent; Patient Education as Topic; Patient Participation; Risk Assessment
PubMed: 22629146
DOI: 10.1100/2012/562637