Palliative Healthcare: Cost Reduction and Quality Enhancement Using End-of-Life Survey Methodology

ABSTRACT

American medical institutions throughout the 20th century prescribed high customer satisfaction, but when it came to death, largely ignored it. An accelerated accumulation of esoteric medical information and the application of this knowledge to affect new cures and longer lives instilled an unquestioning reverence for the medical community among the patient population. Diminishing marginal gains in life expectancy, escalating costs related to life sustaining technologies, and a psychographic shift in the dominant consumer base have challenged this traditional reverence. Armed with unprecedented access to medical information, a more knowledgeable and assertive patient population has emerged in the 21st century to institute its own standards of what constitutes quality health care. In terms of end of life care, this has meant recognition that the emotional needs of the dying have been largely underserved by the current American medical model. Patients and their families are no longer willing to accept the traditional medical perspective of death as failure and have numerous international palliative care models that serve as benchmarks of success when it comes to quality of dying. When cure is a possibility, Americans will pursue it at all costs, but when it is not a possibility, they want honest communication and the opportunity to say good-bye to their loved ones. In the context of these emergent needs, life review is offered as a solution. The value proposition targets not only dying patients and their families, but also society as a whole.     

Regulatory Problems of Commercial Banks in the Context of the European Sovereign Crisis

This study aims to find whether regulatory measurement of banking risks proposed by the Basel Committee provide a framework that allows an adequate reflection of these risks in banks’ capital requirements. The analysis is carried through the prism of financial crisis that started in 2007 and current sovereign crisis in some European countries. In the study we investigated the problems attached to Standardized Approach and risk measurement of a financial instrument based on the rating of issuer. As a result we revealed contradiction in the current regulation, according to which risk free assets provide a better return than riskier assets. We found evidences of the gaps attached to Standardized Approach, which in current sovereign crisis can become problematic not only for commercial banks, but also for the issuers of financial instruments in which commercial banks have investments. Finally, we offered a different method of risk measurement that, we argue, provides a better measurement of banking risks as such.     

What the Other Half Thinks: the Implications of Female Perceptions for Work Demands*

Three hundred fifty-three registered nurses were asked their perceptions of the economic need for continued employment, the “threat” to the husband if her salary was greater than his, and the husband's view of the need for his wife's employment. Most did not feel their husbands would be threatened if their wives had a greater income. Respondents generally saw a greater economic need than they felt their husbands did. A comparison is made between the perceptions of our sample and what other research indicated are the perceptions of men.     

Exploring attitudes toward older workers among Australian employers: an empirical study

Research suggests that negative stereotyping is at the heart of age discrimination in not hiring older workers. As the aging of the population creates pressures to maintain older adults in the work force, it is important to gain knowledge of such stereotyping. A random sample of 128 hiring decision-makers across Australian industries responded to a questionnaire that was specifically developed to assess attitudes toward older workers. Results showed systematic negative stereotyping: Respondents indicated that they were unlikely to hire older workers. The likelihood of hiring significantly correlated with employers' attitudes. Specific attributes for which older workers were seen as inferior compared to younger workers included trainability, adaptability, creativity, and interest in new technology. The findings could inform policymakers and be utilized to develop interventions aimed to reduce hiring discrimination.     

Quality of Life in Older Adults: Benefits from Caring Services in Hong Kong

Many older adults are in need of care. Therefore, older people would generally benefit from the use of caring services, notably including home care, residential care, nursing, and medical services. The contributory factors underlying caring services tend to be a caring perspective that aspires to sustain older people’s social relationships and real-life involvement. To gauge the benefits from various social and health services, the present study relies on a large-scale survey of 3000 older adults in Hong Kong, using quality of life as a criterion. Results showed that an older adult who had used (ordinary or enhanced) home care services for a longer time turned out to have appreciably more improvement in quality of life. Besides, those who joined an interest group more frequently were higher in quality of life, including the health domain. On the other hand, frequent use of medical and meal-to-home services were signals that reflected problems detrimental to the older user’s quality of life. Despite this, the quality of clinics or hospitals, as perceived by the older adult, was the most beneficial. As such, caring services that foster older adults’ interests, cater to their health care needs, and embody quality can have principal contribution to their users’ quality of life.     

Do multiple outcomes and conditional factors improve prediction of batterer reassault?

Researchers and practitioners recognize the need to develop better prediction of abuse and reassault among men referred to batterer programs. Previous approaches have produced relatively weak predictions for primarily dichotomized "reassault versus no reassault" outcomes. The primary objective of this research was to improve prediction using multinomial logistic regressions with multiple outcomes and conditional factors. We used a unique data set from a multisite batterer program evaluation with a large sample size (n = 840), a longitudinal 15-month follow-up, and high response rates (70% of the women). Multiple outcomes included no abuse, verbal abuse or controlling behavior, threats, one-time reassault, and repeated reassaults. Using multiple outcomes improved prediction with risk markers over prediction of a dichotomous outcome and suggests that "repeat reassault" should be distinguished from "one-time reassault." Conditional factors did not substantially improve prediction. The low "correct classification" suggests, however, the difficulty of identifying the most dangerous batterers.     

Detecting Deceit via Analysis of Verbal and Nonverbal Behavior

We examined the hypotheses that (1) a systematic analysis of nonverbal behavior could be useful in the detection of deceit and (2) that lie detection would be most accurate if both verbal and nonverbal indicators of deception are taken into account. Seventy-three nursing students participated in a study about telling lies and either told the truth or lied about a film they had just seen. The interviews were videotaped and audiotaped, and the nonverbal behavior (NVB) and speech content of the liars and truth tellers were analyzed, the latter with the Criteria-Based Content Analysis technique (CBCA) and the Reality Monitoring technique (RM). Results revealed several nonverbal and verbal indicators of deception. On the basis of nonverbal behavior alone, 78% of the lies and truths could be correctly classified. An even higher percentage could be correctly classified when all three detection techniques (i.e., NVB, CBCA, RM) were taken into account.     

Dimensions of social inequality in the Third World

This cross-national assessment of the empirical determinants of income inequality and infant mortality employs policy-relevant variables suggested by the major macrosocial theories of development and stratification. Findings based on sample sizes ranging from 34 to 61 LDCs indicate that modernization and ecological-evolutionary theories provide more consistent explanations of social inequalities than either dependency/world-systems theory or urban bias theory. Our analyses point to economic growth and the development of rural infrastructure and social complexity as the most expedient methods for facilitating mortality reduction and income equalization. We conclude that simplistic policy-orientations stressing such phenomena as urban bias or population growth should be replaced by more complex perspectives that include an emphasis on rural social organization.