Risk of major amputation or death among patients with critical limb ischemia initially treated with endovascular intervention,surgical bypass,minor amputation,or conservative management

Aims: Patients with critical limb ischemia (CLI) have an increased risk of major amputation. The initial treatment approach for CLI may significantly impact the subsequent risk of major amputation or death. The objective of this study was to describe the initial treatment approaches of patients with CLI and the limb outcomes associated with each approach.

Methods: Data from MarketScan Commercial and Medicare Supplemental Databases from January 2006–December 2014 was utilized. Cohorts of CLI patients were defined as follows: (1) peripheral vascular intervention (PVI); (2) peripheral vascular surgery (PVS); (3) minor amputation without concomitant PVI or PVS (MinAMP); and (4) Patients without PVI, PVS, or MinAMP (conservative therapy). The odds of major amputation or inpatient death were estimated using the Cox proportional hazards model. For those patients requiring a major amputation, the incremental expenditures per member per month (PMPM) were estimated using a gamma log-link model.

Results: Conservative therapy was associated with significantly higher odds of major amputation or inpatient death compared to patients who underwent minor amputation (1.59-times), PVI (2.08-times), or PVS (2.12-times). Patients treated with an initial strategy of minor amputation also had higher odds of major amputation or inpatient death compared to PVS (1.31-times) or PVI (1.33-times). The estimated incremental expenditures PMPM for patients with a major amputation was $5,165.

Conclusions: Revascularization reduces the risk of a major amputation or inpatient death for patients with CLI when compared to conservative therapy. Major amputation is also associated with significantly higher healthcare expenditures.     

TOWARDS A VALUE-NEUTRAL POSITIVE SCIENCE OF ACCOUNTING: A COMMENT

This comment points out that Thomas (1981) has misrepresented the views of Lakatos and has misunderstood the role of empirical research in the development of science.     

Current Ethical Issues in Polish HRM

Contemporary HRM was introduced into Poland by the arrival of international corporations with their professional systems of Human Resource Management, which emphasizes ethical personnel management. This research is based on data collected from a questionnaire and interview of 40 women and men professional graduates of the 2004 Weekend MBA Program at Poznan University of Economics eliciting their perceptions of ethical issues in Polish HRM. The present Polish economic situation, with 19% unemployment, precipitates many ethical challenges. The questionnaire and interviews resulted in 217 observations and specific examples of ethical HRM issues. Examples fall in two broad categories and five specific Human Resource areas. The broad external categories are: (1) History and cultural attitudes and (2) Exploitation of the current unemployment situation. Historical and cultural attitudes influence attitudes toward work; company discipline; property and ownership; law and social expectations at work. The history of personnel departments in Socialistic Poland explains many of these attitudes. The five specific categories are: (1) Ethical issues in recruitment; (2) Ethical issues in hiring (Discrimination issues); (3) Ethical issues in performance appraisals and promotions; (4) Abuse of authority (including sexual harassment), and (5) “Mobbing”. Ethical issues in these categories include correlation with appropriate Polish Labor and Penal Laws. This research reveals some HRM ethical challenges unique to Polish HRM. The research emphasizes professional HRM and ethical expectations, which are now being recognized and accepted as a strategic component of Polish management Brother Leo V. Ryan, CSV is Professor of Management – Emeritus and former Dean, College of Commerce, De Paul University. He is a Fellow, St. Edmund’s College, Cambridge, holds honorary degrees from Seton Hall University and Illinois Benedictine University and was a Fulbright Professor in Poland (1993–1995). He is past president, Society for Business Ethics. He is co-author or co-editor of Human Action in Business (1996); Etyka Biznesu (1997); From Autarcy to Market – Polish Economics and Politics (1998); Students Focus on Ethics (2000); Praxiology and Pragmatism (2002) and Poland: A Transformational Analysis (2003). He has been an annual Visiting Professor, Poznan University of Economics, Poznan, Poland since November 1999.     

ICU nurse-physician collaboration & nursing satisfaction

ICU nurses who are satisfied with their work are more likely to be retained, leading to institutional cost savings. In this study, higher levels of nurse-physician collaboration in making decisions about patient care were found to be very important to nurses' satisfaction.     

Budgeting, the individual and the capital market: A case of fiscal stress

Budgetary control is a major aspect of management control. It has undergone major shifts of emphasis in both the literature and practice in the later part of the 20th century. A significant influence on the changing practices of this aspect of control has been the growth of and increased influence of the capital market. This paper draws on a detailed field study focusing on the problematic nature of budgetary control in a changing operational environment that acknowledges both the importance, internally, of the organisation members and their contribution to continued growth—and externally the growing influence of shareholders on business operations. The focus of the paper is on the effects of the constant pressure of the share price on the case unit of analysis and how that changed the use of the budgetary control system. This change is illustrated both at a macro level of organisational accountability for predicted results and also as it is driven down the organisation to the level of the individual.