Aims: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical valve replacement for patients with aortic stenosis (AS). This study assessed the impact of changing from a self-expandable (SE) valve to a balloon-expandable (BE) valve on healthcare resource use and procedural costs in a population of inoperable AS patients.
Methods: In this retrospective single center study, data for 195 patients who received either an SE or a BE valve between 2010–2014 were collected. Procedural and post-procedural healthcare resource use and cost parameters were determined for the two groups.
Results: The study showed that overall procedural time, including time required by medical personnel, was significantly shorter for TAVI using a BE compared with an SE valve. Post-surgery, patients in the BE valve group had significantly shorter hospital stays than the SE valve group, including significantly fewer days spent in the intensive care unit (ICU). Additionally, trends towards reduced 30-day mortality, incidence of new permanent pacemaker implantation, and incidence of blood transfusion were observed in the BE valve group compared with the SE valve group. Finally, total procedural costs were 24% higher in the SE compared with the BE valve group.
Limitations: The BE valve data were acquired in a single year, whereas the SE valve data were from a 5-year period. However, a year-by-year analysis of patient characteristics and study outcomes for the SE valve group showed few significant differences over this 5-year period.
Conclusions: Overall, changing from an SE to a BE valve for TAVI in patients with severe AS reduced both healthcare resource use and procedure-related costs, while maintaining patient safety. For healthcare providers, this could increase efficiency and capacity within the healthcare system, with the added advantage of reducing costs. 相似文献
Many businesses operate long hours that often include nights and weekends to accommodate consumers. However, a few businesses maintain a closed-on-Sunday policy and do so while still operating successfully although closed-on-Sunday policies mean forgoing potential sales hours. As most Christian faiths consider the Sabbath as a day of rest, an oft-used rationalization for the success of businesses maintaining this policy is that they must be supported by consumers with strong religious beliefs, who appreciate the message sent by the company and as a result perceive the company favorably. The purpose of this paper was to investigate whether consumers' religious commitment influences their ethical judgment of a company's closed-on-Sunday policy and to determine whether this ethical judgment impacts a company's corporate or brand image and consumer loyalty intentions. The results suggest that consumers with higher levels of intra-personal religious commitment are more likely to hold favorable ethical judgments of closed-on-Sunday corporate policies. In addition, favorable ethical judgments of closed-on-Sunday corporate policies are likely to positively influence corporate image. A more positive corporate image ultimately results in higher consumer loyalty intentions. 相似文献
The search for a process by which agencies, whether at the national or the local level, might either rank or prioritize disparate risks has been on the minds if not the agenda of policy makers for some decades at least. In the absence of an agreed methodology, risk management practitioners in government, industry, and other walks of life have, through necessity, developed their own. Inspection reveals, however, that many of these are grounded in particular ideologies which may be associated with discrete professional world views or systems of working. It is apparent, however, that even subtle differences in methodologies can generate radically different rankings and, ultimately, actions. Thus, while the ranking of risks as a means of setting goals and prioritizing actions is a crucial activity, the process by which it is conducted may have an overwhelming influence upon the outcome, which in turn might bear little resemblance to the aspirations of stakeholders. It is suggested that more attention needs to be devoted to the assumptions and values inherent in ranking procedures, even those previously regarded as 'objective,' and to the ways in which these, together with artefacts of the ranking procedure itself, may affect outcomes. In the longer term, a shift towards a more holistic prioritization process is seen as highly desirable. Failure to achieve this could mean that neither local nor societal goals are properly accommodated. 相似文献
This paper focuses on the cooperative sector in central Mongolia. Its aim is to provide new insights into the role and importance of cooperatives among poor rural populations. We analyse cooperatives’ inclusiveness of smaller herders and farmers and cooperatives’ governance structures. The research is based on data collected in selected provinces of the central Töv region. The data were collected for three distinctive target groups – cooperative board members, cooperative members and non‐members. We found that the cooperative sector in Mongolia is strongly affected by the governmental policy regarding wool subsidies, which provides subsidies only to cooperative members and has consequently caused rapid growth in the number of new, free‐riding cooperative members and led to very low levels of members’ self‐identification with their cooperatives. This policy also affects the inner organizational structures of cooperatives. Further, we found indications that poorer farmers tend not to be members of cooperatives and that the overall benefits for non‐members and the general community arising from local cooperatives are rather low. 相似文献
We analyze the effect various delivery options embedded in commodity futures contracts have on the futures price. The two embedded options considered are the timing and location options. We show that early delivery is always optimal when only a timing option is present, but not so when joint options are present. The estimates of the combined options are much smaller than the comparable estimates for the timing option alone. The average value of the joint option is about 5% of the average basis on the first day of the maturity month. This suggests that joint options can increase deliverable supplies while potentially having only a small effect on basis behavior. 相似文献
Every successful communication process requires a certain degree of self-disclosure. However, both in real life and on social network sites like Facebook, self-disclosure does not imply a total sacrifice of privacy. People rather tend to disclose one part of the self while keeping another one protected. In doing so, it is less important where the protective line is drawn, but that a line is drawn at all. This basic principle of conditional self-disclosure can be applied in diverse strategies. An online survey among German Facebook users (n = 684) examined this assumption. Items for a scale of subjective privacy regulation were derived from Burgoon’s four dimensions of privacy. Based on user’s varying emphasis on these privacy dimensions, seven different types of privacy management could be distinguished. Among these, six different strategies of conditional self-disclosure were observed (?chatty“, ?blogging“, ?networking“, ?sorting“, ?passive“, and ?inexperienced“). Only ?careless“ users did not follow our expectations, attaching none of the measured protective conditions to their self-disclosure. 相似文献
This review summarizes the research on ethical decision-making from 2004 to 2011. Eighty-four articles were published during this period, resulting in 357 findings. Individual findings are categorized by their application to individual variables, organizational variables, or the concept of moral intensity as developed by Jones (Acad Manag Rev 16(2):366–395, 1991). Rest’s (Moral development: advances in research and theory, Praeger, New York, 1986) four-step model for ethical decision-making is used to summarize findings by dependent variable—awareness, intent, judgment, and behavior. A discussion of findings in each category is provided in order to uncover trends in the ethical decision-making literature. A summary of areas of suggested future research is provided. 相似文献
Many important decisions are made under stress and they often involve risky alternatives. There has been ample evidence that stress influences decision making, but still very little is known about whether individual attitudes to risk change with exposure to acute stress. To directly evaluate the causal effect of psychosocial stress on risk attitudes, we adopt an experimental approach in which we randomly expose participants to a stressor in the form of a standard laboratory stress-induction procedure: the Trier Social Stress Test for Groups. Risk preferences are elicited using a multiple price list format that has been previously shown to predict risk-oriented behavior out of the laboratory. Using three different measures (salivary cortisol levels, heart rate and multidimensional mood questionnaire scores), we show that stress was successfully induced on the treatment group. Our main result is that for men, the exposure to a stressor (intention-to-treat effect, ITT) and the exogenously induced psychosocial stress (the average treatment effect on the treated, ATT) significantly increase risk aversion when controlling for their personal characteristics. The estimated treatment difference in certainty equivalents is equivalent to 69 % (ITT) and 89 % (ATT) of the gender-difference in the control group. The effect on women goes in the same direction, but is weaker and insignificant. 相似文献