Comparative effectiveness of standard endotracheal tubes vs. endotracheal tubes with continuous subglottic suctioning on ventilator-associated pneumonia rates

Ventilator-associated pneumonia (VAP) accounts for the majority of nosocomial pneumonias, which may increase intensive care and prolonged hospital stays. Endotracheal tubes allowing continuous subglottic suctioning may reduce VAP; however, they are more expensive than standard endotracheal tubes not allowing continuous suctioning. he objective of this study was to measure the comparative costs associated with continuous subglottic suctioning endotracheal tubes (CSS-ETT) versus standard endotracheal tubes (S-ETT) among intubated patients and whether cost differential is offset by the occurrence of VAP in patients receiving either type of intubation. A retrospective chart review was conducted for 154 intubated adult patients (77 = S-ETT; 77 = CSS-ETT). The S-ETT group had one case of VAP; the CSS-ETT group had none. The mean total hospital charges were higher for the S-ETT group ($103,600; CSS-ETT= $88,500) (p = 0.3). Although the average number of intubation days and ICU days were greater for the CSS-ETT group, there were no cases of VAP compared to the S-ETT group. ased upon the one S-ETT VAP case and the VAP attributable costs, it is cost effective to use the CSS-ETT.     

Commitment and conflict in the restaurant industry: Perceptions from the Generation Y viewpoint

This study investigates Generation Y restaurant employees’ perceptions of conflict and the extent to which the presence of management team conflict influences employee organizational commitment. Regression analysis found that perceptions of task and process conflict negatively impact organizational commitment, while relationship conflict was not found to have a statistically significant impact on organizational commitment. This study represents the first attempt to understand the carryover effects of management team conflict on employees and offers insights into the perceptions of the Generation Y restaurant worker. Theoretical and managerial implications of the empirical findings as well as directions for future research are discussed.     

Differences in utility elicitation methods in cardiovascular disease: a systematic review

Aims: Utility values inform estimates of the cost-effectiveness of treatment for cardiovascular disease (CVD), but values can vary depending on the method used. The aim of this systematic literature review (SLR) was to explore how methods of elicitation impact utility values for CVD.

Materials and methods: This review identified English-language articles in Embase, MEDLINE, and the gray literature published between September 1992 and August 2015 using keywords for “utilities” and “stroke”, “heart failure”, “myocardial infarction”, or “angina”. Variability in utility values based on the method of elicitation, tariff, or type of respondent was then reported.

Results: This review screened 4,341 citations; 290 of these articles qualified for inclusion in the SLR because they reported utility values for one or more of the cardiovascular conditions of interest listed above. Of these 290, the 41 articles that provided head-to-head comparisons of utility methods for CVD were reviewed. In this sub-set, it was found that methodological differences contributed to variation in utility values. Direct methods often yielded higher scores than did indirect methods. Within direct methods, there were no clear trends in head-to-head studies (standard gamble [SG] vs time trade-off); but general population respondents often provided lower scores than did patients with the disease when evaluating the same health states with SG methods. When comparing indirect methods, the EQ-5D typically yielded higher values than the SF-6D, but also showed more sensitivity to differences in health states.

Conclusions: When selecting CVD utility values for an economic model, consideration of the utility elicitation method is important, as this review demonstrates that methodology of choice impacts utility values in CVD.     

When the Cat's Away: A Content Analysis of MNC Overseas Recruitment Print Ads

This study examines discrimination in the overseas recruitment print ads of Multinational National Corporations (MNCs) in a lax regulatory environment, Singapore. Institutionalization theory suggests that in a weakly regulated environment, MNC affiliates would tend to adopt the less stringent requirements. With the lack of a strong legal framework in the host country, the home country's legal and cultural imperatives would be more salient, suggesting differences in discrimination as a function of home country imperatives. Some 1122 recruitment print ads of U.S., U.K., and Japanese affiliates of MNCs were examined. While discrimination was found in the print ads of all organizations, U.S. affiliates were least discriminatory, followed by Japan and U.K. affiliates. When Singapore firms were included, they were found to be least discriminatory. However, Singapore firms became more discriminatory when the request for a recent photograph was considered in the discrimination index. Implications of the findings are discussed and suggestions for future research advanced.     

Toward a method for the rapid collection of public concerns and benefits of emerging energy technologies

Abstract

The speed and scale with which new technologies emerge sometimes force decision makers to act without the benefit of thorough risk analyses and environmental and social impact analyses. Insights from interested and affected parties (IAPs) can be tapped to alert decision makers to expected risks and benefits associated with emerging technologies. One of the methodological challenges has been to identify IAPs with relevant knowledge of the emerging technology. Here we show how Facebook’s marketing tool can be employed to reach IAPs with experience and knowledge in a new energy technology and recruit them to a survey instrument. We demonstrate the approach in the context of hydraulic fracturing for oil and gas in the United States. A $200 1-week Facebook ad produced a diverse sample of 379 IAPs from 36 states that identified 41 benefits and 80 risks. This knowledge can be used to steer the direction of analyses for impact assessments. Comparison to a similar study showed a surprising number of differences, suggesting that larger samples are needed.     

What actions can be taken to increase whistle-blowing in the classroom?

This study surveyed undergraduate business students on various issues concerning the potential of students whistle-blowing when they observe other students cheating. Developing the courage of one's conviction in our accounting students is important to accounting educators as we are also emphasizing traits such as integrity, skepticism, and professionalism to our accounting students. As the data were gathered in the first introductory-accounting course, students’ cheating and whistle-blowing attitudes were already established. We found that, while students who had cheated in the past were more likely to suggest incentives and cash rewards, students who had never cheated were more concerned with increased confidentiality. Consequently, the need for assuring strict confidentiality is as important to our accounting students as it was to our former accounting clients in developing the trust necessary for the disclosure of sensitive information.     

Understanding and Improving Teamwork in Organizations: A Scientifically Based Practical Guide

Teams are pervasive in today's world, and rightfully so as we need them. Drawing upon the existing extensive body of research surrounding the topic of teamwork, we delineate nine “critical considerations” that serve as a practical heuristic by which HR leaders can determine what is needed when they face situations involving teamwork. Our heuristic is not intended to be the definitive set of all considerations for teamwork, but instead consolidates key findings from a vast literature to provide an integrated understanding of the underpinnings of teamwork—specifically, what should be considered when selecting, developing, and maintaining teams. This heuristic is designed to help those in practice diagnose team‐based problems by providing a clear focus on relevant aspects of teamwork. To this end, we first define teamwork and its related elements. Second, we offer a high‐level conceptualization of and justification for the nine selected considerations underlying the heuristic, which is followed by a more in‐depth synthesis of related literature as well as empirically‐driven practical guidance. Third, we conclude with a discussion regarding how this heuristic may best be used from a practical standpoint, as well as offer areas for future research regarding both teamwork and its critical considerations. © 2014 Wiley Periodicals, Inc.     

Cost effectiveness of adding clostridial collagenase ointment to selective debridement in individuals with stage IV pressure ulcers

Objective: The purpose of this study was to determine the cost effectiveness (from a payer’s perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry.

Methods: A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years.

Results: Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of ?$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient.

Conclusions: In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost.