Big Is Bad: Stereotypes About Organizational Size, Profit-Seeking, and Corporate Ethicality

Individuals tend to hold a dim view of for-profit corporations, believing that profit-seeking comes at the expense of ethicality. In the present research, we show that this belief is not universal; rather, people associate ethicality with an organization's size. Across nine experiments (N = 4,796), people stereotyped large companies as less ethical than small companies. This size-ethicality stereotype emerged spontaneously (Study 1), implicitly (Study 2), and across industries (Study 3). Moreover, we find this stereotype can be partly explained by perceptions of profit-seeking behavior (Supplementary Studies A and B), and that people construe profit-seeking and its relationship to ethicality differently when considering large and small companies (Study 4). People attribute greater profit-maximizing motives (relative to profit-satisficing motives) to large companies, and these attributions shape their subsequent judgments of ethicality (Study 5; Supplementary Studies C and D).

Self-perceived role and knowledge of community pharmacists in organ donation

BACKGROUND

Although a majority of North Americans is in favor of organ donation, registration remains challenging. Community pharmacists are highly accessible frontline health care professionals that could contribute to a new common registration donation consent system.

AIM

The objective of the study was to assess self-perceived professional role and organ donation knowledge of community pharmacists in Quebec.

METHOD

We designed a telephone interview survey using a three round modified Delphi process. Following questionnaires testing, we randomly sampled 329 community pharmacists in Quebec. Following administration, we validated the questionnaire by conducting an exploratory factorial analysis using principal component followed by a varimax rotation and rearranging domains and items accordingly.

RESULTS

A total of 443 pharmacists were contacted, 329 provided answers to the self-perception role and 216 of them completed the knowledge questionnaire. Overall, community pharmacists of Quebec had a positive view on organ donation and demonstrated interest in acquiring knowledge. Respondents have identified lack of time and high pharmacy attendance as non-limiting barriers to implementing the intervention. The average score on the knowledge questionnaire was 61.2%.

CONCLUSION

With the implementation of an appropriate education program to address this knowledge gap, we believe that community pharmacists could be key players in registered organ donation consent.

Refractory Dabigatran-Induced Hemorrhage Despite Multiple Idarucizumab Administration and Renal Replacement Therapy

PURPOSE

This case report describes a patient with dabigatran accumulation due to acute kidney injury on chronic kidney disease, requiring multiple administration of idarucizumab along with renal replacement therapy because of rebound effect causing numerous episodes of bleeding.

SUMMARY

An 86-year-old man on dabigatran etexilate 110 mg twice daily for stroke prevention with atrial fibrillation was admitted to the hospital for bowel obstruction and severe acute kidney injury on chronic kidney disease. The patient had an abnormal coagulation profile and no history of bleeding. Initial laboratory values revealed a hemoglobin concentration of 10.7 g/dL, a platelet count of 115 × 10³ platelets/μL, an activated partial thromboplastin time of 150.4 seconds, an international normalized ratio of 10.28, a thrombin time greater than 100 seconds and a serum creatinine of 5.54 mg/dL (490 μmol/L). An initial dose of idarucizumab was administered 1 hour prior to surgery to prevent bleeding. Significant bleeding and hemodynamic instability occurred following surgery. Three additional doses of idarucizumab, 2 sessions of intermittent hemodialysis, continuous venovenous hemofiltration and blood products were required to achieve normalization of coagulation parameters and hemodynamic stability due to rebound coagulopathy after each dose of idarucizumab.

CONCLUSION

Acute kidney injury on chronic kidney disease and third-space redistribution could have led to important dabigatran accumulation and favored rebound coagulopathy. Multiple therapeutic approaches may be required in the management of complex dabigatran intoxication.

Perampanel: An audit of clinical experience using the epilepsy electronic patient record

Perampanel is a non-competitive antagonist of AMPA glutamate receptors on post synaptic neurons. The aim of this study was to conduct an audit of the experience of perampanel treatment in Ireland based on the interrogation of the national epilepsy electronic patient record (EPR). A retrospective audit was compiled which reviewed the progress of patients who had been treated across two regional epilepsy centres. The EPR was used to identify patients and collect information relevant to their perampanel therapy. Collected data was entered into a statistical package for social sciences for analysis using descriptive statistics. Seventy patients were identified for inclusion in this audit. Partial onset epilepsy was the predominant epilepsy syndrome treated with perampanel. Eight milligrams daily was the maximum dose achieved in 31.45% (n=22). Complex partial seizures demonstrated the best seizure response to perampanel, which was optimal at doses of 4mgs to 8mgs once daily. Treatment was discontinued primarily due to side effect profile (28.5%; n=20). The common side effects reported were behavioural alteration, sedation and dizziness. Abnormal thoughts were identified in 4.2% (n=3). Overall perampanel has been shown to be an effective adjunct. The EPR was demonstrated as an effective tool for audit and research.

Cerebral metabolic dysfunction in AIDS: findings in a sample with and without dementia

Positron-emission tomography was coupled with neurological and neuropsychological evaluation to study regional cerebral activity and neurologic status in two groups. Seventeen patients with full-blown AIDS and 14 seronegative control subjects were studied using [18F]2-fluoro-2-deoxy-D-glucose in a resting state. The AIDS group had relative regional hypermetabolism in the basal ganglia and thalamus; stepwise multiple-regression analyses revealed a significant relationship for the AIDS group between temporal lobe metabolism and severity of dementia on the AIDS Dementia Complex Rating Scale. These results suggest that the basal ganglia, thalamus, and temporal lobes are differentially affected in AIDS.

Visuoconstructional impairment in dementia syndromes

Dementia of the Alzheimer type (DAT) affects most neuropsychological domains including language, memory, and visuo-spatial skills. The latter are usually assessed by poorly quantifiable copying tasks. We assessed constructional abilities using the Developmental Test of Visuomotor Integration (VMI) comprised of a series of model drawings of increasing complexity. Twenty-six patients meeting NINCDS-ADRDA criteria for DAT, 21 normal aged subjects with normal mental status examinations, and 14 patients with vascular dementia were tested. In DAT, we found significant correlations between visuoconstructive ability and memory registration, delayed recall, and language functions such as confrontation naming and word-list generation. Less marked, but significant correlations were found in the vascular dementia group between visuoconstructive ability and memory registration and word-list generation. A few normal elderly subjects were unable to copy the most challenging figures. The study demonstrates that: (1) VMI is a convenient method for quantifying constructional deficits in DAT and other dementing illnesses; (2) constructional deficits are highly correlated with dementia severity and memory and language deficits in DAT; (3) neuropsychological deficits are less highly inter-correlated in vascular dementia than in DAT; and (4) abnormal constructional skills are present in some normal elderly.

Subclinical neuropathy associated with chronic obstructive pulmonary disease: possible pathophysiologic role of smoking

Twenty of 23 patients with chronic obstructive pulmonary disease (COPD) showed electrophysiologic evidence of peripheral nerve dysfunction. Abnormalities of sensory nerve conduction were most common, affecting the sural nerve (20 subjects), ulnar nerve (11), radial nerve (eight), and median nerve (seven). Six subjects had impairment of both sensory and motor nerve function, with the common peroneal being the most frequently affected motor nerve. Clinical signs of neuropathy were found in four patients. Cigarette smoking, expressed as pack-years, was correlated significantly with the electrophysiologic abnormalities. These findings indicate that subclinical polyneuropathy commonly occurs in association with COPD and that this COPD-related neuropathy is correlated with cigarette consumption. From these data we suggest that a substance or substances in cigarette smoke, such as nicotine, taken on a long-term basis, may be toxic to peripheral nerves.