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Lloyd-Esenkaya V, Russell AJ, St Clair MC. Zoti's Social Toolkit: Developing and piloting novel animated tasks to assess emotional understanding and conflict resolution skills in childhood. Br J Dev Psychol 2024; 42:187-214. [PMID: 38323720 DOI: 10.1111/bjdp.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
Current methods used to investigate emotional inference and conflict resolution knowledge are limited in their suitability for use with children with language disorders due to a reliance on language processing. This is problematic, as nearly 8% of the population are estimated to have developmental language disorder (DLD). In this paper, we present 'Zoti's Social Toolkit', a set of animated scenarios that can be used to assess emotion inferencing and conflict resolution knowledge. All animated scenarios contain interpersonal situations centred around a gender-neutral alien named Zoti. Four studies investigated the face and construct validity of the stimuli. The final stimulus set can be used with children, who may or may not have language difficulties and is openly available for use in research.
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Thorsteinson TJ, Clark ME. Effects of explanations and precise anchors on salary offers. J Soc Psychol 2024; 164:351-366. [PMID: 35616065 DOI: 10.1080/00224545.2022.2081527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
Two studies were conducted which examined explanations and precise anchors on counteroffers and perceptions in a salary negotiation. Study 1 found that precise offers reduced counteroffers compared to round offers, but explanations focused on internal equity concerns or external equity concerns had no effect on counteroffers. Study 2 also found that precise offers reduced counteroffers compared to round offers. Explanations, which were manipulated to focus on constraint or disparagement rationales, failed to affect counteroffers, but a constraint explanation led to higher attributions of competence compared to a disparagement explanation or no explanation. These results suggest that precise offers are an effective tactic for reducing counteroffers and that explanations are relatively unimportant. Further research is needed to determine under what conditions an explanation may improve or harm negotiation outcomes.
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Wei X, Liao PC. Connecting the dots: Exploring brain connectivity during responsibility recognition in construction contract negotiations. Comput Biol Med 2024; 173:108347. [PMID: 38554663 DOI: 10.1016/j.compbiomed.2024.108347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
Despite recent advancements in monitoring brain activity, causal relationships within the brain during responsibility identification in construction contracts remain unexplored. We aimed to understand the neural mechanisms involved in the cognitive components and their interactions related to contract text reading by delving into the brain mechanisms of contract responsibility identification. This study investigated students' brain connectivity using electroencephalography (EEG) data during a text-based contract responsibility-identification task. It employed an adaptive directed transfer function based on Granger causality to simulate directed and time-varying information flow in observed brain activity. We evaluated the EEG records of 18 participants under two reading conditions (involving or not involving contractor responsibility). During responsibility identification, the most substantial information exchange occurs in the somatosensory area of the brain. The results revealed a "top-down" cortical mechanism for responsibility identification, with the left parietal-occipital area (PO3) as the central hub promoting connectivity structures. These findings indicate that the perceptual processing of contract responsibility texts is associated with higher visual learning and memory quality. Contracts without contractor-responsibility clauses resulted in more substantial information flow output in the frontal cortex and consumed more cognitive resources. Our findings advance the understanding of cognitive processes involved in contract responsibility identification, providing a framework for investigating causal relationships within the brain and novel insights into cortical mechanisms. By identifying the neural basis of responsibility identification, stakeholders can develop effective training programs for negotiators and enhance their ability to interpret and implement construction contracts.
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Affiliation(s)
- Xinyan Wei
- Department of Construction Management, Tsinghua University, Beijing, 100084, China.
| | - Pin-Chao Liao
- Department of Construction Management, Tsinghua University, Beijing, 100084, China.
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Hewitt SL, Mills JE, Hoare KJ, Sheridan NF. The process of nurses' role negotiation in general practice: A grounded theory study. J Adv Nurs 2024; 80:1914-1926. [PMID: 37929935 DOI: 10.1111/jan.15938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
AIM To explain the process by which nurses' roles are negotiated in general practice. BACKGROUND Primary care nurses do important work within a social model of health to meet the needs of the populations they serve. Latterly, in the face of increased demand and workforce shortages, they are also taking on more medical responsibilities through task-shifting. Despite the increased complexity of their professional role, little is known about the processes by which it is negotiated. DESIGN Constructivist grounded theory. METHODS Semi-structured interviews were conducted with 22 participants from 17 New Zealand general practices between December 2020 and January 2022. Due to COVID-19, 11 interviews were via Zoom™. Concurrent data generation and analysis, using the constant comparative method and common grounded theory methods, identified the participants' main concern and led to the construction of a substantive explanatory theory around a core category. RESULTS The substantive explanatory theory of creating place proposes that the negotiation of nurse roles within New Zealand general practice is a three-stage process involving occupying space, positioning to do differently and leveraging opportunity. Nurses and others act and interact in these stages, in accordance with their conceptualizations of need-responsive nursing practice, towards the outcome defining place. Defining place conceptualizes an accommodation between the values beliefs and expectations of individuals and pre-existing organizational norms, in which individual and group-normative concepts of need-responsive nursing practice are themselves developed. CONCLUSION The theory of creating place provides new insights into the process of nurses' role negotiation in general practice. Findings support strategies to enable nurses, employers and health system managers to better negotiate professional roles to meet the needs of the populations they serve, while making optimum use of nursing skills and competencies. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Findings can inform nurses to better negotiate the complexities of the primary care environment, balancing systemic exigencies with the health needs of populations. IMPACT What Problem Did the Study Address? In the face of health inequity, general practice nurses in New Zealand, as elsewhere, are key to meeting complex primary health needs. There is an evidence gap regarding the processes by which nurses' roles are negotiated within provider organizations. A deeper understanding of such processes may enable better use of nursing skills to address unmet health need. What Were the Main Findings? Nurses' roles in New Zealand general practice are determined through goal-driven negotiation in accordance with individual concepts of need-responsive nursing practice. Individuals progress from occupying workspaces defined by the care-philosophies of others to defining workplaces that incorporate their own professional beliefs, values and expectations. Negotiation is conditional upon access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice. Strong clinical and organizational governance and individuals' own positive personal self-efficacy are enablers of effective negotiation. Where and on Whom Will the Research Have Impact? The theory of Creating Space can inform organizational and individual efforts to advance the roles of general practice nurses to meet the health needs of their communities. General practice organizations can provide safe, supported environments for effective negotiation; primary care leaders can promote strong governance and develop individuals' sense of self-efficacy by involving them in key decisions. Nurses themselves can use the theory as a framework to support critical reflection on how to engage in active negotiation of their professional roles. REPORTING METHOD The authors adhered to relevant EQUATOR guidelines using the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION Researchers and participants currently working in general practice were involved in the development of this study. By the process of theoretical sampling and constant comparison, participants' comments helped to shape the study design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: An understanding of the processes by which health professionals negotiate their roles is important to support them to meet the challenges of increased complexity across all health sectors globally.
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Affiliation(s)
- Sarah Louise Hewitt
- School of Nursing, College of Health, Massey University, Albany, Auckland, New Zealand
| | - Jane Elizabeth Mills
- Office of La Trobe Rural Health, La Trobe University, Bendigo, Victoria, Australia
| | - Karen Jean Hoare
- School of Nursing, College of Health, Massey University, Albany, Auckland, New Zealand
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Wendrich K, Krabbenborg L. Negotiating with digital self-monitoring: A qualitative study on how patients with multiple sclerosis use and experience digital self-monitoring within a scientific study. Health (London) 2024; 28:333-351. [PMID: 37198747 DOI: 10.1177/13634593231175321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Research shows that patients can have values and use practices that are different from those envisioned by technology developers. Using sociomaterialism as an analytical lens, we show how patients negotiated with digital self-monitoring in the context of a scientific study. Our paper draws on interviews with 26 patients with the chronic neurological disease multiple sclerosis (MS) who were invited to use an activity tracker and a self-monitoring app for a period of 12 months as part of their everyday life. Our study aims to fill a gap: relatively little is known about how digital self-monitoring becomes materialized in the everyday lives of patients with chronic diseases. We show that patients engaged in digital self-monitoring because they are eager to participate in research to contribute knowledge that will benefit the larger community of patients rather than to improve their personal self-management. Although respondents adhered to digital self-monitoring during the study, it is not self-evident that they would do so for private self-monitoring purposes. It became clear that respondents did not necessarily perceive digital self-monitoring as useful for their self-management practices due to their established knowledge and routines. Moreover, respondents referred to the inconvenience of having to perform self-monitoring tasks and the emotional burden of being reminded of the MS because of the digital self-monitoring. We conclude by indicating what could be considered when designing scientific studies, including the suitability of conventional study designs for evaluating technologies used daily by patients and the challenge of integrating patients' experiential knowledge into scientific practices.
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van Daalen KR, Wyma N, Schauer-Berg J, Blom IM, Mattijsen J, Othman R, Eissa M, Parks RM, Wyns A, Aboushady AT, Hassan M, Ezzine T, Khan S, Zayed MAE, Neggazi S, Alqodmani L, Lowe R. The global health community at international climate change negotiations. BMJ Glob Health 2024; 9:e015292. [PMID: 38637120 PMCID: PMC11029429 DOI: 10.1136/bmjgh-2024-015292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/31/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
- Kim Robin van Daalen
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Nanine Wyma
- African Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
- Physicians Association for Nutrition South Africa, Pinelands, South Africa
| | - Johanna Schauer-Berg
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Iris M Blom
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Juliette Mattijsen
- Julius Center for Health Sciences and Primary Health, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Razan Othman
- The National Ribat University, Khartoum, Khartoum, Sudan
| | - Mohamed Eissa
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Robbie M Parks
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Arthur Wyns
- Melbourne Climate Futures, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmed Taha Aboushady
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muha Hassan
- Wye Valley NHS Trust, Hereford, Herefordshire, UK
| | - Tarek Ezzine
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Salman Khan
- Grant Government Medical College and Sir J J Group of Hospitals, Mumbai, Maharashtra, India
- International Federation of Medical Students' Associations (IFMSA), Copenhagen, Denmark
| | - Menna-Allah Elsayed Zayed
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- International Pharmaceutical Federation, The Hague, South Holland, Netherlands
| | - Sarah Neggazi
- Faculty of Pharmacy, University of Algiers 1, Alger, Algeria
- International Pharmaceutical Students' Federation, the Hague, Netherlands
| | | | - Rachel Lowe
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Centre on Climate Change & Planetary Health and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
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Martis WR, Alexander Z. Negotiating a competitive speciality programme interview-a Māori clinician perspective. N Z Med J 2024; 137:90-92. [PMID: 38603792 DOI: 10.26635/6965.6411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Walston R Martis
- Consultant Anaesthetist, Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Consultant Anaesthetist, Department of Anaesthesia, Monash Health, Melbourne, Australia; Clinical Lecturer, Department of Critical Care, The University of Melbourne, Melbourne, Australia; Co-founder of iPrep Medical, Australia and New Zealand
| | - Zanazir Alexander
- Senior Orthopaedic Registrar, Department of Orthopaedics, Hutt Hospital, Te Whatu Ora; Co-founder of iPrep Medical, Australia and New Zealand
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Iacobucci G. Hospital doctors in Wales to enter pay negotiations with government. BMJ 2024; 385:q836. [PMID: 38594033 DOI: 10.1136/bmj.q836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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Pierce RG, Fang MC, Radhakrishnan NS, Rogers K. Revisiting negotiation for hospitalist groups: Getting what you need when the game has changed. J Hosp Med 2024; 19:329-332. [PMID: 37551917 DOI: 10.1002/jhm.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Read G Pierce
- Denver Health and Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Margaret C Fang
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Nila S Radhakrishnan
- Department of Medicine, Division of Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kendall Rogers
- Department of Internal Medicine, Division of Hospital Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Hesselberg J, Pedersen S, Grønhøj A. Meat reduction meets family reality: Negotiating sustainable diets in households with adolescents. Appetite 2024; 195:107213. [PMID: 38242360 DOI: 10.1016/j.appet.2024.107213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Limited research exists on how the transition towards more sustainable eating takes place at the meso-level of family decision-making, or how children and adolescents engage in and possibly influence the process towards more sustainable diets in families. In this paper, we study how public recommendations that encourage reducing the consumption of meat for the benefit of both health and climate are interpreted, negotiated, and acted upon in Danish families with adolescents (aged 15-20) residing at home. We use novel methodological stimuli, including vignettes and a visual sorting task, embedded in qualitative, in-depth interviews to elicit data on parents' and adolescents' everyday meat consumption/reduction behaviours. Findings reveal that a desire to uphold harmony and family cohesion serves as simultaneous drivers and barriers to reducing meat consumption. Further, we identify barriers to change in the gendered work hidden in the tasks of planning the integration of more sustainable, green dishes into the meal repertoires. Implications are drawn for social marketers, marketers, and public policymakers, encouraging these to use insights into family food decision-making processes as a lever to facilitate the needed green transition of diets in family households.
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Affiliation(s)
- Julie Hesselberg
- Department of Management, Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, 8210, Aarhus V, Denmark.
| | - Susanne Pedersen
- Department of Management, Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, 8210, Aarhus V, Denmark.
| | - Alice Grønhøj
- Department of Management, Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, 8210, Aarhus V, Denmark.
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11
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UN plastics treaty: don't let lobbyists drown out researchers. Nature 2024; 628:474. [PMID: 38632486 DOI: 10.1038/d41586-024-01089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
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Murawski A, Ramirez-Zohfeld V, Mell J, Tschoe M, Schierer A, Olvera C, Brett J, Gratch J, Lindquist LA. NegotiAge: Development and pilot testing of an artificial intelligence-based family caregiver negotiation program. J Am Geriatr Soc 2024; 72:1112-1121. [PMID: 38217356 PMCID: PMC11018462 DOI: 10.1111/jgs.18775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/02/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Family caregivers of people with Alzheimer's disease experience conflicts as they navigate health care but lack training to resolve these disputes. We sought to develop and pilot test an artificial-intelligence negotiation training program, NegotiAge, for family caregivers. METHODS We convened negotiation experts, a geriatrician, a social worker, and community-based family caregivers. Content matter experts created short videos to teach negotiation skills. Caregivers generated dialogue surrounding conflicts. Computer scientists utilized the dialogue with the Interactive Arbitration Guide Online (IAGO) platform to develop avatar-based agents (e.g., sibling, older adult, physician) for caregivers to practice negotiating. Pilot testing was conducted with family caregivers to assess usability (USE) and satisfaction (open-ended questions with thematic analysis). RESULTS Development: With NegotiAge, caregivers progress through didactic material, then receive scenarios to negotiate (e.g., physician recommends gastric tube, sibling disagrees with home support, older adult refusing support). Caregivers negotiate in real-time with avatars who are designed to act like humans, including emotional tactics and irrational behaviors. Caregivers send/receive offers, using tactics until either mutual agreement or time expires. Immediate feedback is generated for the user to improve skills training. Pilot testing: Family caregivers (n = 12) completed the program and survey. USE questionnaire (Likert scale 1-7) subset scores revealed: (1) Useful-Mean 5.69 (SD 0.76); (2) Ease-Mean 5.24 (SD 0.96); (3) Learn-Mean 5.69 (SD 0.74); (4) Satisfy-Mean 5.62 (SD 1.10). Items that received over 80% agreements were: It helps me be more effective; It helps me be more productive; It is useful; It gives me more control over the activities in my life; It makes the things I want to accomplish easier to get done. Participants were highly satisfied and found NegotiAge fun to use (91.7%), with 100% who would recommend it to a friend. CONCLUSION NegotiAge is an Artificial-Intelligent Caregiver Negotiation Program, that is usable and feasible for family caregivers to become familiar with negotiating conflicts commonly seen in health care.
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Affiliation(s)
- Alaine Murawski
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Vanessa Ramirez-Zohfeld
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Johnathan Mell
- University of Central Florida, Department of Computer Science; Orlando, FL, USA
| | - Marianne Tschoe
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Allison Schierer
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Charles Olvera
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Jeanne Brett
- Northwestern University, Kellogg School of Management; Evanston, IL USA
| | - Jonathan Gratch
- University of Southern California, Viterbi School of Engineering; Los Angeles, CA, USA
| | - Lee A. Lindquist
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
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Nilou FE, Christoffersen NB, Lian OS, Guassora AD, Broholm-Jørgensen M. Conceptualizing negotiation in the clinical encounter - A scoping review using principles from critical interpretive synthesis. Patient Educ Couns 2024; 121:108134. [PMID: 38199175 DOI: 10.1016/j.pec.2024.108134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Negotiation as an analytical concept in research about clinical encounters is vague. We aim to provide a conceptual synthesis of key characteristics of the process of negotiation in clinical encounters based on a scoping review. METHODS We conducted a scoping review of relevant literature in Embase, Psych Info, Global Health and SCOPUS. We included 25 studies from 1737 citations reviewed. RESULTS We found that the process of negotiation is socially situated depending on the individual patient and professional, a dynamic element of the interaction that may occur both tacitly and explicitly at all stages of the encounter and is not necessarily tied to a specific health problem. Hence, negotiation is complex and influenced by both social, biomedical, and temporal contexts. CONCLUSIONS We found that negotiation between patient and health professional occurs at all stages of the clinical encounter. Negotiation is influenced by social, temporal, and biomedical contexts that encompass the social meeting between patient and health professional. We suggest that health professionals strive to be attentive to patients' tacit negotiation practices. This will strengthen the recognition of the patients' actual wishes for their course of treatment which can thus guide the health professionals' recommendations and treatment.
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Affiliation(s)
- Freja Ekstrøm Nilou
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Olaug S Lian
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ann Dorrit Guassora
- Section and Research Unit of General Practice, University of Copenhagen, Denmark
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Ortiz Worthington R, Sekar D, McNeil M, Rothenberger S, Merriam S. Development and Pilot Testing of a Longitudinal Skills-Based Feedback and Conflict Resolution Curriculum for Internal Medicine Residents. Acad Med 2024; 99:414-418. [PMID: 37976405 DOI: 10.1097/acm.0000000000005560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PROBLEM Physicians in training are responsible for leading clinical teams, coordinating interdisciplinary management, navigating conflict, and supervising and giving feedback to junior learners. Giving feedback and resolving conflict are key leadership skills for internal medicine (IM) residents, many of whom desire additional training. Although these skills are integral to successful leadership for physicians in training, residents receive little explicit education and existing curricula have not established best practices for skill acquisition. APPROACH Study authors designed a pilot longitudinal, skills-based curriculum to teach first- through third-year IM residents at the University of Pittsburgh how to give formative feedback and engage in conflict resolution. From February to May 2021, authors delivered a series of interactive lectures utilizing frameworks, workplace-based scenarios, skills practice, and discussion. Skills transfer was evaluated with novel pre- and postcurriculum objective structured clinical examinations (OSCEs) wherein participants played the role of senior resident. Each OSCE involved 2 feedback and 2 conflict resolution stations. OSCE performances were evaluated using an author-created checklist with a 1-4 rating scale. The exposure group comprised post-OSCE participants who attended the curriculum. Data were analyzed using a mixed effects regression model. OUTCOMES Thirty-six residents participated in curriculum evaluation, and 23 were included in postcurriculum data analysis. Within feedback, the skill "explores feedback content" significantly improved for exposure group participants (precurriculum median, 2.64; postcurriculum, 3.24; P < .05). For conflict resolution, among the exposure group, the skill "identifies a common goal, value, or purpose" significantly improved (pre, 3.10; post, 3.62; P < .05). NEXT STEPS This curriculum and evaluation can serve as a stepping stone for further evidence-based leadership frameworks, curricula, and evaluations developed specifically for physicians within their unique leadership roles. The feedback and conflict resolution frameworks used in this curriculum can be applied to various medical specialties, with specialty-relevant scenario adaptations for interactive skills practice.
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Taylor L. Global leaders call for negotiators to push through pandemic accord ahead of May deadline. BMJ 2024; 384:q739. [PMID: 38527754 DOI: 10.1136/bmj.q739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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Ma M, Meng W, Huang B, Li Y. New energy vehicles' technology innovation coordination strategy based on alliance negotiation under dual credit policy. PLoS One 2024; 19:e0299915. [PMID: 38489345 PMCID: PMC10942065 DOI: 10.1371/journal.pone.0299915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/17/2024] [Indexed: 03/17/2024] Open
Abstract
The development of new energy vehicles (NEVs) is one of the effective ways to alleviate carbon emissions, environmental pollution, and energy scarcity in the transportation sector. The Chinese government has innovatively proposed the "dual credit policy," but it is still a hot topic whether it can promote the NEVs' technological innovation. In this study, we construct game models and obtain the technological innovation strategies for NEVs under the dual credit policy, considering that the NEV supply chain contains one manufacturer and N suppliers. Further, we construct bargaining game models and study how to encourage manufacturers and suppliers to enhance technological innovation, realize supply chain coordination, and give the alliance strategy to maximize suppliers' profit. We found that the dual credit policy can effectively stimulate technological innovation, and the higher the credit price or technological innovation credit factor, the higher the technical level of NEVs. The findings could guide the government to adjust and revise the policy. Second, we found that the bargaining games could coordinate the NEV supply chain so that decentralized enterprises can achieve optimal technological innovation under centralized decision-making. Third, we found that suppliers can improve their profits by choosing a suitable alliance strategy under the manufacturer's different negotiating power.
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Affiliation(s)
- Miaomiao Ma
- School of Management, Chongqing Institute of Engineering, Chongqing, China
| | - Weidong Meng
- School of Economics and Business Administration, Chongqing University, Chongqing, China
| | - Bo Huang
- School of Economics and Business Administration, Chongqing University, Chongqing, China
| | - Yuyu Li
- School of Economics and Management, Chongqing Normal University, Chongqing, China
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17
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White EN, Saxon M, Hodge JG, Michaels J. Medicare Drug Pricing Negotiations: Assessing Constitutional Structural Limits. J Law Med Ethics 2024; 51:956-960. [PMID: 38477275 PMCID: PMC10937171 DOI: 10.1017/jme.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
A series of structural constitutional arguments lodged in multiple cases against Centers for Medicare and Medicaid Services' (CMS) authorities to negotiate prescription drug prices via the 2022 Inflation Reduction Act threaten the legitimacy of CMS program and federal agency powers.
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Affiliation(s)
- Erica N White
- SANDRA DAY O'CONNOR COLLEGE OF LAW, ARIZONA STATE UNIVERSITY, PHOENIX, ARIZONA, USA
| | - Mary Saxon
- SANDRA DAY O'CONNOR COLLEGE OF LAW, ARIZONA STATE UNIVERSITY, PHOENIX, ARIZONA, USA
| | - James G Hodge
- SANDRA DAY O'CONNOR COLLEGE OF LAW, ARIZONA STATE UNIVERSITY, PHOENIX, ARIZONA, USA
| | - Joel Michaels
- SANDRA DAY O'CONNOR COLLEGE OF LAW, ARIZONA STATE UNIVERSITY, PHOENIX, ARIZONA, USA
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18
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Saunders B, Chew-Graham C, Sowden G, Cooke K, Walker-Bone K, Madan I, Parsons V, Linaker CH, Wynne-Jones G. Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health. Health (London) 2024; 28:185-202. [PMID: 37092765 PMCID: PMC10900846 DOI: 10.1177/13634593221148446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.
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Affiliation(s)
| | | | | | | | | | | | - Vaughan Parsons
- King's College London, UK
- Guy's and St Thomas' NHS Foundation Trust, UK
- University of Southampton, UK
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19
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Qin X. Sample size and power calculations for causal mediation analysis: A Tutorial and Shiny App. Behav Res Methods 2024; 56:1738-1769. [PMID: 37231326 DOI: 10.3758/s13428-023-02118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/27/2023]
Abstract
When designing a study for causal mediation analysis, it is crucial to conduct a power analysis to determine the sample size required to detect the causal mediation effects with sufficient power. However, the development of power analysis methods for causal mediation analysis has lagged far behind. To fill the knowledge gap, I proposed a simulation-based method and an easy-to-use web application ( https://xuqin.shinyapps.io/CausalMediationPowerAnalysis/ ) for power and sample size calculations for regression-based causal mediation analysis. By repeatedly drawing samples of a specific size from a population predefined with hypothesized models and parameter values, the method calculates the power to detect a causal mediation effect based on the proportion of the replications with a significant test result. The Monte Carlo confidence interval method is used for testing so that the sampling distributions of causal effect estimates are allowed to be asymmetric, and the power analysis runs faster than if the bootstrapping method is adopted. This also guarantees that the proposed power analysis tool is compatible with the widely used R package for causal mediation analysis, mediation, which is built upon the same estimation and inference method. In addition, users can determine the sample size required for achieving sufficient power based on power values calculated from a range of sample sizes. The method is applicable to a randomized or nonrandomized treatment, a mediator, and an outcome that can be either binary or continuous. I also provided sample size suggestions under various scenarios and a detailed guideline of app implementation to facilitate study designs.
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Affiliation(s)
- Xu Qin
- Department of Health and Human Development at the School of Education, University of Pittsburgh, 5312 Wesley W. Posvar Hall, 230 South Bouquet Street, Pittsburgh, PA, 15260, USA.
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20
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Mooney H, Martin M, Bendicksen L, Kesselheim AS, Rome BN, Lalani HS. Identifying therapeutic alternatives in Medicare drug price negotiation: The case of etanercept. J Manag Care Spec Pharm 2024; 30:226-233. [PMID: 38088900 DOI: 10.18553/jmcp.2023.23209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
As the Centers for Medicare & Medicaid Services (CMS) navigates the process of negotiating drug prices, it plans to compare the cost, safety, and effectiveness of each drug with its therapeutic alternatives. How CMS selects therapeutic alternatives is a consequential decision, and there remains uncertainty about their methodology. To understand the challenges CMS will face in selecting therapeutic alternatives, we developed a methodology that leverages clinical guidelines by US medical professional associations to identify potential therapeutic alternatives for etanercept, one of the first 10 drugs selected for Medicare price negotiation. For each of etanercept's 5 US Food and Drug Administration-approved indications, we identified all drugs with the same mechanism of action as etanercept and considered drugs with different mechanisms if they were recommended in place of etanercept at the same treatment stage, or if there was no strong comparative safety or effectiveness evidence that the drug differed from etanercept. We identified 22 potential therapeutic alternatives to etanercept, including 4 drugs with the same mechanism, 10 biologics with different mechanisms, and 8 small-molecule drugs. We faced several challenges in selecting therapeutic alternatives using clinical guidelines, such as how to reconcile strong recommendations that were based on weak evidence and how to consider combination therapies. This exercise demonstrates the complex considerations that CMS will face as it negotiates drug prices based on therapies' cost, safety, and effectiveness relative to therapeutic alternatives.
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Affiliation(s)
- Helen Mooney
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Matthew Martin
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Liam Bendicksen
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Benjamin N Rome
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Hussain S Lalani
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
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21
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Luehring-Jones P, Fulford D, Palfai TP, Simons JS, Maisto SA. Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study. AIDS Behav 2024; 28:854-867. [PMID: 37751109 DOI: 10.1007/s10461-023-04189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.
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Affiliation(s)
- Peter Luehring-Jones
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA.
| | - Daniel Fulford
- Department of Occupational Therapy and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Tibor P Palfai
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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22
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Kang SH, Hur JD, Kilduff GJ. Beating the rival but losing the game: How the source of alternative offers alters behavior and outcomes in negotiation. J Appl Psychol 2024; 109:386-401. [PMID: 37856408 DOI: 10.1037/apl0001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Decades of negotiations research has emphasized the importance of having alternatives. Negotiators with high-value outside offers tend to have greater power and claim higher values in the focal negotiation. We extend this line of work by proposing that the source of alternatives-that is, who negotiators receive an alternative offer from-can significantly shape their negotiation behavior and outcomes. Specifically, we examine how negotiators' behavior changes when they face a counterpart who has an offer from their rival. Four studies demonstrate that this situation enhances negotiators' motivation to outperform their counterpart's alternative by reaching an agreement with the counterpart. This in turn leads the focal negotiator to make less aspirational first offers and eventually claim less value in final agreements. Our findings highlight the importance of considering the existing relationships among actors directly and indirectly involved in a negotiation, reveal a novel motive that can guide negotiators' behavior and outcomes, and uncover a previously unexplored negotiation strategy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Julia D Hur
- Stern School of Business, New York University Shanghai
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23
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Vogel M, Kakani P, Chandra A, Conti RM. Medicare price negotiation and pharmaceutical innovation following the Inflation Reduction Act. Nat Biotechnol 2024; 42:406-412. [PMID: 38297186 DOI: 10.1038/s41587-023-02096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Abstract
The Inflation Reduction Act (IRA) requires Medicare to negotiate lower prices for some medicines with high Medicare spending. Using historical data from public and proprietary sources to apply the IRA's negotiation criteria retrospectively, we identify all drugs that met the eligibility criteria from 2012 to 2021 to classify drugs that would have had a negotiated price in effect in 2022 and to calculate associated decreases in industry revenues. Our results suggest that the IRA's reduction in overall industry revenue will be modest, will not affect most top-selling drugs and will not likely result in large-scale defunding of research and development. Changes in the net present value of drug-development projects will be concentrated in medicines where Medicare is a notable purchaser and where the ratio between expected revenue and development costs was only marginally positive before the IRA. Policymakers considering narrowing or expanding the scope of Medicare negotiation should carefully consider the tradeoffs across medicines with diverse characteristics.
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Affiliation(s)
- Matthew Vogel
- Harvard Kennedy School of Government, Cambridge, MA, USA.
| | | | - Amitabh Chandra
- Harvard Kennedy School of Government, Cambridge, MA, USA
- Harvard Business School, Cambridge, MA, USA
| | - Rena M Conti
- Questrom School of Business, Boston University, Boston, MA, USA
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24
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Hernandez I, Cousin EM, Wouters OJ, Gabriel N, Cameron T, Sullivan SD. Medicare drug price negotiation: The complexities of selecting therapeutic alternatives for estimating comparative effectiveness. J Manag Care Spec Pharm 2024; 30:218-225. [PMID: 38088899 DOI: 10.18553/jmcp.2023.23277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2023]
Abstract
Under the 2022 Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) are able to negotiate prices for topselling drugs in the Medicare Part B and D programs. In determining initial price offers, CMS will compare the prices and clinical benefits of the drugs subject to negotiation to the prices and clinical benefits of therapeutic alternatives. Despite the central role that the selection of therapeutic alternatives will play in the price negotiations, the available guidance published by CMS provides few details about how the organization will undertake this process, which will be particularly complex for drugs approved for more than one indication. To better inform the selection process, we identified all US Food and Drug Administration-approved indications for the first 10 drugs subject to negotiation. Using 2020-2021 Medicare claims data, we identified Medicare Part D beneficiaries using each of the 10 drugs. We extracted medical claims with diagnosis codes for each of the approved indications to report the relative treated prevalence of use by indication for each drug. We reviewed published clinical guidelines to identify relevant therapeutic alternatives for each of the indications. We integrated the evidence on the relative treated prevalence of indications and clinical guidelines to propose therapeutic alternatives for each of the 10 drugs. We describe challenges that CMS may face in selecting therapeutic alternatives.
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Affiliation(s)
| | - Emma M Cousin
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle
| | - Olivier J Wouters
- Department of Health Policy, London School of Economics and Political Science, United Kingdom
| | - Nico Gabriel
- Skaggs School of Pharmacy, University of California San Diego
| | - Teresa Cameron
- Skaggs School of Pharmacy, University of California San Diego
| | - Sean D Sullivan
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle
- Department of Health Policy, London School of Economics and Political Science, United Kingdom
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25
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McKeown S. Striving for affordable medicine: Lessons in price negotiation learned from the United Kingdom. J Manag Care Spec Pharm 2024; 30:259-264. [PMID: 38241261 DOI: 10.18553/jmcp.2024.23276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
In August 2022, the Centers for Medicare & Medicaid Services were granted unprecedented power to negotiate the price of some pharmaceuticals covered under Medicare Part D of the Inflation Reduction Act. Price negotiation was previously banned by Medicare Part D legislation but is not a new idea globally. For decades, nations like the United Kingdom have price set or negotiated the cost of medicine with manufacturers, fine-tuning their methodologies, with mixed success. The United States can learn from other countries' work to develop a methodology capable of achieving increased affordability and patient access to medicine. Secretary Xavier Becerra should consider the United Kingdom's policy approach, which facilitates early and transparent collaboration with key stakeholders like patient groups and industry but limits flexibility in evidence submission, to help the United States minimize unintended damage to patient access to new medicines and achieve the Inflation Reduction Act's goals.
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Affiliation(s)
- Sarah McKeown
- University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
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26
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Fiester A. The "Ladder of Inference" as a Conflict Management Tool: Working with the "Difficult" Patient or Family in Healthcare Ethics Consultations. HEC Forum 2024; 36:31-44. [PMID: 35435533 DOI: 10.1007/s10730-022-09476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
Abstract
Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken down. The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties' respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place.
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Affiliation(s)
- Autumn Fiester
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr., Blockley Hall Floor 14, Philadelphia, PA, 19104, USA.
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27
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Poudel N, Ricci S, Slejko JF. Evidence inventory: A patient-centered framework for Centers for Medicare & Medicaid Services to assess the clinical benefit of drugs to inform its maximum fair price negotiation. J Manag Care Spec Pharm 2024; 30:234-240. [PMID: 38088898 DOI: 10.18553/jmcp.2023.23272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
The Inflation Reduction Act passed in August 2022 empowers the Centers for Medicare & Medicaid Services (CMS) to negotiate maximum fair prices for certain expensive drugs. In the process of determining maximum fair prices, CMS gathers evidence on the clinical benefits of these drugs as compared with their therapeutic alternative(s) from various sources. As patients are the primary beneficiaries of the treatment, we recommend that CMS should embrace an approach that prioritizes patient experience when evaluating such diverse sources of evidence in the assessment of the clinical benefit. Thus, we propose to draw on several existing frameworks to support the concept of "evidence inventory," a patient-centered approach to systematically evaluate benefits of drugs under consideration. This 4-step process to develop an evidence inventory includes the following: (1) Formulate the research question-in a PICO(T) (P = population, I = Intervention or exposure, C = comparator, O = outcome, and T = time frame) format, (2) Synthesize evidence, (3) Evaluate the evidence-using evidence inventory, and (4) Reevaluate evidence as new information become available. Patients and other relevant stakeholders play a critical role in each of these 4 steps. The proposed evidence inventory holds the potential to provide a structured and transparent patient-centered framework for evaluating the clinical benefits of drugs as compared with their therapeutic alternative(s) informing CMS maximum fair price negotiation.
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Affiliation(s)
- Nabin Poudel
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore
| | - Salome Ricci
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore
| | - Julia F Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore
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28
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DiStefano MJ, Zemplenyi A, McQueen RB. Assessing clinical benefit in the Medicare Drug Price Negotiation Program: A 2-step approach for improving transparency, consistency, and meaningful patient engagement. J Manag Care Spec Pharm 2024; 30:252-258. [PMID: 38241282 DOI: 10.18553/jmcp.2024.23255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
In early 2024, the Centers for Medicare & Medicaid Services (CMS) will send initial price offers to the manufacturers of the first 10 drugs selected for the Medicare Drug Price Negotiation Program, established under the Inflation Reduction Act. However, CMS has not specified exactly how it will adjust the starting point for an initial price offer based on assessment of a drug's clinical benefit. This article addresses unanswered questions relating to CMS' methods for assessing clinical benefit. Specifically, we address how CMS can weigh various measures of evidence, ensure transparency and consistency, meaningfully incorporate patient and other stakeholder perspectives, and support addressing evidence gaps. We propose a 2-step approach for assessing the overall clinical benefit of a selected drug compared with its therapeutic alternatives that builds on the framework outlined by CMS. In step 1, CMS would evaluate conventional clinical benefit, defined in terms of outcomes commonly used in clinical studies for the selected drug and indications. In step 2, CMS would evaluate other outcomes broadly related to patient experience that are not adequately represented in the clinical literature. Overall, our approach incorporates the advantages of both qualitative and quantitative approaches to value assessment and decision-making. We describe a set of loose decision rules to improve transparency and consistency, recommend incorporating ranks and weights to signal to researchers and manufacturers which elements of clinical benefit and sources of data are the most important, and center meaningful deliberation with clinical experts, patients, and caregivers.
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Affiliation(s)
- Michael J DiStefano
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
| | - Antal Zemplenyi
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
- Syreon Research Institute, Budapest, Hungary
| | - R Brett McQueen
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
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29
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Odouard IC, Anderson GF, Alexander GC, Ballreich J. Sociodemographic and spending characteristics of Medicare beneficiaries taking prescription drugs subject to price negotiations. J Manag Care Spec Pharm 2024; 30:269-278. [PMID: 38140901 DOI: 10.18553/jmcp.2023.23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND The 2022 Inflation Reduction Act authorizes Medicare to negotiate the prices of 10 drugs in 2026 and additional drugs thereafter. Understanding the sociodemographic and spending characteristics of beneficiaries taking these specific drugs could be important describing the impact of the legislation. OBJECTIVE To describe sociodemographic and spending characteristics of Medicare beneficiaries who use the 10 prescription drugs ("negotiated drugs") that will face Medicare drug price negotiations in 2026. METHODS A 20% sample of Medicare Part D beneficiaries from 2020 (n = 10,224,642) was used. Sociodemographic and spending characteristics were descriptively reported for beneficiaries taking the negotiated drugs, including subgroups by low-income subsidy (LIS) status and by drug, and for Part D beneficiaries not taking negotiated drugs. RESULTS Part D beneficiaries taking a negotiated drug compared with Part D beneficiaries not taking a negotiated drug overall had similar sociodemographic characteristics, more comorbidities (3.9 vs 2.2) and higher mean [median] Medicare ($33,882 [$18,251] vs $12,366 [$3,429]) and out-of-pocket (OOP) spending ($813 [$307] vs $441 [$160]). There was variation in characteristics by LIS status. The mean age was highest among non-LIS beneficiaries taking a negotiated drug compared with LIS beneficiaries taking a negotiated drug and beneficiaries not taking a negotiated drug (76.2 vs 69.9 vs 71.4). Among beneficiaries using negotiated drugs, a higher percentage of LIS beneficiaries compared with non-LIS was female (59.7% vs 48.0%), was Black (20.9% vs 6.6%), and resided in lower-income areas (39.1% vs 20.3%). Mean [median] annual Part D OOP spending for negotiated drugs was $115 [$59] for beneficiaries with LIS and $1,475 [$1,204] for beneficiaries without LIS. There were also differences depending on which negotiated drug was used. Drugs for cancer and blood clots had the highest proportions of White users, whereas type 2 diabetes and heart failure drugs had the highest proportions of Black users and beneficiaries residing in lower-income areas. Annual Part D OOP costs were lowest for sitagliptin (LIS: $104 [$60], non-LIS: $1,391 [$1,153]) and highest for ibrutinib (LIS: $649 [$649], non-LIS: $6,449 [$6,867]). Among non-LIS beneficiaries, 24% (22% to 76%) had more than $2,000 in OOP costs. CONCLUSIONS Inflation Reduction Act OOP spending caps and LIS expansion will lower prescription drug costs for beneficiaries with OOP costs exceeding $2,000 who are mostly White and live in higher-income areas, insulin users who are disproportionately Black with multiple chronic conditions, and beneficiaries with low incomes. However, these provisions will not impact the 76% of non-LIS beneficiaries using negotiated drugs who have OOP costs that are still substantial but below $2,000. Negotiations could reduce OOP costs through reduced coinsurance payments for this group, which is older and has more chronic conditions compared with beneficiaries not taking negotiated drugs. Part D plan design, spending, and utilization changes should be monitored after negotiation to determine if further solutions are needed to lower OOP costs for this group.
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Affiliation(s)
- Ilina C Odouard
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gerard F Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - G Caleb Alexander
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeromie Ballreich
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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30
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Poudel N, Ngorsuraches S. Using a patient-centered value assessment to optimize fair prices for Inflation Reduction Act's Medicare Drug Price Negotiation Program. J Manag Care Spec Pharm 2024; 30:241-246. [PMID: 38140902 DOI: 10.18553/jmcp.2023.23233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
In the United States, various federal agencies, institutions, and foundations, including the Centers for Medicare & Medicaid Services (CMS), have supported the incorporation of patient perspective in health care decision-making. Despite a series of patient-focused listening sessions planned as part of the Inflation Reduction Act's Medicare Drug Price Negotiation Program, the details of these sessions in the guidance developed by CMS remain unclear. CMS has not specified how patients' inputs will be used to determine the maximum fair prices (MFPs) of selected drugs for the first round of the negotiations. In this Viewpoint article, we urge CMS to use patient-centered value assessment methods to optimize MFPs in the Medicare Drug Price Negotiation Program. We focused on a stated preference method, the discrete choice experiment, which has been increasingly used to determine patient preferences and patient's willingness to pay for drugs. We discussed an example using a discrete choice experiment as a patient-centered method to assess the value of Jardiance and optimize its MFP in the negotiation program.
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Affiliation(s)
- Nabin Poudel
- University of Maryland School of Pharmacy, Baltimore, MD
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Badenes-Sastre M, Beltrán-Morillas AM, Expósito F. Absence Versus Presence of Intimate Partner Violence in a Sample of Spanish Women: Conflict Resolution Strategies and Associated Variables. Violence Against Women 2024; 30:832-853. [PMID: 36628445 DOI: 10.1177/10778012221147907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Through two studies (N = 544 women), the role of types of relational problems (absence vs. presence of intimate partner violence [IPV]) in the use of conflict resolution strategies (exit and loyalty) was analyzed, considering the serial mediating effect of dependency and commitment and the moderating effect of benevolent sexism. The main results showed that higher scores in dependency and commitment predicted less use of exit strategies among women who reported IPV. No significant results were found regarding loyalty strategy and benevolent sexism. Ultimately, implications for women's perceived risk of future violence were discussed.
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Affiliation(s)
- Marta Badenes-Sastre
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Social Psychology, University of Granada, Granada, Spain
| | - Ana M Beltrán-Morillas
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Francisca Expósito
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Social Psychology, University of Granada, Granada, Spain
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Abstract
In light of research that shows the importance of effective sexual communication for healthier sexual relationships, less unwanted sexual activity, and less sexual violence, this article explores how both dominant and alternative sexual scripts influence sexual communication. Drawing on 51 in-depth interviews with adults in heterosexual, queer, non-monogamous, and kink sex communities about their actual communication and consent practices in sexual interactions, we asked 1) In what ways do dominant sexual scripts affect communication and consent in sexual interactions? 2) What factors encourage people to diverge from these dominant scripts? and 3) How do alternative scripts produce new forms of communication and consent? We found that traditional scripts remain common, especially among those with less sexual experience, and that adherence to these scripts is more likely to correspond to coercive or unwanted sex. Conversely, exposure to alternative sexual scripts via sexual experience, education, or communities often encourages sexual agency and communication. We conclude by discussing the implications of these insights about communicative consent negotiations for sexual violence prevention.
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Affiliation(s)
| | - Michael Sauder
- Department of Sociology and Criminology, University of Iowa
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Miller M, van Geertruyden S, Saxton MC, Savage CY, Weir D, Werner S. A summit on amplifying voices of patients, caregivers, and people with disabilities in Inflation Reduction Act drug price negotiations. J Manag Care Spec Pharm 2024; 30:247-251. [PMID: 38289281 DOI: 10.18553/jmcp.2024.23278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
On September 18, 2023, Cancer Support Community convened patient and caregiver advocates, health care providers, policy experts, and health care innovators and thought leaders for a roundtable discussion on the need to ensure that patients, people with disabilities, and caregivers have a voice in defining "clinical benefit" for the purpose of Medicare Part D drug price negotiations and future health care policies that impact patients. The meeting featured presentations from Lara Strawbridge, Deputy Director for Policy at the Medicare Drug Rebate and Negotiations Group in the Center for Medicare, regulatory expert, Dr Monique Nolan, Counsel at Arnold and Porter, LLP, and 3 panel discussions: IRA Implementation-What Matters to Patients, a discussion of policies expected to impact patients and caregivers who are likely to rely heavily on high-cost drugs or biologics to treat cancer or other chronic illnesses, as well as the future development of novel therapies; The Science of Measuring Patient Experience, a discussion of current science of measuring patient experience and how it should be incorporated into the definition of clinical benefit; and Developing an Infrastructure for External Feedback, a discussion of actions and goals for patient engagement, advocacy opportunities, and how to best coordinate such efforts. This article represents an analysis of relevant resources as well as highlights from these sessions and subsequent discussions. It also outlines principles for engaging patient and provider advocacy organizations, whether in policy, media, or online discussions, surrounding the implementation of the Medicare Drug Price Negotiation Program.
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Jensen AH, Herlin MK, Vogel I, Lou S. A life course perspective on Mayer-Rokitansky-Küster-Hauser syndrome: women's experiences and negotiations of living with an underdeveloped uterus and vagina. Disabil Rehabil 2024; 46:1130-1140. [PMID: 36987844 DOI: 10.1080/09638288.2023.2191014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by the absence or underdevelopment of the uterus and upper part of the vagina. It is usually diagnosed during adolescence, and the present study investigates how women experience and negotiate to live with MRKH syndrome long-term. METHODS From January to March 2021, eighteen Danish women with MRKH syndrome participated in semi-structured interviews via video conference. The mean time since diagnosis was 11.5 years. A thematic analysis using the life course framework as a theoretical approach was applied. RESULTS The analysis identified the diagnosis as a turning point, that dramatically altered the women's imagined futures. Not conforming to dominant social norms regarding sexuality and pregnancy meant that the women continuously managed and negotiated the meaning and impact of MRKH syndrome in relation to the five principles of the life course perspective: (1) Lifelong development, (2) Timing, (3) Human agency, (4) Linked lives, and (5) Historical time and place. CONCLUSION Using the life course framework contributed to a holistic understanding of life with MRKH syndrome by showing how the meaning and consequences of the congenital condition changed over time and in adaptation to gendered and age-related social norms and expectations.IMPLICATIONS FOR REHABILITATIONThe perceived meaning and impact of living with Mayer-Rokitansky-Küster-Hauser syndrome change over time, and women's information and support needs thus change accordinglySensitive, clinical communication is essential when discussing treatment optionsOnline communities may provide support and reduce feelings of loneliness.
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Affiliation(s)
- Amalie Hahn Jensen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Morten Krogh Herlin
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Stina Lou
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
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Ehsan A. Negotiating access to community-based participatory research. Soc Psychiatry Psychiatr Epidemiol 2024; 59:515-522. [PMID: 37966524 PMCID: PMC10944405 DOI: 10.1007/s00127-023-02583-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Community-based participatory research (CBPR) that improves social capital can be a powerful tool for promoting mental health and well-being. This work explores what gaining, maintaining, and losing access to this type of CBPR looks like from a reflexive research perspective. METHOD I describe and reflect on my experiences conducting a mixed-methods study of an existing CBPR to increase social capital in Switzerland. I draw on ethnographic observations, field notes, and reflexive memos collected during fieldwork between 2016 and 2020. RESULTS I negotiated access to the CBPR across three levels: (1) formal organizational with intervention leaders, (2) implementational with facilitators, and (3) the community/group level with participants. Intervention leaders let me conduct research if they benefitted from my work in a timely and reinforcing way, facilitators granted access if I made myself helpful and supported their work, and community members accepted me if I participated in their community meaningfully. I lost access when my findings posed a potential risk to the intervention funding. CONCLUSION I highlight how access is a fluid and complex process that can change throughout CBPR. I show the importance of reflexive analysis to understand how access is negotiated in diverse settings, what sources of social capital are needed to engage in these negotiations, and how positionality and power play a role in this process.
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Affiliation(s)
- Annahita Ehsan
- ESRC Centre for Society and Mental Health, King's College London, London, UK.
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Tunçer M. Doing old(er) age in a translocal context: Turkish-born women's experiences of ageing, care and post-mortem care practices. J Women Aging 2024; 36:107-122. [PMID: 37632741 DOI: 10.1080/08952841.2023.2250236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
This article elaborates on how Turkish-born women in Sweden do old age in relation to gender and migrancy and aims to understand the fluid process of doing over their life course. It draws upon 20 in-depth and semi-structured interviews with Turkish-born women aged 60-78 and aims to address the tensions between agency and intersecting power positions. Theoretically, the article relies on critical feminist gerontology and doing old age to address the negotiations and performances of the interviewed women. The findings show that there are several ambivalences and dilemmas in how the women do old age in a transnational setting. Intergenerational and gendered old age care comes to fore as a significant negotiation site. The women negotiate identity categories with both imagined others and the social actors in their lives (such as their children) over their life course, which implies the situated and relational aspect of doing old age.
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Sommers R. What do consumers understand about predispute arbitration agreements? an empirical investigation. PLoS One 2024; 19:e0296179. [PMID: 38394135 PMCID: PMC10889883 DOI: 10.1371/journal.pone.0296179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/07/2023] [Indexed: 02/25/2024] Open
Abstract
The results of a survey of 1,071 adults in the United States reveal that most consumers do not pay attention to, let alone understand, arbitration clauses in their everyday lives. The vast majority of survey respondents (over 97%) report having opened an account with a company that requires disputes to be submitted to binding arbitration (e.g., Netflix, Hulu, Cash App, a phone or cable company), yet most are unaware that they have, in fact, agreed to mandatory arbitration (also known as "forced arbitration"). Indeed, over 99% of respondents who think they have never entered into an arbitration agreement likely have done so. Over 92% of respondents report that they have never based a decision to use a product or service on whether the terms and conditions contain an arbitration agreement. When prompted, they largely endorse the following reasons: they were unaware of the arbitration clause, they did not read the terms and conditions, and they thought they had no choice but to agree to mandatory arbitration. Moreover, many respondents presume that if a dispute arises, they will still be able to access the public courts, notwithstanding that they agreed to the terms and conditions. Consumers are largely unaware of opportunities to opt out of mandatory arbitration. They generally do not pay attention to or retain information about the steps required to opt out successfully (e.g., contacting the company within a specified time period). Generally, consumers are unaware that companies like Cash App and Venmo (mobile payment systems utilized by nearly 60% of respondents) allow customers to opt out of mandatory arbitration if they act within a limited time period. Among the minority of respondents (21%) who stated that they had been given an opportunity to opt out, vanishingly few could name any of the steps required to opt out successfully. When presented with a run-of-the-mill contract, of the type consumers routinely encounter, most respondents did not take notice of the arbitration clause. Less than 5% of respondents could recall that the contract they were shown had said anything at all about arbitration. Furthermore, most consumers misperceive the consequences of signing a predispute arbitration agreement. Most mistakenly believe that, after agreeing to terms and conditions mandating binding arbitration, they can still choose to settle their dispute in court, have a jury decide their case, join a class action, and appeal a decision made based on a legal error. For instance, less than 5% of respondents correctly reported that they could neither appeal an erroneous decision to another arbitrator (or set of arbitrators) nor start all over again in court. Less than 1% of respondents correctly understood the full significance of the arbitration agreement, as indicated by their responses to questions about whether they retained the rights to sue, have a jury decide their case, access the public courts, and appeal a decision based on a legal error. In summary, consumers are generally unaware of arbitration clauses, and they tend to hold mistaken beliefs about how arbitration agreements affect consumers' procedural rights.
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Affiliation(s)
- Roseanna Sommers
- Michigan Law School, University of Michigan, Ann Arbor, Michigan, United States of America
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Simon JD, Reddy-Best KL. Art, Media, and Fashion: Negotiating Queerness and Catholicism Through Depictions of Saint Sebastian, From the 15 th Century to the Present. J Homosex 2024; 71:691-721. [PMID: 36250980 DOI: 10.1080/00918369.2022.2132442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Queerness and Catholicism have historically been at odds with one another. The Church's condemnation of queer individuals was pervasive globally for centuries, yet one way queerness and Catholicism converge is via Saint Sebastian depictions. The purpose of this research is to examine how and why Sebastian, a Catholic saint, has come to serve as an icon for the queer community as well as how dress has been used in depicting shifting representations of the Saint from the 15th to 21st centuries. Drawing upon the historic method, we critically analyze the meanings present in imagery of Saint Sebastian. Through our study of portrayals of the Saint, several key themes have emerged. Several of these contemporary artworks incorporated written language that reifies sainthood and associated suffering. Furthermore, many artworks' overall composition surrounding Saint Sebastian reinforced sainthood through contextual visual elements. Ambivalence in depictions of Saint Sebastian's fleshy body was apparent, with an emphasis on depicting Sebastian within the context of his executions. A gap in time periods and differing artwork styles was observed, with many of our examples being either from the Renaissance or post 1960s. Finally, many of the contemporary artworks surveyed included overt signifiers of queerness, with minimal references to subtle queerness.
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Affiliation(s)
- Joshua D Simon
- Department of History, Western Michigan University, Kalamazoo, Michigan, USA
| | - Kelly L Reddy-Best
- Apparel, Merchandising, and Design Program, Iowa State University, Ames, Iowa, USA
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Bodin M. 'It wasn't what I was suited for': regretful mothers negotiating their reproductive decision and mother role. Med Humanit 2024; 50:70-76. [PMID: 37977805 DOI: 10.1136/medhum-2023-012717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/19/2023]
Abstract
This study contributes to our understanding of why women without a longing to have children and who, in theory, have the possibility of refraining from parenthood still become mothers. The article is based on in-depth interviews with six Swedish mothers who never longed to have children in the first place. It illustrates how they make sense of their reproductive decision-making process and their current role as a mother. The analysis shows how reproductive decision-making is highly influenced by cultural perceptions of proper womanhood and the idea that every woman has an innate longing to have children, as well as other people's wishes and pressure. Although the mothers did their best to align with motherhood expectations, their narratives show that they are still oriented towards non-motherhood on an emotional level. This manifests through their experiences of existential regret about having children. Hence, the mothers' understandings of their path to motherhood reveal a complex conflict between outer expectations and inner wishes, which destabilises the idea of reproduction as a promise of happiness.
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Affiliation(s)
- Maja Bodin
- Centre for Medical Humanities, Uppsala University Department of History of Science and Ideas, Uppsala, Sweden
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Accoe D, Segers S. 'False hope' in assisted reproduction: the normative significance of the external outlook and moral negotiation. J Med Ethics 2024; 50:181-184. [PMID: 37137697 DOI: 10.1136/jme-2023-108916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023]
Abstract
Despite the frequent invocation of 'false hope' and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of 'false hope' only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from being an object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate.
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Affiliation(s)
- Dorian Accoe
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent & Metamedica, Ghent University, Ghent, Belgium
| | - Seppe Segers
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent & Metamedica, Ghent University, Ghent, Belgium
- Department of Health, Ethics and Society, CAPHRI & GROW, Maastricht University, Maastricht, The Netherlands
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Frumer M. Signs of Nothing: Negotiations Over Semiotic Indeterminacy in Danish Lung Cancer Diagnostics. Med Anthropol 2024; 43:102-114. [PMID: 37603702 DOI: 10.1080/01459740.2023.2206966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
In Denmark, injunctions of "early" cancer diagnosis increasingly imply surveillance of small tissue changes, which may or may not develop into cancer. Based on fieldwork at diagnostic lung cancer clinics and with people in CT surveillance for tissue changes, I explore how detected tissue changes are ascribed meaning as signs of "nothing" or "something." Inspired by Peircean semiotics, I suggest that the semiotic indeterminacy of tissue changes points to how diagnostic socialities both expand medical semiotics and enable this expansion. The article, thereby, contributes to understandings of signs as diagnostic infrastructures.
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Affiliation(s)
- Michal Frumer
- Research Unit of General Practice Aarhus, Denmark
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Mota CP, Sousa JR, Relva IC. Sibling Violence and Bullying Behaviors in Peers: The Mediational Role of Self-Esteem. Int J Environ Res Public Health 2024; 21:227. [PMID: 38397716 PMCID: PMC10888345 DOI: 10.3390/ijerph21020227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
In the context of the existing research on families, sibling violence is a less explored area. However, it has seemingly received more attention recently, and it can assume a relevant role in understanding the maladaptive behavior of youngsters and bullying. Additionally, adolescents involved in bullying and self-esteem are associated with disruptive violence inside the family context. This study's sample consisted of 286 students, aged between 12 and 17 years, from both sexes. This study intends to explore the association between sibling violence and bullying behavior in peers and the mediator effect of self-esteem. The measures for data collection were a demographic questionnaire, the Social Exclusion and School Violence Questionnaire, The Revised Conflict Tactics Scales (Portuguese version for siblings), and the Rosenberg Self-Esteem Scale. The results show a negative effect between negotiation in the sibling relationship (victimization) and social exclusion and verbal aggression related to bullying behavior. Self-esteem represents a total and negative mediator in this connection. Our results also show a variety of indirect outcomes amongst the negotiation dimension, psychological aggression and injury between siblings, and the social exclusion and verbal aggression dimensions (on the aggression and victimization scales). The results will be discussed according to the attachment theory but considering the importance of affective bonds with siblings as a predisposing factor to an adaptive development course.
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Affiliation(s)
- Catarina Pinheiro Mota
- Department of Education and Psychology, University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal; (J.R.S.); (I.C.R.)
- Center for Psychology at the University of Porto (CPUP), R. Alfredo Allen, 4200-135 Porto, Portugal
| | - Joana Rita Sousa
- Department of Education and Psychology, University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal; (J.R.S.); (I.C.R.)
| | - Inês Carvalho Relva
- Department of Education and Psychology, University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal; (J.R.S.); (I.C.R.)
- Center for Psychology at the University of Porto (CPUP), R. Alfredo Allen, 4200-135 Porto, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Centre for Research and Intervention in Education (CIIE), University of Porto, 4200-135 Porto, Portugal
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Patterson JA, Wagner TD, O’Brien JM, Campbell JD. Medicare Part D Coverage of Drugs Selected for the Drug Price Negotiation Program. JAMA Health Forum 2024; 5:e235237. [PMID: 38334994 PMCID: PMC10858397 DOI: 10.1001/jamahealthforum.2023.5237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/06/2023] [Indexed: 02/10/2024] Open
Abstract
This cross-sectional study describes and historically benchmarks Medicare Part D coverage in 2019 and 2023 for the first 10 drugs selected for negotiation.
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Fischer SE, Vitale L, Agutu AL, Kavanagh MM. Intellectual Property and the Politics of Public Good during COVID-19: Framing Law, Institutions, and Ideas during TRIPS Waiver Negotiations at the WTO. J Health Polit Policy Law 2024; 49:9-42. [PMID: 37522338 DOI: 10.1215/03616878-10910269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
CONTEXT To facilitate the manufacturing of COVID-19 medical products, in October 2020 India and South Africa proposed a waiver of certain intellectual property (IP) provisions of a World Trade Organization (WTO) agreement. After nearly two years, a narrow waiver agreement that did little for vaccine access passed the ministerial despite the pandemic's impact on global trade, which the WTO is mandated to safeguard. METHODS The authors conducted a content analysis of WTO legal texts, key-actor statements, media reporting, and the WTO's procedural framework to explore legal, institutional, and ideational explanations for the delay. FINDINGS IP waivers are neither legally complex nor unprecedented within WTO law, yet these waiver negotiations exceeded their mandated 90-day negotiation period by approximately 18 months. Waiver opponents and supporters engaged in escalating strategic framing that justified and eventually secured political attention at head-of-state level, sidelining other pandemic solutions. The frames deployed discouraged consensus on a meaningful waiver, which ultimately favored the status quo that opponents preferred. WTO institutional design encouraged drawn-out negotiation while limiting legitimate players in the debate to trade ministers, empowering narrow interest group politics. CONCLUSIONS Despite global political attention, the WTO process contributed little to emergency vaccine production, suggesting a pressing need for reforms aimed at more efficient and equitable multilateral processes.
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DiStefano MJ, Zemplenyi A, Anderson KE, Mendola ND, Nair KV, McQueen RB. Alternative approaches to measuring value: an update on innovative methods in the context of the United States Medicare drug price negotiation program. Expert Rev Pharmacoecon Outcomes Res 2024; 24:171-180. [PMID: 37961908 DOI: 10.1080/14737167.2023.2283584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The United States has begun assessing the value of pharmaceuticals to inform negotiated prices in the Medicare program. Given strong political objections in the United States to the use of QALYs, Medicare will need to adopt an alternative approach to measuring value. AREAS COVERED In this narrative review, we identified six alternative approaches to measuring value (equal value life-years, health years in total, generalized risk-adjusted cost-effectiveness, severity weighting based on absolute or proportional shortfall, comparative effectiveness based on conventional clinical endpoints, and comparative effectiveness based on both conventional endpoints and patient-centric value elements) and five criteria for assessing these approaches (responsiveness to concerns about discrimination, feasibility, transparency, flexibility, and the ability to incorporate factors beyond traditional value elements). EXPERT OPINION Four of the alternatives are broadly aligned with the cost-effectiveness framework, but none fully addresses all aspects of the stated concerns that QALYs may be used to unintentionally implement discrimination. We note, however, that the extent to which these concerns lead to discrimination in practice is unknown. Finally, we recommend an approach for measuring value in terms of comparative effectiveness that combines quantitative ranking and weighting of distinct criteria (including patient-centric value elements) with deliberation.
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Affiliation(s)
- Michael J DiStefano
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Antal Zemplenyi
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, USA
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Kelly E Anderson
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Nicholas D Mendola
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Kavita V Nair
- Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Robert Brett McQueen
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, USA
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Oke I, Tisdale AK. Comment on: Salary Negotiations: Gender Differences in Attitudes, Priorities, and Behaviors of Ophthalmologists. Am J Ophthalmol 2024; 258:217. [PMID: 37863303 DOI: 10.1016/j.ajo.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/16/2023] [Indexed: 10/22/2023]
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Sood S, Al-Aswad LA. Reply to Comment on "Salary Negotiations: Gender Differences in Attitudes, Priorities and Behaviors of Ophthalmologists". Am J Ophthalmol 2024; 258:218. [PMID: 37863304 DOI: 10.1016/j.ajo.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Shefali Sood
- Department of Ophthalmology, Medstar Georgetown University Hospital/Washington Hospital Center, Washington DC, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, University of Pennsylvania, Scheie Eye Institute, Philadelphia, Pennsylvania, USA
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Capuozzo M, Celotto V, Zovi A, Langella R, Ferrara F. Recovery of suspended reimbursements of high-cost drugs subjected to monitoring registries and negotiated agreements (MEAs): a tool for governance and clinical appropriateness in the Italian reality. Eur J Health Econ 2024; 25:1-5. [PMID: 37878195 DOI: 10.1007/s10198-023-01640-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
The Monitoring Registries and negotiated agreements (MEAs) established by the Italian Medicines Agency (AIFA) exemplify a pinnacle of excellence in Italian healthcare governance, playing a pivotal role in achieving economic sustainability and ensuring judicious allocation of financial resources. Within a local territorial health company catering to a populace of around 1 million individuals in Italy, an assessment of the meticulous implementation of all negotiation procedures was carried out by scrutinizing the monitoring records. This examination served to pinpoint and address potential issues in the platform management executed by healthcare professionals, including physicians and pharmacists. Such issues had the potential to result in economic setbacks owing to the non-reimbursement from pharmaceutical companies. Through diligent verification undertaken by the pharmacists, a financial recovery amounting to approximately €579,443.4 for the fiscal year 2022 was achieved. The essence of this analysis is to underscore how collaborative, multidisciplinary efforts between physicians and pharmacists yield tangible economic advantages. This collaborative approach ensures a streamlined healthcare system characterized by efficiency, devoid of unnecessary expenditures, and marked by the highest standards of care appropriateness, ultimately serving the best interests of the citizens.
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Affiliation(s)
- Maurizio Capuozzo
- Pharmaceutical Department, Asl Napoli 3 Sud, Marittima Street 3, Ercolano, 80056, Naples, Italy.
| | - Venere Celotto
- Pharmaceutical Department, Asl Napoli 3 Sud, Castellammare, Naples, Italy
| | - Andrea Zovi
- Ministry of Health, Viale Giorgio Ribotta 5, 00144, Rome, Italy
| | - Roberto Langella
- Italian Society of Hospital Pharmacy (SIFO), SIFO Secretariat of the Lombardy Region, Carlo Farini Street, 81, 20159, Milan, Italy
| | - Francesco Ferrara
- Pharmaceutical Department, Asl Napoli 3 Sud, Dell'amicizia Street 22, 80035, Naples, Nola, Italy
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Lewis S, Newton G, Kenny K, Boyle F. The incurable self: Negotiating social bonds and dis/connection with metastatic breast cancer. Sociol Health Illn 2024; 46:295-314. [PMID: 37610256 DOI: 10.1111/1467-9566.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
As the culture of silence that once surrounded cancer has gradually given way to greater public awareness, normative visions of what cancer survivorship should entail have proliferated. These visions emphasise positivity and perseverance in pursuit of cure. While these visions provide comfort to many, for people with metastatic cancer, the emphasis on cure can undermine their sense of belonging to the broader collective of people living with cancer. Drawing on semi-structured interviews with 38 Australian women living with metastatic breast cancer, we explore how incurable cancer inflects understandings of self and transforms interpersonal relationships. Extending ideas around biosociality and belonging, we explore the tenuousness of social bonds, revealing how (in)visibility, (in)authenticity and (in)validation circulate within the daily lives of women with metastatic breast cancer. We conceptualise accounts according to four social bonds: (1) threatened bonds where a relationship is strained by misunderstanding, (2) severed bonds where a relationship is ruptured due to misunderstanding, (3) attuned bonds whereby a relationship is based on shared identification and (4) flexible social bonds when a relationship is based on mutual understanding. More broadly, we illustrate the persistence of normative visions of cancer survivorship and their enduring effects on those whom such visions exclude.
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Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, The University of Sydney, New South Wales, Sydney, Australia
| | - Giselle Newton
- Digital Cultures and Societies, University of Queensland, Queensland, Brisbane, Australia
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, New South Wales, Sydney, Australia
| | - Frances Boyle
- Mater Hospital, North Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Horn DM, Jacobson M, Alpert AE, Duggan MG. Why Does the Inflation Reduction Act Exclude Expensive Cancer Treatments in Price Negotiations? JCO Oncol Pract 2024; 20:254-261. [PMID: 38060993 DOI: 10.1200/op.23.00400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 02/15/2024] Open
Abstract
PURPOSE The Inflation Reduction Act (IRA) includes provisions for price negotiations of certain high-spending drugs in Medicare Parts B and D. This provision received considerable attention from those interested in the costs of cancer care since Medicare covers most patients with cancer and many cancer drugs are expensive. We simulate how many cancer drugs may be eligible for IRA price negotiations and examine the reasons that many are likely to be excluded from negotiation. METHODS This study uses 2021 Medicare Fee-for-Service Part B and Part D prescription drugs expenditure data. Cancer drugs were identified using the SEER Program list of cancer medications. Our measures included total spending, beneficiary users, and spending-per-beneficiary for all cancer drugs covered under Medicare. Each drug was evaluated for eligibility on the basis of IRA negotiation provisions, including estimated loss of patent exclusivity, current competitors, and orphan drug designation. RESULTS We found that very few cancer drugs will meet the IRA eligibility thresholds to be included in negotiations. We estimate that only 2.2% of beneficiaries with cancer will see lower costs because of the IRA negotiations. The main reason for this is that although novel cancer drug treatments are priced high, they generally treat relatively few beneficiaries and thus do not meet negotiation eligibility criteria, which are primarily based on a ranking of total spending. CONCLUSION The IRA negotiation provisions will have limited impact on cancer drug prices and will likely leave most patients with cancer exposed to high drug costs.
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Affiliation(s)
| | | | - Abby E Alpert
- The Wharton School, University of Pennsylvania, Philadelphia, PA
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