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Organizing for autonomy
Get PDFThis article aims at explaining work autonomy using contingency theory and agency theory. While prior research relies on individual level data (sometimes across nations), the present analysis specifically aims at understanding work autonomy as a management decision at the organizational level. Data were collected among 670 private companies in the Netherlands using a survey. The companies represent a cross section of the Dutch economy. The data are analyzed using regression analysis. The factors derived from contingency theory and agency theory turn out to predict the use of work autonomy. More generally, they can be understood as internal and external fit factors and the agency problems associated with them. These contingency factors include task characteristics, organizational size, organizational governance, and external developments. Whereas work autonomy is often viewed as a matter of organizational design, much of the empirical work relied on individual level data. As a result, little is known about organizational factors related to the provision of autonomy of workers. For actors involved in organizational practices (e.g. managers and consultancy), the article offers a number of suggestions for managing autonomy. This article specifically focuses on the organizational level by examining data collected among companies
Clinical aspects of a large group of adults with Angelman syndrome
Get PDFDescriptions of the clinical features of Angelman syndrome (AS) have mainly been focused on children. Here, we describe the evolution of the clinical phenotypes of AS in adulthood, using clinical data from 95 individuals (mean age 31.6 years, median 29.0 years, range 18–83 years), with genetically confirmed AS. Data was collected through physical examination and inspection of medical records, combined with questionnaires and interviews. Adults with AS experience substantial debilitating health problems. Constipation, reflux, visual problems, scoliosis, behavioral and sleeping problems occurred frequently and require appropriate attention. Epilepsy was reported in 57% of adults, negatively affecting the level of functioning. Non-convulsive status epilepticus was not observed in the adults, however some individuals developed prolonged episodes of rhythmic shaking while awake. A decline in mobility was noted in the majority of adults. A minority of adults with AS showed microcephaly. Taken together, this first phenotypic study of adults with AS to include in person interviews with care-givers and physical examination of patients, including the eldest adult reported to date, provides important insight in the development of the syndrome into adulthood. This knowledge is required to improve care for adult individuals with AS and to evaluate future therapies for this group
Unveiling the controversy on egg freezing in The Netherlands: A Q-methodology study on women's viewpoints
Get PDFPreserving the option to conceive through egg freezing (oocyte cryopreservation) is surrounded by value conflicts and diverse viewpoints, particularly when non-medical or so-called ‘social’ reasons are involved. The debate is controversial and shaped by normative perceptions of the life course, including concepts regarding reproductive ageing, gender, motherhood and biomedicalization. To unravel the controversy and systematically identify the variety of viewpoints on egg freezing, a Q-methodology study was conducted in The Netherlands between December 2018 and October 2019. Thirty-four women of reproductive age participated in the study. They ranked 40 statements according to their level of agreement, and explained their ranking during follow-up interviews. Data were analysed using by-person factor analysis and interpreted using both quantitative and qualitative data. Four viewpoints, of which the fourth was bipolar, were identified: (1) cautious about egg freezing technology; (2) my body, my choice; (3) egg freezing is unnatural; and (4) have children and have them early. The distinct viewpoints illustrate different prioritizations of values and normative dimensions of biomedical innovations. By knowing more about the prevalent opinions on egg freezing and the surrounding controversy, policy makers and practitioners can make better informed decisions in terms of promoting and providing patient-centred infertility care. The findings furthermore stimulate continuing scholarly work on egg freezing and other innovations in reproductive medicine which may continue to disrupt normative standards
Transnational Systems of Care and Women's Labour Migration: A study of Indonesian domestic workers to and in Malaysia
Get PDFCommunicating Environmental CSR towards Consumers
Get PDFWhile engaging in corporate social responsibility (CSR) has gradually become mainstream in the business context, the investigation of CSR communication and its effectiveness remains limited. This study examines how environmental CSR communication affects consumer perception and behavior through an experiment design. We distinguish three CSR communication factors—message content (climate responsibility vs. sustainable use of natural resources), message style (greenhushing vs. uniform vs. greenwashing) and praise tactics (consumer praise vs. company praise)—and assess their impacts on consumer trust, purchase intention and consumer advocacy, respectively. We also investigate the moderating role of attributed intrinsic and extrinsic corporate motives on engaging in environmental CSR. An online experiment (N = 304) revealed that a uniform message style outperforms the other two styles, whereas greenwashing is found to be least effective. In addition, attributed intrinsic corporate motives moderate the impacts of environmental CSR communication on consumer trust, purchase intention and consumer advocacy, respectively. No moderation effect was found for attributed extrinsic corporate motives. The findings provide important implications for effective environmental CSR communication with respect to specific message styles and attributed corporate motives
Getting Ecosystem-based Management Implemented; How successful decision-makers (should) take up and fill in their task of knowledge governance
Get PDFKnowledge governance is a key but underdeveloped skill in ecosystem-based management. This thesis unravels how successful decision-makers take up and fill in their task of knowledge governance. Using in-depth case study research based on material from ecosystem-based management applications in the North European Wadden Sea area, it shows how decision-makers can make use of different organisational patterns to realize effective generation and utilization of knowledge. Comparative analysis of governance approaches and decision-making contexts furthermore reveals which type of governance approach should be applied in which type of decision-making context. Important suggestions to further improve knowledge governance and insights about how to organize knowledge governance from scratch are provided. With this thesis an attempt is made to professionalize knowledge governance for ecosystem-based management and to increase its implementation in terms of both, quantity and quality
The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies
Get PDFIntroduction: The handling of drug–drug interactions regarding QTc-prolongation (QT-DDIs) is not well defined. A clinical decision support (CDS) tool will support risk management of QT-DDIs. Therefore, we studied the effect of a CDS tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. Methods: An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of three months were included. The impact of the use of a CDS tool to support the handling of QT-DDIs was studied. For each QT-DDI, handling of the QT-DDI and patient characteristics were extracted from the pharmacy information system. Primary outcome was the proportion of QT-DDIs with an intervention. Secondary outcomes were the type of interventions and the time associated with handling QT-DDIs. Logistic regression analysis was used to analyse the primary outcome. Results: Two hundred and forty-four QT-DDIs pre-CDS tool and 157 QT-DDIs post-CDS tool were included. Pharmacists intervened in 43.0% and 35.7% of the QT-DDIs pre- and post-CDS tool respectively (odds ratio 0.74; 95% confidence interval 0.49–1.11). Substitution of interacting agents was the most frequent intervention. Pharmacists spent 20.8 ± 3.5 min (mean ± SD) on handling QT-DDIs pre-CDS tool, which was reduced to 14.9 ± 2.4 min (mean ± SD) post-CDS tool. Of these, 4.5 ± 0.7 min (mean ± SD) were spent on the CDS tool. Conclusion: The CDS tool might be a first step to developing a tool to manage QT-DDIs via a structured approach. Improvement of the tool is needed in order to increase its diagnostic value and reduce redundant QT-DDI alerts. Plain Language Summary: The use of a tool to support the handling of QTc-prolonging drug interactions in community pharmacies Introduction: Several drugs have the ability to cause heart rhythm disturbances as a rare side effect. This rhythm disturbance is called QTc-interval prolongation. It may result in cardiac arrest. For health care professionals, such as physicians and pharmacists, it is difficult to decide whether or not it is safe to proceed treating a patient with combinations of two or more of these QT-prolonging drugs. Recently, a tool was developed that supports the risk management of these QT drug–drug interactions (QT-DDIs). Methods: In this study, we studied the effect of this tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of 3 months were included. Results: Two hundred and forty-four QT-DDIs pre-implementation of the tool and 157 QT-DDIs post-implementation of the tool were included. Pharmacists intervened in 43.0% of the QT-DDIs before the tool was implemented and in 35.7% after implementation of the tool. Substitution of one of the interacting agents was the most frequent intervention. Pharmacists spent less time on handling QT-DDIs when the tool was used. Conclusion: The clinical decision support tool might be a first step to developing a tool to manage QT-DDIs via a structured approach
Avoiding Tacrolimus Underexposure and Overexposure with a Dosing Algorithm for Renal Transplant Recipients: A Single Arm Prospective Intervention Trial
Get PDFBodyweight-based tacrolimus dosing followed by therapeutic drug monitoring is standard clinical care after renal transplantation. However, after transplantation, a meager 38% of patients are on target at first steady-state and it can take up to 3 weeks to reach the target tacrolimus predose concentration (C0). Tacrolimus underexposure and overexposure is associated with an increased risk of rejection and drug-related toxicity, respectively. To minimize subtherapeutic and supratherapeutic tacrolimus exposure in the immediate post-transplant phase, a previously developed dosing algorithm to predict an individual’s tacrolimus starting dose was tested prospectively. In this single-arm, prospective, therapeutic intervention trial, 60 de novo kidney transplant recipients received a tacrolimus starting dose based on a dosing algorithm instead of a standard, bodyweight-based dose. The algorithm included cytochrome P450 (CYP)3A4 and CYP3A5 genotype, body surface area, and age as covariates. The target tacrolimus C0, measured for the first time at day 3, was 7.5–12.5 ng/mL. Between February 23, 2019, and July 7, 2020, 60 patients were included. One patient was excluded because of a protocol violation. On day 3 post-transplantation, 34 of 59 patients (58%, 90% CI 47–68%) had a tacrolimus C0 within the therapeutic range. Markedly subtherapeutic ( 20 ng/mL) tacrolimus concentrations were observed in 7% and 3% of the patients, respectively. Biopsy-proven acute rejection occurred in three patients (5%). In conclusion, algorithm-based tacrolimus dosing leads to the achievement of the tacrolimus target C0 in as many as 58% of the patients on day 3 after kidney transplantation