Objective: Patients' satisfaction is one of the most important goals in complete denture therapy, and there are many factors influencing this parameter. This study aimed to determine patient satisfaction with conventional removable complete denture made by clinical year students at the Faculty of Dentistry, Al Azhar University - Gaza. Methods: A sample of 85 patient who had conventional removable complete denture made by clinical year students at the Faculty of Dentistry Al Azhar University - Gaza filled (...) a questionnaire two months after denture insertion. The questionnaire involving four sections including personal information, history, denture evaluation in aspects of mastication, speech, aesthetics and retention, and patient comfort. Results: Of the 85 patient studied, 81% were males, and the mean age was 60.3 years SD+-9.64. The majority (n= 67, 79 %) lost their teeth because of bad oral hygiene. The overall satisfaction level was (92.1%), and patients were more satisfied with their upper denture. A significant association was found between the patient satisfaction and prior denture use experience (p=0.013). No significant correlation was established between the patient satisfaction and their gender (p=0.188), age group (p=0.640) and employment status (p=0.667).Conclusion: The patients have shown a high level of overall satisfaction. A significant association was found between the overall satisfaction level of patients and prior denture use experience. No statistically significant association was observed between the overall satisfaction level of patients and with each of age group, employment status and gender. (shrink)

Objectives: This study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care. -/- Methods: Interviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps for Coding (...) and Theorization (SCAT) method. -/- Results: The major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers. -/- Conclusion: These findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs. (shrink)

Health service consumers' satisfaction with the services they receive has been a challenge over the past decade, and this has been attributed to many factors that diverse scholars have investigated using different variables. In this study, the attitude and ethical behaviours of healthcare providers as antidotes to health service consumers' satisfaction in the Primary Health Centre at Mgbuoshimini, Port Harcourt, Nigeria, were investigated. A cross-sectional descriptive research design was used to select participants from pregnant women, nursing mothers, couples (...) for family planning, and sick patients. The data were analysed using descriptive statistical tools. The results of the grand total response values were 400 (100%) and strongly agree had 190 (47.5%), agree had 160 (40%), 390 (100%) and strongly agree had 260 (66.7%), agree had 100 (25.6%), and strongly disagree had 13 (3.3%). The overall results were strongly agreed (66.7%) and agreed (25.6%); these connote that the attitudes and ethical behaviours of the healthcare providers towards healthcare service consumers in the primary healthcare facility were poor and that healthcare providers do not execute good ethical behaviour towards health service consumers in the facility, leading to low levels of health resource consumption, low patronage image promotion, and consumers' loss of confidence in the service provider. Therefore, the government should put mechanisms in place to ensure a positive attitude and favourable ethical behaviour among healthcare providers, and individual healthcare providers should also acquire soft skills to improve their attitude and ethical behaviour. (shrink)

The healthcare industry has become a paramount concern for most people in Ghana and the quality of services rendered to the patients in the private hospitals cannot be overemphasized. Patients need quality of services most and are willing to seek better services. The government has been the main provider of health care services in Ghana but recently, some Non-Governmental Organization’s (NGO’s), private individuals and stakeholders also provide health care services which has surged the competitiveness in creating more healthcare facilities in (...) Ghana. This study seeks to explore patients' choice of selecting quality healthcare services and the factors that affect patient satisfaction in private hospitals using the case of Comboni Hospital in Sogakope, Ghana. The study therefore used the quantitative research method to collect the data and SPSS version 22 was used to analyze the data on high-quality healthcare. The SERVQUAL model was used as the measurement scale. Multiple regression analysis was used to reveal the effect of the independent variables (reliability, responsiveness, empathy, assurance, and tangibility) on the dependent variable (patient satisfaction). A detailed description in the analysis and the data processing identified the main factors affecting the general perceptions and patient preferences about their healthcare in the private hospital. The study revealed that there exist a positive result and perception for quality healthcare services without a negative expectation of the patient healthcare being compromised. The study recommends that both the government and the private agencies should consider the important aspects of the hospital’s healthcare management and also the policy and decision makers should have an efficient and effective standard that impact the quality of healthcare assessment in Ghana. (shrink)

Background The health care sector is experiencing a drastic transition all over the world. This has an impact not only on the way hospitals, clinics, special-care homes etc. are organized, but also on patients, personnel and other stakeholders involved. The consequences of changes for both physicians and patients are investigated using a comprehensive health care reform in Ukraine as an example. -/- Methods The analysis is based on empirical data collected from general physicians in 2 Ukrainian cities. Based on the (...) Job Demands-Resources Model, we developed a set of hypotheses and tested them using the structural equation modelling technique. A total of 178 general physicians (81% of the approached population) participated in the study. -/- Results Our investigation reveals a clear relationship between the organizational job demands (additional tasks, structural changes, new processes) and their psychological effects (e. g., burnout). The latter have a negative impact on cooperation of physicians in hospitals leading to lower patient satisfaction. -/- Discussion and Conclusions Change in health care is inevitable. The example of Ukraine shows that openness of hospitals towards change reduces the probability of physicians’ burnout and, eventually, increases patient satisfaction. We strongly suggest applying the process management approach in order to increase openness to change, especially in turbulent times. (shrink)

Aim Excellent organization of the internal processes is essential for a well-functioning health care system. Particularly, the process of treatment and interaction with the patients is important because the perception of treatment and interaction has a direct relation to the patients’ satisfaction. The latter has a strong influence on the recovery of the patients. The impact of the maturity level of the treatment and interaction process on patient orientation is investigated at the example of an extensive survey of (...) hospital managers in Ukraine. -/- Method The analysis is based on an empirical data collection conducted with hospital managers and their deputies in a large Ukrainian city, which is acknowledged as a ‘model city’ with regard to a comprehensive health care reform in the country. By means of the Business Process Maturity Model (BPMM) we have tested our hypothesis that a high level of process maturity leads to a high level of patient orientation. For this purpose, we have developed a scale for measuring the level of process maturity and have checked the method on validity and reliability. A total of 79 hospital managers and deputies, who represent all public health care facilities of the city (hospitals, primary care clinics, etc.), participated in the study. -/- Results The study reveals a clear relationship between the level of maturity of the treatment and interaction process and the level of patient orientation of the respective health care facility. The variance, which is explained by the independent variable process maturity level, is 16.3 %. All formative dimensions have a strong significant influence on the construct “patient orientation”. Likewise the maturity level of the treatment and interaction process shows a strong significant influence on patient orientation. -/- Conclusion For health care facilities it is of great importance to achieve a high maturity level of the treatment and interaction process to live up to the claim of being patient oriented. The maturity of the process can be tested using the questionnaire developed in the course of our study. (shrink)

In Deep Medicine, Eric Topol argues that the development of artificial intelligence (AI) for healthcare will lead to a dramatic shift in the culture and practice of medicine. Topol claims that, rather than replacing physicians, AI could function alongside of them in order to allow them to devote more of their time to face-to-face patient care. Unfortunately, these high hopes for AI-enhanced medicine fail to appreciate a number of factors that, we believe, suggest a radically different picture for the (...) future of healthcare. Far from facilitating a return to “the golden age of doctoring”, the role of economic and institutional considerations in determining how medical AI will be used mean that it is likely to further erode therapeutic relationships and threaten professional and patient satisfaction. (shrink)

The study aimed to identify the sharing of information and its impact on the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The study adopted the descriptive analytical approach. The number is 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was that there is a statistically significant effect at the (...) level (α≤0.05) of information sharing for the performance of the medical staff in the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The axis of participation in information came with a relative weight (69.6%) and a high degree. The level of health care quality was high with a relative weight of (69.0%). One of the most important recommendations of the study was the need to pay attention to measuring patients' satisfaction levels, and to set up a box for complaints and suggestions for patients, and what are their suggestions and point of view for the service provided to them. (shrink)

Introduction. The medical sphere is constantly evolving, requiring improved approaches to its organisation and functioning. Advances in medical technology, observable changes in patient needs and growing competition challenge medical institutions to improve their strategies and approaches. Marketing technologies are becoming one of the key tools for achieving strategic goals. Purpose. This article is aimed at studying the peculiarities of the use of marketing technologies in the medical field. The main purpose of the study is to analyse the impact of (...) marketing tools on the development and success of medical institutions. Method (methodology). The methodological approach involves the use of an analytical approach to studying current trends in marketing and their impact on the healthcare sector. The study uses methods of data analysis and comparative analysis of marketing practices in medical institutions. Results. The study found that the use of targeted marketing strategies allows healthcare facilities to attract more patients, increase customer satisfaction and ensure an excellent reputation. The results of the study show a positive impact of the use of marketing tools on changing the perception of medical services by patients. Conclusions. The scope of application of the results is the practical activities of medical institutions seeking to improve their strategy of promotion and interaction with customers. The findings of the study can be used by marketers and managers of healthcare organisations to develop and implement effective marketing strategies. In summary, this article reveals the importance of using marketing technologies in the healthcare sector and provides practical recommendations for their successful implementation. The study emphasises that marketing in the healthcare industry is necessary to increase competitiveness and ensure quality medical care. (shrink)

Cycling is one of the typical recreational activities, transportation, and sport among elderly adults in the Philippines. Based on the study, cycling provides many benefits to physical health, promotes well-being, contributes to improved quality of life, and is a great way for elderly adults to prevent depression, anxiety, and other mental health issues. As cycling becomes more prevalent during pandemics, the road has changed to include adding more bicycle lanes. Thus, the researchers explore the lived experiences of senior cyclists, specifically: (...) (1) to describe the experiences, (2) challenges, and (3) coping mechanisms. Correspondingly, the study used fifteen (15) participants in an Interpretative Phenomenology Analysis (IPA) procedure. The following findings are drawn from the study: (1) Most of the senior cyclists experienced life-threatening events while cycling, they experienced a high level of satisfaction and happiness, (2) Most senior cyclists are not bothered by the difficulties that others might view as a barrier to them continuing to pedal with passion. (3) Despite all the obstacles they may encounter, senior cyclists choose to get through those challenges by being understanding, patient, and calm. (shrink)

This essay is divided into two parts, deeply intermingled. Part I examines not only the origin of conscious experience but also how it is possible to ask of our own consciousness how it came to be. Part II examines the origin of experience itself, which soon reveals itself as the ontological question of Being. The chief premise of Part I is that symbolic communion and the categorizations of language have enabled human organisms to distinguish between themselves as actually existing entities (...) and their own immediate experience of themselves and their world. This enables them to reflect upon abstract concepts, including “self,” “experience,” and “world.” Symbolic communication and conceptualization grow out of identification, the act of first observing conscious experiencing and intimating what it is like, mimesis, a gestural protolanguage learned through imitation, and reflection, seeing oneself through the eyes of others. The step into actual intentional speech is made through self-assertion, narrative, and intersubjectivity. These three become the spiral of human cultural development that includes not only the adaptive satisfaction of our biological needs, but also the creativity of thought. With the mental-conceptual separation of subject and object – of self and world – the human ability to witness the universe (and each other) is the ground of our genuinely human quality. Consciousness gives human life its distinctively human reality. It is, therefore, one and the same ability that enables us to shape planet Earth by means of conceptual representations (rather than by means of our hands alone) while also awakening us to the significance of being. -/- Looking beyond human self-consciousness to investigate the origin and nature of awareness itself in Part 2, reductive objective materialism is found to be of little use. Direct experience also falls short in that, in order to be transformed into objective knowledge about itself, it must always be interpreted through and limited by the symbolic contexts of culture and the idiosyncratic conceptualizations of the individual. Awareness-in-itself must thus be considered ultimately unexplainable, but this may more indicate its inexpressible transcendence of all symbolic qualifiers than its nonexistence. It is suggested that awareness is not “self-aware” (as in deity) but is instead unknowing yet identical with the only true universal: the impetus of creative unfolding. Our human knowledge, as an expression of this unfolding, is seen to emerge from our conscious experiencing and, in turn, to have the power – and enormous responsibility – of directing that experience. Our underlying symbolic worldviews are found to be autopoietic: They limit or open our conscious experience, which, in turn, confirms those worldview expectations. As we explore a future of unforeseeable technological breakthroughs on an ailing planet who patiently copes with our “success,” truly vital decisions about the nature, meaning, extent, and future of conscious experience will have to be made. (shrink)

Abstract The values of the healthcare sector are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. But their ability to honor these values is significantly determined by the nature of the system they work in. -/- The paper starts with a model of the prevailing pharmacist workforce model in Scotland, in which core roles are predominantly separated into hierarchically disaggregated jobs focused (...) on one professional ‘pillar’: Clinician /Practice Provider; Educator; Leader/Manager; and Researcher. This is the ‘Atomistic’ Model. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating together, and lacking a shared information flow, purpose and identity. Key strategic flaws include suboptimal responsiveness to population and subpopulation needs, inconsistency and inequity of care, an erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. -/- The paper contrasts this with a new emerging workforce vision, The Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, will support sustainability and succession planning. Horizontal skills integration (across practice, leadership and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral theory and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize and honor healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-pillar professional curricula across the career spectrum. Potential pitfalls and challenges are also discussed. -/- Co-Authors: 1. Paul Forsyth (PF) Lead Pharmacist Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Writing - original draft (lead author), Writing - review & editing (lead author) 2. Andrew Radley (AR), Consultant in Public Health Pharmacy, NHS Tayside. Contribution: Conceptualization; Model curation; Model Theory; Writing - review & editing 3. Gordon Rushworth (GR), MPharm MSc FFRPS FRPharmS (Consultant). Programme Director, Highland Pharmacy Education & Research Centre, NHS Highland, Inverness. Contribution: Model curation; Writing - review & editing 4. Fiona Marra (FM) National Lead Clinician Scottish Infection and Immunology Network (SPAIIN) / Advanced Pharmacist HCV / HIV, NHS Greater Glasgow & Clyde. Contribution: Model curation; Writing - review & editing 5. Susan Roberts (SR) Associate Postgraduate Pharmacy Dean, NHS Education for Scotland. Contribution: Model curation; Writing - review & editing 6. Roisin O’Hare (RO) Lead Teacher Practitioner Pharmacist, Northern Ireland University Network, Southern Health and Social Care Trust. Contribution: Model curation; Writing - review & editing 7. Catherine Duggan (CD) Chief Executive Officer, International Pharmaceutical Federation (FIP). Contribution: Model curation; Writing - review & editing 8. Barry Maguire (BM) Senior Lecturer, School of Philosophy, Psychology and Life Sciences, The University of Edinburgh. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Supervision; Writing - original draft (senior academic supervisor), Writing - review & editing (senior academic supervisor) -/- . (shrink)

The fifth text-revised iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines paraphilia as “any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners”. Paraphilic disorders specifically denote a paraphilia that is “currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others”. A diagnosis of paraphilic disorder either demands the (...) personal distress and/or impairment of function that is caused by the atypical sexual urges and fantasies to be present, or the status of non-consent of the other person that these sexual fantasies and urges are directed towards when acted upon by the patient. This paper discusses how consent not only becomes the standard for permissible and legal sexual activity with other persons, but also, when the diagnostic criteria are taken at face-value, for sexual pathology in the DSM-5-TR when the patient acts on their sexual urges. After a close investigation of various possible interpretations of the element of non-consensuality in the diagnostic criteria for paraphilic disorders, this paper concludes that the DSM-5-TR does not offer a clarifying explanation on how mental health professionals should under-stand its approach to diagnosing paraphilic disorders, leaving us with an ambiguous, unclear and unsettled conceptualisation of what it would mean to fulfil its diagnostic criteria. (shrink)

The issue of safety culture is one of the most important in a modern medical facility because any problems during the provision of services may lead to irreversible consequences. Not only the patient may suffer, but the doctor who assisted. Unfortunately, very little attention to this issue is paid in Ukraine. Based on this, we can say that the topic is relevant and requires studying. -/- The purpose of writing this article is the analysis of the ways of forming (...) professional safety culture in clinical medicine. The methods by which we carried out scientific research are observation, analysis, evaluation, comparison, generalization. -/- The work examined interpretation of the term "safety culture", types of innovation in which it belongs and the main methods of its creation in the medical field. -/- Safety culture in the medical field involves the right of all health care workers to use measures to prevent actions that can harm a patient or a colleague. Different approaches were considered in the interpretation of the term "safety culture" and we proposed our own: safety culture is a system of values, objectives, knowledge and skills, rules and procedures, convictions shared by representatives of a certain medical profession and supported by patients, creating a favourable working climate, atmosphere of trust and becoming an efficient tool for achieving the goals of the organization. -/- The main components of the safety culture were defined: responsibilities of managers, communication, performance, resources of safety, trust, the degree of job satisfaction, etc. Based on several studies, it was found that no country has a perfect medical system. Every system should be improved. -/- We proposed measures to fix the situation with the safety culture in health care facilities. The correct management of safety can eliminate or fix many medical errors. That is why the need for a clear program of implementation, execution and control of SC in the medical establishment is necessary. -/- Scientific novelty of this work lies in the interpretation of the term "safety culture" at medical institutions and in determining major steps towards its creation. Practical value of the work is the opportunity to implement these steps in medical institutions for improvement of the safety culture and, therefore, to reduce the risk of bad accidents during treatment. -/- Further research can address safety culture management in medical institutions on the examples from the experience of countries with effective systems of health care. (shrink)

Parenthood is one of the best gifts nature and god has given to humans. Being a parent is a feeling that can be compared to none other but as a baby caretaker a nanny can do this. As a parent, we always strive to provide the best of everything to our children. This however often comes at a price. Mostly it means that both the parents have to be working in order to provide the best facilities and at the same (...) time secure the future of their children and Newborn Baby. Even if one of the parent chooses to sacrifice the career and stay at home, raising a child in a nuclear family set up is still a challenge. -/- This is when an experienced and gentle baby caretaker can be of utmost help. However such caretaker who can be entrusted with the care and security of your child is often hard to find. Especially in cities like NOIDA baby caretaker are available for your service. Well no more. -/- No more is the need to sacrifice your career or professional aspirations. You can peacefully leave to work, entrusting your lovely children in the hands of the baby caretaker. Majority of the time that your child will be spending is with the caretaker and it is therefore absolutely necessary that a baby caretaker possess all the qualities of a good parent. Benevolence, patience, care and attention, all these qualities can be found in the baby caretaker provided by us. Our caretaker ensures the welfare of the child, creating the environment for sound mental, emotional and health development of the children. -/- We need to guarantee that the caretaker has the child's best interest at heart and looks at the security of our child with the same eye as we do. We select the baby caretakers that view this profession as means of contentment and satisfaction in their lives and not just another menial job to earn their livelihood. Children have the inherent need to have somebody always around them in oder to feel secure and wanted, avoiding loneliness and boredom. A Caretaker for baby in Noida not only provides this companion but also ensures that the natural curiosity of a child is kept alive even in the absence of their parents. -/- Big cities with the diverse kind of population, mostly coming to work from various parts of the country, have had some history of violent cases. And that’s why precaution should be taken while hiring Best caretaker in Noida . With thorough background check and verified references, all such apprehensions can be laid to rest.+ . (shrink)

One notable component to look at in the teaching-learning process is the way the subject is taught because one way or another, students are greatly affected by it. Viewing students’ perspectives on the use of the different teaching methods, this study determined the frequency of use of these teaching methods and their level of satisfaction. Through a systematic investigation, the findings from a critical questionnaire administered to first-year BS Hospitality Management college students at Ifugao State University were analyzed and (...) summarized. The frequency of use of the indicated instructional strategies was shown to have a significant relationship with student satisfaction in this study. Furthermore, the data reveal a substantial difference in student satisfaction with instructional approaches utilized before and during the pandemic. Students, on the other hand, prefer the teaching techniques employed before the outbreak to those utilized during the pandemic. (shrink)

The purpose of this paper is to present a general mechanistic framework for analyzing causal representational claims, and offer a way to distinguish genuinely representational explanations from those that invoke representations for honorific purposes. It is usually agreed that rats are capable of navigation because they maintain a cognitive map of their environment. Exactly how and why their neural states give rise to mental representations is a matter of an ongoing debate. I will show that anticipatory mechanisms involved in rats’ (...) evaluation of possible routes give rise to satisfaction conditions of contents, and this is why they are representationally relevant for explaining and predicting rats’ behavior. I argue that a naturalistic account of satisfaction conditions of contents answers the most important objections of antirepresentationalists. (shrink)

I theorize that relationship satisfaction can be increased by spending more time in nature, primarily through stress reduction that is induced by nature environments.

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

Background and Aim: Today universities admit International Students as well as national students. Tehran University of Medical Sciences has been also started admitting International Students in regards of its Internationalization aims. Student’s satisfaction is of high importance in order to gain the given goals. The purpose of this study was to evaluate the satisfaction of International students of TUMS. -/- Materials and Methods: This was a descriptive study. The target group was international students of TUMS, the participants were (...) selected through availability sampling. The research instrument was researcher-made questionnaire which the reliability calculated as 0.97 by Chronbach’s alpha. The data was analysied by Microsoft Excell version 2010. -/- Results: The overall satisfaction of the students was 70% (satisfied and completely satisfied) while the overall dissatisfaction was 10% (dissatisfied and completely dissatisfied). -/- Conclusion: Given satisfaction of more than half of the International students, TUMS has performed reasonably. Based on the results obtained in this research the university may pay attention to the fields reported as dissatisfied. (shrink)

This article considers two different ways of formulating a desire-satisfaction theory of prudential value. The first version of the theory (the object view) assigns basic prudential value to the state of affairs that is the object of a person’s desire. The second version (the combo view) assigns basic prudential value to the compound state of affairs in which (a) a person desires some state of affairs and (b) this state of affairs obtains. My aims in this article are twofold. (...) First, I aim to highlight that these are not mere notational variants, but in fact have quite different implications, so that this distinction is not one that the theorist of prudential value should ignore. More positively, I argue that the object view is better able to capture what is distinctive and appealing about subjective theories of prudential value, on any plausible account of what the central subjectivist insight is. (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and (...) Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

Desire satisfaction has not received detailed philosophical examination. Yet intuitive judgments about the satisfaction of desires have been used as data points guiding theories of desire, desire content, and the semantics of ‘desire’. This paper examines desire satisfaction and the standard propositional view of desire. Firstly, I argue that there are several distinct concepts of satisfaction. Secondly, I argue that separating them defuses a difficulty for the standard view in accommodating desires that Derek Parfit described as (...) ‘implicitly conditional on their own persistence’, a problem posed by Shieva Kleinschmidt, Kris McDaniel, and Ben Bradley. The solution undercuts a key motivation for rejecting the standard view in favour of more radical accounts proposed in the literature. (shrink)

Recently, Jardas _et al_ have convincingly defended the patient preference predictor (PPP) against a range of autonomy-based objections. In this response, I propose a new autonomy-based objection to the PPP that is not explicitly discussed by Jardas _et al_. I call it the ‘objection from higher-order preferences’. Even if this objection is not sufficient reason to reject the PPP, the objection constitutes a pro tanto reason that is at least as powerful as the ones discussed by Jardas _et al._.

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...) decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices (...) are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

The study examined the influence that the psychological contract has on the job satisfaction and dissatisfaction of employees in the South African workplace. It also studied in detail, the effect that psychological contract breach and fulfilment have on the satisfaction of employees with regard to their work, fellow-employee, supervisor, and the as a whole organisation. The data for this study therefore, was collected through perusal of existing scientific articles/papers, published/unpublished dissertations and theses, text books and other relevant informative (...) documents. This makes the study to be premised on theoretical and analytical methodology. This article therefore, reveals the destructive effects that psychological contract breach has on the operation of organisations in South Africa, which are also presented and discussed in detail. The article also reveals the costly effect that employees’ job dissatisfaction has on organisations in terms of unplanned employee turnover. For the enhancement of psychological contract fulfilment, this article proposes strategies for organisations to adopt and implement, with an aim of improving employees’ job satisfaction in the workplace and ultimately discouraging turover intentions among employees. This study therefore, plays a very important and significant role in terms of contributing to literature and better understanding of psychological contract in general, and the effects that psychological contract has on employees’ job satisfaction and dissatisfaction in particular. (shrink)

Biosemiotics deal with the study of signs and meanings in living entities. Constructivism considers human knowledge as internally constructed by sense making rather than passively reflecting a pre-existing reality. Consequently, a constructivist perspective on biosemiotics leads to look at an internal active construction of meaning in living entities from basic life to humans. That subject is addressed with an existing tool: the Meaning Generator System (MGS) which is a system submitted to an internal constraint related to the nature of the (...) agent containing it (biological or artificial). Simple organisms generate meanings to satisfy a “stay alive” constraint. More complex living entities manage meaningful representations with more elaborated constraints. The generated meanings are used by the agents to implement actions aimed at satisfying the constraints. The actions can be physical, biological or mental and take place in the agent or in its environment. The case of human agency is introduced with meaningful representations that may have allowed our ancestors to become self-conscious by representing themselves as existing entities. This paper proposes to use the MGS as a thread to address the above items linking biosemiotics to constructivism with relations to normativity, agency and autonomy. Possible continuations are introduced. (shrink)

It is common to distinguish moral rules, reasons, or values that are agent-relative from those that are agent-neutral. One can also distinguish moral rules, reasons, or values that are moment-relative from those that are moment-neutral. In this article, I introduce a third distinction that stands alongside these two distinctions—the distinction between moral rules, reasons, or values that are patient-relative and those that are patient-neutral. I then show how patient-relativity plays an important role in several moral theories, gives (...) us a better understanding of agent-relativity and moment-relativity, and provides a novel objection to Derek Parfit’s “appeal to full relativity” argument. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on (...) the treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

According to the popular Whole Life Satisfaction theories of happiness, an agent is happy when she judges that her life fulfils her ideal life-plan. Fred Feldman has recently argued that such views cannot accommodate the happiness of spontaneous or pre-occupied agents who do not consider how well their lives are going. In this paper, I formulate a new Whole Life Satisfaction theory which can deal with this problem. My proposal is inspired by Michael Smith’s advice-model of desirability. According (...) to it, an agent is happy when a more informed and rational hypothetical version of her would judge that the agent’s actual life matches the best life-plan for her. This view turns out to be a flexible model which can avoid many problems of the previous theories of happiness. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on (...) the treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

This paper presents a new analysis of the concept of non-instrumental need, and, using it, demonstrates how a need-satisfaction theory of well-being is much more plausible than might otherwise be supposed. Its thesis is that in at least some contexts of evaluation a central part of some persons’ well-being consists in their satisfying certain “personal needs”. Unlike common conceptions of other non-instrumental needs, which make those out to be moralised, universal, and minimal, personal needs are expansive and particular to (...) particular persons, generated rather by persons’ non-moral personal commitments. Against objections to the contrary, I show how these are genuine necessities, since unlike mere desires and freely escapable aims, personal needs constitute objective, inescapable, and non-compensable practical requirements. The personal-need-satisfaction theory of well-being combines objectivity with subject-dependence in novel ways, and motivates well-being pluralism at the level of individual agency. Implicating necessity as it does in the structure of individual well-being, this account presents a robust challenge to ethical and political theories that rely on the intrapersonal aggregation of well-being to be unproblematic. (shrink)

Higher educational Institutions aim to produce quality graduates. They want their graduates to manifest better skills in their jobs. Thus, this research aimed to gather feedback from employers about the CTEAS alumni. This sequential explanatory research explored the satisfaction of 100 employers with the manifested skills of the College of Teacher Education, Arts, and Sciences (CTEAS) alumni. Through Google Forms, the employers rated the manifested skills of the CTEAS alumni. Based on the results, employers have a high level of (...) satisfaction in terms of the skills of the alumni. They were very satisfied with the manifested foundation, enterprise, technical and knowledge, adaptive, teamwork, employability, and managerial skills. Thus, to sustain in producing fully equipped graduates, the department needs to hone further the foundation and technical and knowledge skills of their graduates. (shrink)

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, (...) and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient. (shrink)

A number of bioethicists have been critical of the power of the family to “veto” a patient’s decision to posthumously donate her organs within opt-in systems of organ procurement. One major objection directed at the family veto is that when families veto the decision of their deceased family member, they do something wrong by violating or failing to respect the autonomy of that deceased family member. The goal of this paper is to make progress on answering this objection. I (...) do this in two stages. First, I argue that the most plausible interpretation of what happens when a person registers as an organ donor in an opt-in system is that she gives her consent to the state to posthumously remove her organs for transplantation purposes. Call this the Authorization Account. Second, given the Authorization Account, I argue by analogy that when families veto an individual’s decision to donate and the individual’s organs are not in the end removed, neither the doctors nor the family violate the individual’s autonomy in any morally objectionable sense. Call this the Nonremoval Thesis. I argue that since the Nonremoval Thesis is true, we do not violate or fail to respect the autonomy of registered donors when we fail to remove their organs because their family has objected. (shrink)

Except in extraordinary circumstances, patients' clinical care should reflect their preferences. Incapacitated patients cannot report their preferences. This is a problem. Extant solutions to the problem are inadequate: surrogates are unreliable, and advance directives are uncommon. In response, some authors have suggested developing algorithmic "patient preference predictors" (PPPs) to inform care for incapacitated patients. In a recent paper, Earp et al. propose a new twist on PPPs. Earp et al. suggest we personalize PPPs using modern machine learning (ML) techniques. (...) In this paper, I argue that, contrary to Earp et al.'s claim, personalized patient preference predictors are neither technically feasible nor ethically desirable. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Job motivation remains an area of concern among researchers due to the rising issues of poor or lack of motivation among workers. This refers to one’s personal will or drives to perform a task at work. Meanwhile, job satisfaction refers to an employee’s sense of fulfillment with his or her work experience. Therefore, the current study utilized the descriptive- correlational research design to investigate the impact of job motivation on the job satisfaction of accountants. To gather essential data (...) and achieve the objectives of the study, Multidimensional Work Motivational Scale (MWMS) and Minnesota Satisfaction Questionnaire (MSQ) were administered to the target respondents. The collected data were then analyzed using a Multiple Regression Analysis; findings revealed that job motivation has a significant impact on the job satisfaction of accountants. Additionally, the results of this study were carefully evaluated and discussed, and recommendations were made to benefit the stakeholders of the study and contribute to the existing body of knowledge. (shrink)

If one can get the targets of one's current wants only by acquiring new wants (as in the Prisoner's Dilemma), is it rational to do so? Arguably not. For this could justify adopting unsatisfiable wants, violating the rational duty to maximize one's utility. Further, why cause a want's target if one will not then want it? And people "are" their wants. So if these change, people will not survive to enjoy their wants' targets. I reply that one rationally need not (...) advance one's future wants, only current ones. Furthermore, rational choice seeks not utility (the co-obtaining of a want and its target), but satisfaction (the eventual obtaining of what is now wanted) -- otherwise, it would be irrational to care now about what happens after one dies. Finally, persons survive "rational" changes of values. Thus reflection on the rational revision of values illuminates the conditions on personal identity and the bases and aims of rational choice. (shrink)

This paper presents a novel perspective on the force-content distinction making use of truthmaker semantics and an ontology of attitudinal objects, things that are neither acts (or states) nor propositions. It gives a novel norm-based definition of the notion of direction of fit, strictly linking truth and (non-action-guiding) correctness.

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for (...) rational choice in alignment with one's values and goals). (shrink)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal (...) should be respected. (shrink)

This paper gives an account of Kant’s concept of self-contentment (Selbstzufriedenheit), i.e. the satisfaction involved in the performance of moral action. This concept is vulnerable to an important objection: if moral action is satisfying, it might only ever be performed for the sake of this satisfaction. I explain Kant’s response to this objection and argue that it is superior to Francis Hutcheson’s response to a similar objection. I conclude by showing that two other notions of moral satisfaction (...) in Kant’s moral philosophy, namely ‘sweet merit’ and the highest good, also avoid the objection. (shrink)

The problem of satisfaction conditions arises from the apparent difficulties of explaining the nature of the mental states involved in our emotional responses to tragic fictions. Greg Currie has recently proposed to solve the problem by arguing for the recognition of a class of imaginative counterparts of desires - what he and others call i-desires. In this paper I will articulate and rebut Currie's argument in favour of i-desires and I will put forward a new solution in terms of (...) genuine desires. To this aim I will show that the same sort of puzzling phenomenon involved in our responses to tragic fictions arises also in a non-fictional case, and I will offer a solution to the problem of satisfaction conditions that dispenses with i-desires. The key to the explanation is in the notion of condition-dependent desires triggered by fictions. (shrink)

Extant literature suggests a positive correlation between social trust (also called generalized trust) and life satisfaction. However, the psychological pathways underlying this relationship can be complex. Using the Bayesian Mindsponge Framework (BMF), we examined the influence of social trust in a high-violence environment. Employing Bayesian analysis on a sample of 1237 adults in Cali, Colombia, we found that in a linear relationship, generalized trust is positively associated with life satisfaction. However, in a model including the interactions between trust (...) and education level as well as between trust and socioeconomic status, generalized trust is found to be negatively associated with life satisfaction. In this non-linear relationship, both education level and socioeconomic status have moderating effects against the negative association between generalized trust and life satisfaction. In other words, less educated people living in worse socioeconomic conditions are more likely to have lower life satisfaction when they have higher levels of social trust. In contrast, highly educated people living in better socioeconomic conditions are more likely to have higher life satisfaction when they have higher levels of social trust. Due to the facilitating function of trust in information processing, lowering the rigor of the filtering system in a high-violence social environment will likely put an individual at risk. Based on our findings, we suggest that policymakers should consider the impacts of social contexts when advocating for increasing social trust. We also recommend that researchers carefully examine the psychological mechanism underlying an observed association before making suggestions for policymaking. (shrink)

Patient-funded trials are gaining traction as a means of accelerating clinical translation. However, such trials sidestep mechanisms that promote rigor, relevance, efficiency, and fairness. We recommend that funding bodies or research institutions establish mechanisms for merit review of patient-funded trials, and we offer some basic criteria for evaluating PFT protocols.

Existence value refers to the value humans ascribe to the existence of something, regard­less of whether it is or will be of any particular use to them. This existence value based on preference satisfaction should be taken into account in evaluating activities that come with a risk of species extinction. There are two main objections. The first is that on the preference satisfaction interpretation, the concept lacks moral importance because satisfying people’s preferences may involve no good or well-being (...) for them. However, existence value can be based on a restricted version of the preference satisfaction theory, which is not vulnerable to the skeptical arguments about the link between preference satisfaction and well-being. The second objection is that even if preference satisfaction can be linked to well-being, understanding existence value in terms of individual preference satisfaction is incoherent, because existence value reflects disinterested preferences that involve no benefits to the individual. However, the fact that existence value may involve disinterested preferences does not threaten the coherence of the concept, but suggests that it does not fit smoothly into the “utilitarian” or “welfarist” framework it is commonly considered within. A pluralistic normative approach based on prima facie duties can be an alternative to standard utilitarian-style approaches for considering existence value in concrete cases involving a risk of species extinction, such as through deep sea mining. (shrink)

With the ageing of the Portuguese population, there are more people in dependency situations and needing long-term care (LTC). In this context, it is important to ensure the quality of life (QoL) of those individuals, and that quality can be measured through their health-related quality of life (HRQoL) and overall well-being. Also, understanding how perceived service quality (PSQ) can be related to how people perceive their QoL is pertinent since service quality is an important factor to achieve patient health (...) outcomes. To develop this project, a LTC unit located in the district of Lisbon was chosen, the LTC unit of Arruda dos Vinhos. The main objective was to assess the relation between the PSQ, the HRQoL and the overall well-being of patients receiving LTC at the LTC unit of Arruda dos Vinhos. A project based on a case study was performed, through interviews based on the items of the SERVPERF, EQ-5D and ICECAP-O questionnaires, which were then analysed through content analysis. Results showed there is a relation between PSQ and HRQoL and between HRQoL and overall well-being. It was also possible to realise that to better evaluate the quality of this specific service, other subjects as the activities performed at the LTC unit, the physiotherapy service and the food provided, should be taken in consideration. Concluding, there is a relation between PSQ and the QoL of the patients receiving LTC at the LTC unit of Arruda dos Vinhos, when quality of life is measured through HRQoL. (shrink)

In order to determine whether current (or future) machines have a welfare that we as agents ought to take into account in our moral deliberations, we must determine which capacities give rise to interests and whether current machines have those capacities. After developing an account of moral patiency, I argue that current machines should be treated as mere machines. That is, current machines should be treated as if they lack those capacities that would give rise to psychological interests. Therefore, they (...) are moral patients only if they have non-psychological interests. I then provide an account of what I call teleo interests that constitute the most plausible type of non-psychological interest that a being might have. I then argue that even if current machines have teleo interests, they are such that agents need not concern themselves with these interests. Therefore, for all intents and purposes, current machines are not moral patients. (shrink)