66 resultados para clinical risk management


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Enterprise Risk Management (ERM) is the discipline by which enterprises monitor, analyze, and control risks from across the enterprise, with the goal of identifying underlying correlations and thus optimizing the risk-taking behavior in a portfolio context. This study analyzes the valuation implications of ERM Maturity. We use data from the industry leading Risk and Insurance Management Society Risk Maturity Model over the period from 2006 to 2011, which scores firms on a five-point maturity scale. Our results suggest that firms that have reached mature levels of ERM are exhibiting a higher firm value, as measured by Tobin's Q. We find a statistically significant positive relation to the magnitude of 25 percent. Upon decomposition of the maturity score, we find that the most important aspects of ERM from a valuation perspective relate to the level of top–down executive engagement and the resultant cascade of ERM culture throughout the firm. Firms that have successfully integrated the ERM process into both their strategic activities and everyday practices display superior ability in uncovering risk dependencies and correlations across the entire enterprise and as a consequence enhanced value when undertaking the ERM maturity journey ceteris paribus.

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This multi-centre UK study assesses the impact of predictive testing for breast and ovarian cancer predisposition genes (BRCA 1/2) in the clinical context. In the year following predictive testing, 261 adults (59 male) from nine UK genetics centres participated; 9 I gene mutation carriers and 170 noncarriers. Self-report questionnaires were completed at baseline (pre-genetic testing) and 1, 4 and 12 months following the genetic test result. Men were assessed for general mental health (by general health questionnaire (GHQ)) and women for general mental health, cancer-related worry, intrusive and avoidant thoughts, perception of risk and risk management behaviour. Main comparisons were between female carriers and noncarriers on all measures and men and women for general mental health. Female noncarriers benefited psychologically, with significant reductions in cancer-related worry following testing (P

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This article examines recent research on risk assessment and probation practice in Ireland and relates the findings to the ongoing debate regarding risk management practices in probation. The piece discusses current theoretical arguments on the influence of risk in criminal justice and outlines the impact of risk discourse on probation practice in Ireland and England and Wales. Using a mix of qualitative and quantitative methods, Irish probation officers’ attitudes are examined in order to highlight key issues facing probation officers when making risk decisions. These findings are compared and contrasted to other research results from England and Wales. All the conclusions identify both positive and negative consequences of adopting risk tools and point to the continued salience of clinical judgment over actuarial methods of risk assessment. It is argued that the research highlights the role of ‘resistance’ by criminal justice professionals in mediating the effects of the ‘new penology’ at the level of implementation. The idea of resistance holds particular relevance for probation practice in Ireland where professional discretion is maintained within the National Standards framework. Despite this, to date there has been an uncritical approach taken to risk assessment which may ignore the dangers of risk inflation/deflation and the need to take into account local factors in assessing risk of reoffending

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Drawing on research in Northern Ireland into the process of release under the Belfast/Good Friday Agreement, this article explores the identification and classification of risk in relation to prisoners released early under the Sentences (NI) Act. The main argument is that conflict, post-conflict and transitional conditions expose more starkly the political underpinnings of risk-management strategy and the article demonstrates the particular variant of Politicized Risk Assessment (PRA) recently used in the release of prisoners in Northern Ireland

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Is there evidence that market forces effectively discipline risk management behaviour within Chinese financial institutions? This study analyses information from a comprehensive sample of Chinese banks over the 1998-2008 period. Market discipline is captured through the impact of four sets of factors namely, market concentration, interbank deposits, information disclosure, and ownership structure. We find some evidence of a market disciplining effect in that: (i) higher (lower) levels of market concentration lead banks to operate with a lower (higher) capital buffer; (ii) joint-equity banks that disclose more information to the public maintain larger capital ratios; (iii) full state ownership reduces the sensitivity of changes in a bank's capital buffer to its level of risk;(iv) banks that release more transparent financial information hold more capital against their non-performing loans. © 2010 Springer Science+Business Media, LLC.

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In the last number of years the management of the dangerous in the community, particularly sex offenders, has generated enormous concern. This concern has been reflected at a number of different levels - in media and popular responses to the risk posed by released sex offenders in the community and in official discourses where an abundance of legislation and policy reforms have been enacted within a relatively short period of time. This analysis seeks to critically evaluate these developments within the context of contemporary criminal justice policy and practice in relation to the management of sex offenders in the community. The article analyses the contemporary focus on risk management or preventative governance which underpins the current regulatory framework and has been reflected in both the sentencing options and in control in the community initiatives for sex offenders. In this respect, the article highlights the gap between policy and practice in terms of the effective risk management of sex offenders. Given the failure of the traditional justice system with respect to these types of offences, it will be argued that the retributive framework could usefully be supplemented by the theory and practice of reintegrative or restorative community justice, and public education in particular, in order to better manage the risk presented by sex offenders in the community.

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Background: Increasingly women at high risk of breast cancer are opting for risk reducing surgery. The aim of this study was to assess the effectiveness of this approach in women at high risk in both carriers and non-carriers of BRCA1/2.

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Over a period of several centuries, the academic study of risk has evolved as a distinct body of thought, which continues to influence conceptual developments in fields such as economics, management, politics and sociology. However, few scholarly works have given a chronological account of cultural and intellectual trends relating to the understanding and analysis of risks. Risk: A Study of its Origins, History and Politics aims to fill this gap by providing a detailed study of key turning points in the evolution of society's understanding of risk. Using a wide range of primary and secondary materials, Matthias Beck and Beth Kewell map the political origins and moral reach of some of the most influential ideas associated with risk and uncertainty at specific periods of time. The historical focus of the book makes it an excellent introduction for readers who wish to go beyond specific risk management techniques and their theoretical underpinnings, to gain an understanding of the history and politics of risk.

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Hyperkalaemia, an elevated extracellular fluid potassium concentration, is a common electrolyte disorder and is present in 1-10% of hospitalised patients. Elevated serum potassium concentrations are usually asymptomatic but may be associated with electrocardiogram (ECG) changes. Hyperkalaemia occasionally leads to life-threatening cardiac arrhythmias. Prompt recognition of this disorder, patient risk management and administration of appropriate treatment can prevent serious cardiac complications of hyperkalaemia. Further assessment of the underlying basis for hyperkalaemia usually reveals a problem with renal potassium excretion (rather than transcellular shift of potassium or excess potassium intake). Reduced potassium excretion is typically associated with decreased potassium secretion in the aldosterone-sensitive distal nephron of the kidney. Common causes for hyperkalaemia include kidney failure, limited delivery of sodium and water to the distal nephron and drugs that inhibit the renin-angiotensin-aldosterone system. Treatment of life-threatening hyperkalaemia (particularly those patients with ECG changes) involves administration of intravenous calcium salts to stabilise the resting cardiac membrane potential. The potassium concentration can be lowered by administration of intravenous insulin combined with an infusion of glucose to stimulate intracellular uptake of potassium. Nebulised β-2 adrenoceptor agonists can augment the effects of intravenous insulin and glucose pending more definitive management of the recurrent hyperkalaemia risk. Additional management steps include stopping further potassium intake and careful review of prescribed drugs that may be adversely affecting potassium homeostasis. Changes to prescribing systems and an agreed institutional protocol for management of hyperkalaemia can improve patient safety for this frequently encountered electrolyte disorder.

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The vulnerability of coastal areas to associated hazards is increasing due to population growth, development pressure and climate change. It is incumbent on coastal governance regimes to address the vulnerability of coastal inhabitants to these hazards. This is especially so at the local level where development planning and control has a direct impact on the vulnerability of coastal communities. To reduce the vulnerability of coastal populations, risk mitigation and adaptation strategies need to be built into local spatial planning processes. Local government, however, operates within a complex hierarchal governance framework which may promote or limit particular actions. It is important, therefore, to understand how local coastal planning practices are shaped by national and supranational entities. Local governments also have to respond to the demands of local populations. Consequently, it is important to understand local populations’ perceptions of coastal risk and its management. Adopting an in-depth study of coastal planning in County Mayo, Ireland, this paper evaluates: (a) how European and national policies and legislation shape coastal risk management at local level; (b) the incorporation of risk management strategies into local plans; and (c) local perception of coastal risks and risk management. Despite a strong steer from supranational and national legislation and policy, statutory local plans are found to be lacking in appropriate risk mitigation or adaptation strategies. Local residents appear to be lulled into a sense of complacency towards these risks because of the low level of attention afforded to them by the local planning authorities. To avoid potentially disastrous consequences for local residents and businesses, it is imperative that this situation is redressed urgently. Based on our analysis, we recommend: the development and implementation of a national ICZM strategy, supported by detailed local ICZM plans; and obliging local government to address known risks in their plans rather than defer them to project level decision making.

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Prolonged duration of diabetes, poor glycaemic control and hypertension are major risk factors for both diabetic nephropathy and cardiovascular disease. Optimising blood sugar control together with excellent control of blood pressure can reduce the risk of developing diabetic nephropathy. Diabetic nephropathy should be considered in any patient with diabetes when persistent albuminuria develops. Microalbuminuria is the earliest clinically detectable indicator of diabetic nephropathy risk. The majority of patients with diabetic nephropathy are appropriately diagnosed based on elevated urinary albumin excretion and/or reduced 0032-6518 renal function. Patients with type 2 diabetes should have annual urinary ACR measurements from the time of diabetes diagnosis while those with type 1 diabetes should commence five years after diagnosis. Blood pressure lowering to 130/80mmHg and reduction of proteinuria to <1 g/day retards progression of diabetic nephropathy and reduces the number of cardiovascular events. Drugs that block the renin-angiotensin-aldosterone system (RAAS) are effective in reducing proteinuria, managing hypertension and reducing cardiovascular risk. Unless there are clear contraindications or intolerance all patients with diabetic nephropathy should be prescribed an ACEI or ARB. Stopping an ACEI or ARB during intercurrent illness or times of volume depletion is critically important. Patients with diabetic nephropathy should have at least yearly measurements of blood pressure, renal function and urinary ACR.