Gamble Approach Research Articles

Would You Rather: Quantifying TBI Survivor Perceptions of Functional Status via Their Surrogates.

To quantify health utilities of the Glasgow Outcome Scale-Extended (GOSE) states after actual Traumatic Brain Injury (TBI). Recovery after TBI is measured using the GOSE, a validated clinical trial endpoint. A recent public survey quantified the health utilities of some GOSE states after hypothetical TBI as worse than death. However, no health utilities exist for disability after actual TBI. This national computer-adaptive survey followed EQUATOR-CHERRIES guidelines and recruited adult TBI survivors (injury>1y prior) via their available surrogates. Using a standard gamble approach in randomized order, participants gave preferences for post-TBI categorical health states ranging from GOSE 2-8. We calculated median [interquartile range, IQR] health utilities for each GOSE state, from -1 (worse than death) to 1 (full health), with 0 as reference (death, GOSE 1). Of 515 eligible, 298 surrogates (58%) consented and completed the scenarios on TBI survivors' behalf. TBI survivors had a current median GOSE 5 [3-7]. GOSE 2, GOSE 3, and GOSE 4 were rated worse than death by 89%, 64%, and 38%, respectively. The relationship was nonlinear, and intervals were unequal between states, with a bimodal distribution for GOSE 4. In this index study of actual post-TBI disability, poor neurologic outcomes represented by GOSE 2-4 were perceived as worse than death by at least one in three survivors. Similar to previously reported public perceptions after a hypothetical TBI, these long-term perceptions may inform earlier post-TBI shared decision making, as well as help shape value-based research and quality of care. II, Economic & Value-based Evaluations.

Surrogate Perception of Disability after Hospitalization for Traumatic Brain Injury.

The Glasgow Outcome Scale Extended (GOSE) is a measure of recovery after traumatic brain injury (TBI). Public surveys rate some GOSE states as worse than death. Direct family experience caring for patients with TBI may impact views of post-TBI disability. We conducted a national cross-sectional computer-adaptive survey of surrogates of TBI dependents incurring injury more than 1 year earlier. Using a standard gamble approach in randomized order, surrogates evaluated preferences for post-TBI GOSE states from GOSE 2 (bedridden, unaware) to GOSE 8 (good recovery). We calculated median (interquartile range [IQR]) health utilities for each post-TBI state, ranging from -1 to 1, with 0 as reference (death = GOSE 1), and assessed sociodemographic associations using proportional odds logistic regression modeling. Of 515 eligible surrogates, 298 (58%) completed scenarios. Surrogates were median aged 46 (IQR 35 to 60), 54% married, with Santa Clara strength of faith 14 (10 to 18). TBI dependents had a median GOSE5 (3 to 7). Median (IQR) health utility ratings for GOSE 2, GOSE 3, and GOSE 4 were -0.06 (-0.50 to -0.01), -0.01 (-0.30 to 0.45), and 0.30 (-0.01 to 0.80), rated worse than death by 91%, 65%, and 40%, respectively. Surrogates rated GOSE 4 (daily partial help) worse than the general population. Married surrogates rated GOSE 4 higher (p < 0.01). Higher strength of faith was associated with higher utility scores across GOSE states (p = 0.034). In this index study of surrogate perceptions about disability after TBI, poor neurologic outcomes-vegetative, needing all-day or partial daily assistance-were perceived as worse than death by at least 1 in 3 surrogates. Surrogate perceptions differed from the unexposed public. Long-term perceptions about post-TBI disability may inform earlier, tailored shared decision-making after neurotrauma.

Linkages between high-performance work practices and family-centered goals: implications for financial performance in family firms

PurposeThis study explores what impact high-performance work practices (HPWP) – from the ability-motivation-opportunity (AMO) framework – might have on financial performance among family firms and examines the mediating role played by family-centered goals (FCGs).Design/methodology/approachThe empirical approach is based on data collected from a sample of 339 Spanish small and medium-sized family enterprises operating in the industry and service sectors. To test the hypotheses, this paper applies a path analysis modeling tool to estimate both indirect and direct effects in mediator models.FindingsThe results indicate that the AMO framework has a significant impact on financial performance through the lens of FCGs. In addition, family businesses' keen concern to preserve family wealth influences the effectiveness of HPWPs, making firms more socioemotionally oriented at the expense of economic impact.Research limitations/implicationsThis paper underscores the importance of integrating family aspirations into strategic human resource management (HRM) design, emphasizing the significance of socioemotional wealth (SEW) preservation.Practical implicationsThe findings offer practical insights for family managers, family owners and human resource (HR) practitioners, suggesting the need to align HR practices with family goals and to strategically balance socioemotional and financial wealth considerations. Family owners in key management positions must skillfully manage HR strategies in order to harmonize family and firm goals.Originality/valueBy examining the mediating effect of FCGs, this paper advances and extends SEW theory in the context of HRM by considering the relationships between HR practices and firm performance as a mixed gamble approach.

Unveiling new opportunities: A mixed gamble approach to external search breadth within family firms

This study introduces the idea that external search breadth constitutes a ‘mixed gamble’ where family firms face a unique trade-off between financial and socioemotional wealth (SEW) gains and losses. Considering the peculiarities of family firms, we examine the distinctive influence that two sources of family firm heterogeneity, namely family management and family generational stage, have on the mixed gamble of external search breadth. In addition, we also investigate export propensity as a contingent factor with the potential to alter the manners in which family management and family generational stage affect the external search breadth mixed gamble. Using a longitudinal sample of 1240 Spanish family firms, we empirically find that family firms with greater family management and in first-generation attach more importance to current SEW losses than to potential financial and SEW gains, resulting in lower external search breadth. Furthermore, we find that export propensity alters family managers' mixed gamble of external search breadth, so that current SEW losses become less pronounced in the financial and SEW trade-off, which leads to a higher external search breadth.

Performance below and above aspirations as an antecedent of succession planning in family firms: A socio-emotional wealth mixed gamble approach

Performance below and above aspirations as an antecedent of succession planning in family firms: A socio-emotional wealth mixed gamble approach

Assessing and Improving Digital Ability: Procter &amp; Gamble's Approach to Raising Brands' Digital Competency

Assessing and Improving Digital Ability: Procter &amp; Gamble's Approach to Raising Brands' Digital Competency

High-performance work systems in family firms: A mixed gamble approach

Research on the use of high-performance work systems (HPWSs) in family firms has yielded mixed evidence. This study aims to bridge this gap by using the socioemotional wealth (SEW) approach and the behavioral agency model (BAM) to explain why certain family firms have a greater incentive to use HPWS. We argue that the decision of family firms to implement HPWS is part of a mixed-gamble scenario of balancing risks with financial and family wealth prospects. Our results from 453 Spanish medium-sized and private family firms confirm that the importance of preserving SEW has a positive effect on the adoption of HPWS and that this influence is particularly pronounced in high-risk firms whose management is mainly controlled by family members and by the second generation. These findings contribute to the literature by explaining how using HPWS by family firms is significantly contingent on business risk.

Patient acceptance of transvaginal sonographic endometrial thickness assessment compared with hysteroscopy and biopsy for exclusion of endometrial cancer in cases of postmenopausal bleeding.

Available examinations for women with postmenopausal bleeding include transvaginal sonography to measure endometrial thickness (TVS-ET), and invasive endometrial assessment using hysteroscopy/endometrial biopsy. However, selection of the examination method seldom involves consideration of patient preferences. The aim of this study was to examine patient preferences for the method used to investigate postmenopausal bleeding. Women were asked to complete an interviewer-administered structured survey before they underwent clinical investigations at a university gynaecology unit from June 2016 to June 2017. Using the standard gamble approach, women were asked to choose between invasive assessment by hysteroscopy/endometrial biopsy (gold standard) or TVS-ET with a risk of missing endometrial cancer. The risk of missing endometrial cancer during TVS-ET was varied until each woman was indifferent to either option. The median detection rate for endometrial cancer required using TVS-ET was 95% (interquartile range=80%-99.9%). In total, 200 women completed the survey, and 77 (38.5%) women required TVS-ET to have a 99.9% detection rate for endometrial cancer. Prior hysteroscopy experience was the only factor that influenced the women's decisions: a significantly higher detection rate was required by this patient group than by patients without previous hysteroscopy experience (P=0.047). A substantial proportion of women would accept TVS-ET alone for the investigation of postmenopausal bleeding. In the era of patientcentred care, clinicians should incorporate patient preferences and enable women to make informed choices concerning the management of postmenopausal bleeding.

Population-based utility scores for HPV infection and oropharyngeal squamous cell carcinoma among Indigenous Australians

BackgroundOropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals’ preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians.MethodsDevelopment and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test.ResultsData from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91–0.92 in ‘screened, cytology normal, HPV vaccination’ and ‘screened, HPV positive, endoscopy normal’, to less than 0.90 (ranging from 0.87–0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75–0.79) in ‘early stage throat cancer’. Higher utility scores were observed for ‘screened, cytology normal and HPV vaccination’ among younger participants (18–40 years), for ‘early stage invasive throat cancer’ among females, and for ‘oral intraepithelial neoplasia’ and ‘early stage invasive throat cancer’ among metropolitan-dwelling participants.ConclusionAmong a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians.

Cohort profile: indigenous human papillomavirus and oropharyngeal squamous cell carcinoma study - a prospective longitudinal cohort

PurposeOur aims are to: (1) estimate prevalence, incidence, clearance and persistence of oral human papillomavirus (HPV) infection among Indigenous Australians; (2) identify risk factors associated with oropharyngeal squamous cell carcinoma...

Nicotine dependence and its association with health utility ratings among a sample of Indian dental patients.

To measure utility ratings and quality-adjusted life-years(QALYs) for nicotine dependence-related health states using the standard gamble approach among a sample of dental patients; investigate the possible associations of nicotine dependence, and study the influences on tobacco-related health state utilities estimates among patients. A sample of 200 adult outpatients who were current or former consumers of tobacco were included in the cross-sectional study. Demographic, oral health self-rating and tobacco-related data (Fagerstrom scale for nicotine dependence, type of tobacco consumed, frequency and duration of the habit) were collected. A standard gamble method of utility valuation was also carried out. Older age, lower educational attainment, higher frequency of consumption, increased duration of the habit, consumption of chewing tobacco, as opposed to smoking tobacco, and poor oral health were associated with higher nicotine dependence. Lower nicotine dependence, better oral health and quitting the habit were associated with better health utility estimates. QALYs lost due to the habit among the 'low to moderate' and 'significant' nicotine dependence groups were 2.7 (sd, 3.7) and 6.7 (sd, 8.0) years, respectively. Higher health utility ratings were seen among patients with 'low to moderate' nicotine dependence, better oral health status and quitters of the tobacco habit. Quality of life weights generated through this method could be used for cost-utility analyses of tobacco cessation/prevention interventions in different settings and cultures.

Effect of Counseling Based on Gamble's Approach on Postpartum Anxiety in Primiparous Women

Background & aim: The postpartum period is a time of extreme vulnerability to various psychiatric disorders, such as anxiety, which exert profound negative impacts on the health of neonates, mothers, and families. Therefore, it is necessary to perform some interventions to prevent and mitigate postpartum anxiety. The current study investigated the effect of counseling based on Gamble's approach on postpartum anxiety in primiparous women.Methods: This randomized clinical trial was carried out on 60 primiparous women referred to Mashhad health centers in 2018. Participants in the intervention group received midwife-led individual counseling based on Gamble's approach during three prenatal and one postpartum session, apart from routine prenatal care. The control group only received routine prenatal care. A questionnaire to measure demographic and obstetric data as well as Depression, Anxiety and Stress Scale-21 (DASS-21) were used to collect data. The obtained data were analyzed in SPSS software (version 16) using Mann-Whitney, chi-square and independent t-test.Results: There was no significant statistical difference between the two groups before intervention (P<0.05). The mean and standard deviations of women's anxiety in the intervention and control groups were obtained as 7.5±1.1 and 8.6±2.4, respectively. The results of the Mann-Whitney test demonstrated that the level of anxiety in the intervention group was significantly lower, compared to that in the control group (P=0.008).Conclusion: Counseling based on Gamble’s approach reduced postpartum anxiety in primiparous women. Therefore, it can be used during pregnancy and postpartum period as an effective, simple, and adverse-effect-free method to reduce anxiety during the postpartum period.

The influence of family ownership on acquisition activity: The moderating role of acquisition experience

ABSTRACT We investigated how heterogeneity in family ownership influences on the frequency of acquisitions in a sample of 1,096 publicly traded manufacturing companies from the Asia Pacific region in the period 2009–2016. We found that the level of family ownership decreases the activity consisting in engaging in acquisitions. Moreover, the negative influence of family ownership on acquisition frequency becomes less important when the firm has been involved in prior acquisitions. We drew on the mixed gamble approach to better understand acquisition decisions in family firms.

Worse Than Death: Survey of Public Perceptions of Disability Outcomes After Hypothetical Traumatic Brain Injury.

The aim of this study was to determine the health utility states of the most commonly used traumatic brain injury (TBI) clinical trial endpoint, the Extended Glasgow Outcome Scale (GOSE). Health utilities represent the strength of one's preferences under conditions of uncertainty. There are insufficient data to indicate how an individual would value levels of disability after a TBI. This was a cross-sectional web-based online convenience sampling adaptive survey. Using a standard gamble approach, participants evaluated their preferences for GOSE health states 1 year after a hypothetical TBI. The categorical GOSE was studied from vegetative state (GOSE2) to upper good recovery (GOSE8). Median (25th percentile, 75th percentile) health utility values for different GOSE states after TBI, ranging from -1 (worse than death) to 1 (full health), with 0 as reference (death). Of 3508 eligible participants, 3235 (92.22%) completed the survey. Participants rated lower GOSE states as having lower utility, with some states rated as worse than death, though the relationship was nonlinear and intervals were unequal between health states. Over 75% of participants rated a vegetative state (GOSE2, absence of awareness and bedridden) and about 50% rated lower severe disability (GOSE3, housebound needing all-day assistance) as conditions worse than death. In the largest investigation of public perceptions about post-TBI disability, we demonstrate unequally rated health states, with some states perceived as worse than death. Although limited by selection bias, these results may guide future comparative-effectiveness research and shared medical decision-making after neurologic injury.

Firm Acquisitions by Family Firms: A Mixed Gamble Approach

This study elucidates the mixed gamble confronting family firms when considering a related firm acquisition. The socioemotional and financial wealth trade-off associated with related firm acquisitions as well as their long-term horizon turns family firms more likely to undertake a related acquisition than nonfamily firms, especially when they are performing above their aspiration level. Postmerger performance pattern confirms that family firms are able to create long-term value through these acquisitions, and by doing so, they surpass nonfamily firms. These findings stand in contrast to commonly used behavioral agency predictions but can be reconciled with theory through a mixed gamble lens.

A Mixed Gamble Approach of the Impact of Family Management on Firm's Growth: A Longitudinal Analysis

We draw upon the socioemotional wealth perspective and the mixed gamble approach to employ a five‐year panel dataset of 223 Belgian private family firms to investigate the relationship between family management and growth, with family management ownership, generational involvement, and the CEO's family status moderating this link. We find an inverted U‐shaped relationship, with growth reaching its maximum at intermediate levels of family management. Additionally, we demonstrate that family management ownership, generational involvement, and the presence of a family CEO hamper the family management‐growth link: all these variables attenuate the positive effect of low to moderate family management, and accentuate the negative impact of high family management. Consequently, our research contributes to a deeper understanding of the relationship between family management and growth.

Family Firm Heterogeneity and Tax Aggressiveness: A Mixed Gamble Approach

AbstractFew studies try to understand how the unique preferences of family firms affect tax strategies, and how family firm heterogeneity drives variation in tax activities. Drawing on the mixed gamble approach, this study examines the tax aggressiveness of different types of family firms, considering how various sources of heterogeneity alter the perception of potential gains and losses to socioemotional and financial wealth. Based on a panel dataset of 242 private family firms for the period 2012–2014, this study shows that strong family‐owned firms, family firms with a family CFO, family‐founder firms, and family‐named firms display lower levels of tax aggressiveness. These findings demonstrate that family firm heterogeneity is a crucial factor in the mixed gamble calculus of tax aggressiveness.

Patients choose certainty over burden in bladder cancer surveillance

BackgroundDue to the high risk of recurrence of non-muscle invasive bladder cancer, all patients undergo regular cystoscopic surveillance for early detection. As cystoscopy is invasive, costly and increases the burden of the disease considerably, there is significant ongoing research and development into non-invasive urinary biomarker substitutes. This study aims to assess the level of sensitivity required before patients accept a new urinary biomarker.MethodsWe studied the preferences for a hypothetical diagnostic urinary biomarker and compared this to usual care (cystoscopy) at different levels of sensitivity among 437 patients with bladder cancer (354 men and 83 women) from the UK Bladder Cancer Prognosis Programme. A standard gamble approach was used to estimate the minimally acceptable sensitivity (MAS) of the new biomarker. Additionally, non-parametric statistical analyses were performed to investigate the association between surveillance preference and various patient characteristics.ResultsAlmost half of patients (183, 43%) would not replace cystoscopy with a urinary biomarker unless it was 100% sensitive. The median MAS was 99.9999%, and nearly 85% of patients demanded a sensitivity of at least 99% before preferring a urinary biomarker test over cystoscopy. These results were consistent across all patient characteristics and demographic categories.ConclusionsOur results indicate that patients demand urinary biomarkers as sensitive as cystoscopy before they would be willing to forego cystoscopy for bladder cancer surveillance.

Firm Acquisitions by Family Firms: A Mixed Gamble Approach

This study elucidates the mixed gamble confronting family firms when considering a related firm acquisition. The socioemotional and financial wealth trade-off associated with related firm acquisitions as well as their long-term horizon turns family firms more likely to undertake a related acquisition than non-family firms, especially when they are performing above their aspiration level. Post-merger performance pattern confirm that family firms are able to create long-term value through these acquisitions and by doing so they surpass non-family firms. These findings stand in contrast to commonly used behavioural agency predictions, but can be reconciled with theory through a mixed gambles’ lens.

Estimates of health utility scores in chronic kidney disease.

Coverage decisions in publicly funded healthcare systems require a formal, systematic and transparent assessment process for policies related to distribution of resources. The process is complex and employs multiple types of information, such as clinical effectiveness, costs and health utility scores which are used to produce quality-adjusted life years. The purpose of this study was to create health utility scores for CKD patients within the Canadian population. This is a cross-sectional study of CKD patients. We administered the Short-Form 36 Quality of Life Questions to all participants and employed the Short-Form 6 Dimension index to create health utility scores which were created using a set of parametric preference weights, nonparametric preference weights and ordinal health state valuation techniques obtained from a sample of the general population. Utility values in the dialysis group were lower than in the non-dialysis group. There was a significant relationship between age and health utility scores: As age increases, health utility scores decrease. Diabetes was associated with lower health utility scores in dialysis patients, whereas other covariates did not reach levels of statistical significance in our stepwise regression models. The parametric Bayesian model and standard gamble approach yielded the same results, while the correlation between the nonparametric and parametric methods was above 0.9. Health utility scores were low relative to the general population norm in our study cohort. Longitudinal assessment of CKD patients to capture possible fluctuations in health utility scores may add useful information.