Explore the vast range of titles available.

Abstract Objectives Evidence suggests that approximately 30% of the tests and treatments currently prescribed in healthcare are potentially unnecessary, may not add value, and in some cases cause harm. We describe the evolution of our hospital’s Choosing Wisely (CW) program over the first 5 years of existence, highlighting the enablers, challenges, and overall lessons learned with the goal of informing other healthcare providers about implementing resource stewardship initiatives in paediatric healthcare settings. Methods We describe the development of de novo “top 5” CW lists of recommendations using anonymous surveys and Likert scale scoring. Composition and role of the steering committee, measurement of data and outcomes, and implementation strategies are outlined. Results Many projects have resulted in a successful decrease in inappropriate utilization while simultaneously monitoring for unintended consequences. Examples include respiratory viral testing in the emergency department (ED) decreased by greater than 80%; ankle radiographs for children with ankle injuries decreased from 88% to 54%; and use of IVIG for treatment of typical ITP cases decreased from 88% to 55%. Early involvement focused within General Paediatrics and the ED, but later expanded to include perioperative services and paediatric subspecialties. Conclusions An internally developed CW program in a children’s hospital can reduce targeted areas of potentially unnecessary tests and treatments. Enablers include credible clinician champions, organizational leadership support, reliable measurement strategies, and dedicated resource stewardship education. The lessons learned may be generalizable to other paediatric healthcare settings and providers looking to introduce a similar approach to target unnecessary care in their own organizations.

Regional anesthesia (RA) is often perceived to be more environmentally sustainable than alternative forms of anesthesia. Nevertheless, the principles of sustainable RA remain ill-defined in the presence of variability of resource utilization within RA practice. Many infection prevention practices are based on low-level evidence, and recommendations vary internationally. We sought to conduct an evidence review and Delphi consensus study to provide guidance on aspects that lack high-quality evidence in RA practice to reconcile responsible resource stewardship and infection prevention in RA. We conducted a three-round modified Delphi process. After distributing an initial free-text questionnaire to all collaborators, we created structured questions, followed by two rounds of anonymized voting. We defined strong consensus as ≥ 75% agreement and weak consensus as ≥ 50% but < 75% agreement. Forty-six experts agreed to take part in the study and 36 (78%) completed all the voting rounds. Regional anesthesia practice parameters with strong consensus included hand hygiene using alcohol scrub rather than soap and water, sterile gowns being unnecessary for single-injection RA techniques, only minimal equipment in the premade packs, and goal-directed use of sedation and supplemental oxygen. We obtained consensus on the safe and environmentally responsible practice of RA for both single-injection and indwelling catheter techniques and identified areas of research focus. While more robust evidence is being generated, clinicians may use these findings as a guide to infection prevention and environmental sustainability in their anesthesia practice.

Purpose This study aims to explore the interplay between resource stewardship, relational connectedness and value co-creation in business-to-business (B2B) marketing, addressing gaps in understanding how these elements collectively influence stakeholder relationships and organizational outcomes. Drawing on stewardship theory, social exchange theory and service-dominant logic, the study develops a model that highlights the synergies between ethical resource management, strategic relational engagement and co-creative value processes. Design/methodology/approach Using an abductive qualitative approach, the study focuses on the B2B service sector in an emerging economy. Data were collected through in-depth interviews with 30 management professionals and analyzed thematically, supported by a network view to visualize the interconnected dynamics. Findings Resource stewardship emerges as a key driver of trust and relational connectedness, which facilitates collaborative innovation and value co-creation. Relational connectedness enhances loyalty and cooperative problem-solving, while active participation in co-creation fosters shared ownership, satisfaction and long-term engagement. Research limitations/implications The study’s context-specific focus on an emerging economy limits broader applicability, suggesting future cross-industry, cross-cultural approach and quantitative validation. Originality/value This study presents an empirically grounded framework that advances theoretical understanding and offers practical insights for optimizing B2B marketing strategies through resource stewardship, relational connectedness and co-creative practices.

[...]each CGZ package was labeled with a sticker identifying its purchase price. [...]an educational email was sent to all clinical ED staff at the beginning of the intervention; this email described the clinical utility of combat gauze, instructions and limitations regarding use, provided information about its cost, and advised staff of the other intervention elements. [...]a multifaceted cost awareness initiative utilizing stocking location changes, informative stickers, and educational communications can reduce ED supply costs.

Abstract In this controlled before–after study, wound swabs were only processed for culture, identification, and susceptibility testing if a quality metric, determined by the Q score, was met. Rejection of low-quality wound swabs resulted in a modest decrease in reflexive antibiotic initiation while reducing laboratory workload and generating few clinician requests.

Fishing cooperatives (co-ops) and patron-client relationships are the most common cooperative and noncooperative strategies for self-governance for small-scale fisheries around the world. We studied what drives fishers to choose between these two self-governance arrangements in 12 communities in the Gulf of California, Mexico. The communities depend on similar fishing resources, are located in contiguous portions of the coast, fish roughly the same species, have similar socioeconomic characteristics, and sell to similar markets, yet half of the fisheries are organized around co-ops and the other half work through patron-client arrangements. Using participant observation, in-depth interviews of key informants between 1995-2008, and a survey of 55% of the fisheries in the study area, we found that the presence of high transaction costs of commercialization, the desire to acquire fishing licenses, and the existence of traditions of successful collective action among fishing groups within each community strongly influence fishers’ choices regarding membership in fishing co-ops. We also examined the implications of our findings for conservation of fishing resources. Given that the emergence of co-ops was associated with high transaction costs of commercialization, we hypothesize that cooperative strategies are more likely than patron-client strategies to emerge in communities in isolated locations. In an era of globalization, in which the rate of development and urbanization will increase in coastal areas, patron-client strategies are likely to become more prevalent among fisheries, but such self-governance strategies are thought to be less conducive to conservation behaviors.

After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe is the future of sustainable medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation.

Institutions play an important role in shaping individual incentives in complex social-ecological systems, by encouraging or discouraging resource overuse. In the Gulf of California, Mexico, there is widespread evidence of declines in small-scale fishery stocks, largely attributed to policy failures. We investigated formal and informal rules-in-use regulating access and resource use by small-scale fishers in the two most important fishing communities of the Midriff Islands region in the Gulf of California, which share several target species and fishing grounds. The Midriff Islands region is a highly productive area where sustainable use of fisheries resources has been elusive. Our study aimed to inform policy by providing information on how management and conservation policies perform in this unique environment. In addition, we contrast attributes of the enabling conditions for sustainability on the commons in an effort to better understand why these communities, albeit showing several contrasting attributes of the above conditions, have not developed sustainable fishing practices. We take a novel, comprehensive institutional approach that includes formal and informal institutions, incorporating links between land (i.e., communal land rights) and sea institutions (i.e., fisheries and conservation policies) and their effects on stewardship of fishery resources, a theme that is practically unaddressed in the literature. Insufficient government support in provision of secure rights, enforcement and sanctioning, and recognition and incorporation of local arrangements and capacities for management arose as important needs to address in both cases. We highlight the critical role of higher levels of governance, that when disconnected from local practices, realities, and needs, can be a major impediment to achieving sustainability in small-scale fisheries, even in cases where several facilitating conditions are met.

This paper investigates several views along the George Washington Memorial Parkway, which runs along the Potomac River between Washington, DC, and George Washington’s home, Mount Vernon. It focuses on the role these views have had in transforming the banks of the Potomac into a landscape, and it compares them to a set of landscape paintings that reveal complexities in the ideology of landscape. These dimensions of landscape ideology are used to interpret the parkway as a landscape, a projection of certain values on the land. The paper concludes with a discussion of the values of this approach for the stewardship of visual resources.

The overuse of low value medical tests and treatments drives costs and patient harm. Efforts to address overuse, such as Choosing Wisely campaigns, typically rely on passive implementation strategies- a form of low reliability system change. Embedding guidelines into clinical decision support (CDS) software is a higher leverage approach to provide ordering suggestions through an interface embedded within the clinical workflow. Growth in computing power is increasingly enabling artificial intelligence (AI) to augment such decision making tools. This article offers a roadmap of opportunities for AI-enabled CDS to reduce overuse, which are presented according to a patient’s journey of care.