A review of clinical decision-making: Models and current research

Aims and objectives: The aim of this paper was to review the current literature with respect to clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information processing model, the intuitive-humanist model and the clinical decision making model. Background: Clinical decision-making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognised from the literature; the information processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Design: Literature review Methods: Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 – November 2005

The Prevalence and Context of Adult Female Overweight and Obesity in Sub-Saharan Africa

Adult women bear a disproportionate burden of overweight and obesity in Sub-Saharan Africa (SSA). Precise information to understand disease distribution and assess determinants is lacking. Therefore, this dissertation aimed to: (i) analyze the prevalence of adult female overweight and obesity combined in lower-level administrative units; (ii) analyze the effect modification of educational attainment and age on the association between household wealth and adult female overweight and obesity; (iii) synthesize qualitative research evidence to describe contextual factors contributing to female overweight and obesity at different life stages. Bayesian and logistic regression models were constructed with Demographic and Health Survey (DHS) data to respectively estimate the prevalence of overweight and obesity and assess the interaction of education on the association between household wealth and overweight. The synthesis of qualitative research studies was conducted in accordance with PRISMA guidelines and findings were grouped by themes. Prevalence estimates revealed heterogeneity at second-level administrative units in the seven SSA countries examined, which was not visible in first-level administrative units. The combined prevalence of overweight and obesity ranged from 7.5 – 42.0% in Benin, 1.4 – 35.9% in Ethiopia, 1.6 – 44.7% in Mozambique, 1.0 – 67.9% in Nigeria, 2.2 - 72.4% in Tanzania, 3.9 – 39.9% in Zambia, and 4.5 - 50.6% in Zimbabwe. Additionally, education did not have a statistically significant modifying effect on the positive association between household wealth and overweight in the 22 SSA countries eligible for the study. Body shape and size ideals, barriers to healthy food choices and physical activity were key themes in the research synthesis encompassing four SSA countries. Positive symbolism, including beauty, was linked to overweight and obesity in adult women. Among adolescents, although being overweight or obese was not accepted, girls were expected to be voluptuous. Body image dissatisfaction and victimization characterized the experiences of non-conforming women and girls. Barriers to healthy nutrition included migration and the food environment. Whereas, barriers to physical activity included ageism. While additional work is encouraged to validate the prevalence estimates, overweight and obesity interventions must consider whether the determinants identified in this study are relevant to their context to inform improved outcomes

Cost-effectiveness of RAS genetic testing strategies in patients with metastatic colorectal cancer. A systematic review

Background: Monoclonal antibodies against epidermal growth factor receptor (EGFR) have proved beneficial for the treatment of metastatic colorectal cancer (mCRC), particularly when combined with predictive biomarkers of response. International guidelines recommend anti-EGFR therapy only for RAS (NRAS, KRAS) wild-type tumors because tumors with RAS mutations are unlikely to benefit. Objectives: We aimed to review the cost-effectiveness of RAS testing in mCRC patients before anti-EGFR therapy and to assess how well economic evaluations adhere to guidelines. Methods: A systematic review of full economic evaluations comparing RAS testing with no testing was performed for articles published in English between 2000 and 2018. Study quality was assessed using the Quality of Health Economic Studies scale, and the British Medical Journal and the Philips checklists. Results: Six economic evaluations (2 cost-effectiveness analyses, 2 cost-utility analyses, and 2 combined cost-effectiveness and cost-utility analyses) were included. All studies were of good quality and adopted the perspective of the healthcare system/payer; accordingly, only direct medical costs were considered. Four studies presented testing strategies with a favorable incremental cost-effectiveness ratio under the National Institute for Clinical Excellence (£20 000-£30 000/QALY) and the US ($50 000-$100 000/QALY) thresholds. Conclusions: Testing mCRC patients for RAS status and administering EGFR inhibitors only to patients with RAS wild-type tumors is a more cost-effective strategy than treating all patients without testing. The treatment of mCRC is becoming more personalized, which is essential to avoid inappropriate therapy and unnecessarily high healthcare costs. Future economic assessments should take into account other parameters that reflect the real world (eg, NRAS mutation analysis, toxicity of biological agents, genetic test sensitivity and specificity)

A retrospective quasi-qualitative synthesis of the literature to identify and evaluate communication processes in community-campus partnerships to address health disparities

Background: Community-campus partnerships have been a major developing field of study in improving health outcomes to reduce health disparities. However, there is limited literature that evaluates communication strategies used to improve health outcomes among disadvantaged populations during the early stages of implementing community-campus partnerships. Objectives: Based on the Donabedian model, we conducted a retrospective quasi-qualitative synthesis of literature relating to the identification and evaluation of community engaged communication in community-campus partnerships to address health disparities. Data sources: All published peer-reviewed articles from 2001 to 2013 that addressed health disparities in community-campus partnerships were reviewed. Key word searches from PubMed, MEDLINE, CINAHL, Social SciSearch, ProQuest, and Communication and Mass Media Complete databases were performed. Design: Donabedian’s structure, process and outcome model was used to provide a framework for the inclusion and exclusion criteria of studies. Using a quasi-qualitative approach, qualitative and quantitative analysis were used to compare the relationship between studies and inferential statistics respectively. Themes were identified and described. Data were extracted on each study’s characteristic and application of components on the Donabedian model in community-campus partnerships. Results: Forty-two articles met the inclusion criteria. All articles described by using some part of the Donabedian model to improve health outcomes. However, there was great variability in the frequency of communication structures and processes used. We found that communication processes and strategies have an association with improving health outcomes, especially among disadvantaged and vulnerable populations (r = 0.863, p\u3c0.01). Conclusion: Community engaged communication processes and strategies are powerful tools to engage underserved populations. Consequently, under the premise of a community-campus partnership, well-conceived and implemented communication approaches greatly improve health outcomes in disadvantaged populations

Governance with sustainable development: Overcoming the barriers

Indian organisations often face allegations or charges of red-tapism whereby collected evidences for future planning with sustainable development become inaccessible due to a number of reasons. Whereas it is pertinent to note that, governance of a state/nation depends upon the trust of the people to receive tangible/intangible opportunities for development in the socio-economic, legal environment. When there is deficit of trust due to corrupt practices, tracing the source for decision becomes a herculean task. The authors hypothesize that the evidences collected through investigations end up being discarded or locked up and stacked in files and never is considered for relevant for future decisions. We propose to find the actionable forces who try to use ‘power’ to strategically attain their desired goals. The paper intends to discuss the role of interested groups or state actors (top bureaucratic, politicians, and business houses) who have access to such information where scientific probe could be set up and evidence gets collected for larger good of the society. The authors hypothesize that stakeholders would incrementally destroy the core evidences such that relevant information gets disjointed for future decision making and sustainable development to give themselves a raised platform to continue their power wielding. The authors intend to compare UK model of evidence generation with that of Indian model. We propose to highlight the necessary changes to formulate relevant laws and procedures with respect to evidence collection and the accessibility of information of the policy making decisions of the governments

Data Protection: International Trends and the Austrian Example

Ensuring personal privacy in today's computerized-information society seems to be a common goal among the member states of the OECD. In this paper an attempt is made to summarize the discussions at the political and law-making level, both nationally and internationally within the framework of the OECD member countries. From the concrete outcome of these discussions, i.e., the data protection acts adopted and yet in force, the Austrian situation has been chosen as example

Developing service supply chains by using agent based simulation

The Master thesis present a novel approach to model a service supply chain with agent based simulation. Also, the case study of thesis is related to healthcare services and research problem includes facility location of healthcare centers in Vaasa region by considering the demand, resource units and service quality. Geographical information system is utilized for locating population, agent based simulation for patients and their illness status probability, and discrete event simulation for healthcare services modelling. Health centers are located on predefined sites based on managers’ preference, then each patient based on the distance to health centers, move to the nearest point for receiving the healthcare services. For evaluating cost and services condition, various key performance indicators have defined in the modelling such as Number of patient in queue, patients waiting time, resource utilization, and number of patients ratio yielded by different of inflow and outflow. Healthcare managers would be able to experiment different scenarios based on changing number of resource units or location of healthcare centers, and subsequently evaluate the results without necessity of implementation in real life.fi=Opinnäytetyö kokotekstinä PDF-muodossa.|en=Thesis fulltext in PDF format.|sv=Lärdomsprov tillgängligt som fulltext i PDF-format

Defining and documenting threats in the context of ill-treatment and torture

Threats are a common feature of detention and interrogation settings and have long been regarded as a routine procedure. Despite their prevalence and propensity to amount to ill-treatment and torture, threats have not been systematically and thoroughly analysed in case documentation processes. Given a lack of understanding, threats have unduly been considered a form of “torture-lite” at best by some juridical actors. However, its effect as an instrument of coercion can be devastating – engendering states of fear and anxiety and forcing its subject to act against their will. There is an important lack of theoretical reflection on what threats are, what types exist and how they impact the survivor. In this editorial, we aim to partly fill this gap from a medical and psychological perspective, providing a framework of understanding that will hopefully improve conceptual and practical assessment, documentation and qualification