How confident are general dental practitioners in their decision to administer antibiotic prophylaxis? A questionnaire study

Abstract Background Common dental procedures induce bacteremia. To prevent infectious complications from bacteremia in patients with specific medical conditions, antibiotic prophylaxis is considered. Recommendations are often unclear and ambiguous. In a previous study we reported wide variations in general dental practitioners' (GDPs') administrations of antibiotic prophylaxis. We hypothesized that within such a conflicting clinical area, decisions are made with a high level of personal uncertainty. This study examined GDPs' confidence in their decisions and analyzed the extent to which case-related factors might explain individual variations in confidence. Methods Postal questionnaires in combination with telephone interviews were used. The response rate was 51% (101/200). There were no significant differences between respondents and non-respondents regarding sex, age, or place of work. The GDPs were presented to patient cases of different medical conditions, where some should receive antibiotic prophylaxis according to recommendations when performing dental procedures that could cause gingival bleeding. The GDPs assessed on visual analogue scales how confident they were in their decisions. The extent to which case-related factors, medical condition and dental procedure, could explain individual variation in confidence was analyzed. Results Overall the GDPs exhibited high confidence in their decisions regardless of whether they administered antibiotic prophylaxis or not, or whether their decisions were in accordance with recommendations or not. The case-related factors could explain between 30–100% of the individual variation in GDPs' confidence. For 46%, the medical condition significantly explained the individual variation in confidence. However, for most of these GDPs, lower confidence was not presented for conditions where recommendations are unclear and higher confidence was not presented for conditions where recommendations are more clear. For 8% the dental procedure significantly explained the variation, although all procedures could cause bacteremia. For 46% neither the medical condition nor the dental procedure could significantly explain the individual variation in confidence. Conclusion The GDPs presented high confidence in their decisions, and the majority of GDPs did not present what could be considered a justified varied level of confidence according to the clarity of recommendations. Clinicians who are overconfident in their decisions may be less susceptible to modifications of their behavior to more evidence-based strategies.</p

Designing societal safety: A study of the Swedish crisis management system

Design is an activity aimed at solving an unsolved problem or improving an existing solution. In the area of societal safety, there are many activities that could be classified as design activities. For example when different actors are implementing measures to mitigate certain risk scenarios or when they are considering actions that could improve their capability to respond to various crises. We provide a descriptive study of how design problems are dealt with in the Swedish crisis management system. Our focus is on the risk and vulnerability analyses that are conducted annually by most Swedish authorities, and on efforts to improve various actors’ command and control capability. Within these two areas, both highly relevant for societal safety, we analyse how the actors address design problem using a framework inspired by design science. We present the results from a content analysis of all risk and vulnerability analyses (RVA:s) performed by the county administrative boards (regional level) in 2010 (there are 21 such boards in Sweden) and from 14 semi-structured interviews with representatives for various local and regional authorities in Sweden conducted in 2011. We conclude that when measures to reduce risk or improve crisis management capability are suggested in the RVA:s the context in which the measures are supposed to be useful in are not always described (including description of scenarios). Moreover, the effect of implementing the suggested measures are not explicitly described in any of the RVA:s. The results from the interview study indicates that leaving out or not describing important information explicitly when conducting design activities is not a phenomenon isolated to RVA:s but is also present when, for example, suggesting measures to improve command and control capability

The roles of policy differences and inconsistency in policy conflict

Brehmer,B. The roles of policy differences and inconsistency in policy conflict. Umeå Psychological Reports, No. 18, 1970. - Disagreement caused by policy differences is shown to be a function of two factors: the systematic differences between the policies and the consistency of these policies. The relative importance of the two factors is studied in an illustrative experiment involving decision making under conditions of uncertainty. The results of the experiment indicate that in the beginning of the conflict period,most disagreement is caused by systematic diffe- .rences in policy. These differences are, however,rapidly reduced. At the same time, the consistency of the policies decreases so that at the end of the conflict period, most of the disagreement is caused by lack of consistency in the policies.Due to this lack of consistency, the actual differences between the decisions made by the subjects are not very much reduced, despite the fact that the systematic differences between their policies have all but disappeared.digitalisering@um

Harmony Rather than Unity : A Command Concept for Complex Endeavours

This paper discusses concepts of command for complex endeavors. The traditional concepts of Unity of Command and Unity of Effort are found wanting, the former because there is no single individual in command of a complex endeavor, the latter because there is often no time to develop the comprehensive plan required, and if there is time, it is nevertheless difficult because different organizations have different planning methods and different planning cultures. A new command concept, based on our experience from studies of peace support operations is proposed. It is called Harmony of Efforts and it is a C2 concept for complex endeavors that involve a number of organizations, each of which does what it usually does, and for which there is no one commander with authority to enforce unity of command or unity of effort. Under these circumstances, Harmony of Efforts is all that one can hope for. The command concept of Harmony of Efforts specifies the spirit in which C2 issues should be approached, which is cooperation, the method to be used, which is negotiation, and the substance of C2, i.e., what C2 can usefully be concerned with in complex endeavors, which is the management of interfaces between organizations