Participation in medical decision-making across Europe: an international longitudinal multicenter study

Background: The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries. Methods: The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations. Results: We found large cross-national differences in patients’ desire to participate in decision-making, with the center explaining 40% of total variance in the desire for participation (p<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable. Conclusions: This study demonstrates that patients’ desire for participation in decisionmaking varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe

The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS).

BACKGROUND: The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) - with versions for patients (CDIS-P) and staff (CDIS-S) - for use in mental health services. METHODS: An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. RESULTS: After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. CONCLUSIONS: CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments. TRIAL REGISTRATION: ISRCTN75841675.CEDAR study is funded by a grant from the Seventh Framework Programme (Research Area HEALTH-2007-3.1-4 Improving clinical decision making) of the European Union (Grant no. 223290)

Quantifying Reagent Spreading by Cross-Borehole Electrical Tomography to Assess Performance of Groundwater Remediation

In situ remediation of contaminated groundwater often relies on the installation of a treatment zone (TZ) degrading the contamination. Zero-valent-iron (ZVI) is a type of reagent used for this purpose. Adequate delivery of ZVI in the whole target volume is particularly challenging and requires monitoring with high spatial resolution. We present a monitoring tool for imaging the dynamic spreading of ZVI and its associated ionic cloud, using cross-borehole time-lapse electrical resistivity tomography (ERT). This tool works in urban areas and is particularly suitable for achieving the required spatial resolution at the scale of the target volume. Groundwater and sediment samples show a consistent spatial and temporal distribution of the remediation cloud with cross-borehole ERT. Yet, the 2D anomalies observed with cross-borehole ERT provide a more spatially complete and rapid image of the remediation cloud distribution than if based solely on monitoring screens. At the study site, ZVI injection leads to uneven spreading, clearly documented by cross-borehole ERT monitoring. The benefit of hydraulic conductivity (K) mapping by cross-borehole induced polarization (IP) to understand unexpected injection paths (upstream leakage, spreading in preferred pathways) is investigated. A 2D, IP-based, continuous, and coherent K-distribution is obtained that compares well with estimations by grain size analyses from the TZ. However, the IP-based K-field fails at predicting injection paths, suggesting the creation of pathways during the high-pressure injection of ZVI. Cross-borehole time-lapse ERT is the most promising geophysical tool for performance assessment of in situ remediation involving reagents with conductivity contrast

Artistic Journalism: Confluence in Forms, Values and Practices

In the context of changing values, practices and working arrangements, the worlds of journalism and art converge. Evaluating these professions in conflux and beyond their (supposed) opposing ideologies and discourses, remains both controversial and complex. Through a critical hermeneutic analysis, this paper highlights key areas of tension regarding the confluence of journalism and arts. It is argued that journalism is and always has been inextricably interwoven with the arts, a shared existence not limited to Western democracies. The article proposes a continuum as a theoretical model for mapping and exploring the coexistence of artistic and journalistic approaches of news and news work. This “arts and journalism” continuum offers a potentially fruitful dimension of studying news work as a form of artistic practice in a variety of contexts. In conclusion, a consideration of “Artistic Journalism” is proposed as a way for the profession to articulate its creative foundation with its goal to pursue the truth, including the intrinsic and affective motivations of its practitioners

Content and implementation of clinical decisions in the routine care of people with severe mental illness

Background: Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains. Aims: To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content. Method: As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented. Results: Agreement between patients and staff regarding decision making was moderate (κ = 0.21-0.49; p&lt;0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content. Conclusions: A variety of relevant decision topics were shown for mental health care. Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad