Improving Dynamic Decision Making Through Training and Self-Reflection

The modern business environment requires managers to make decisions in a dynamic and uncertain world. In the current study, experimenters investigated the effects of a brief training aimed at improving dynamic decision making (DDM) skills on individual performance in a virtual DDM task. During the training, experimenters explained the DDM process, stressed the importance of self-reflection in DDM, and provided 3 selfreflective questions to guide participants during the task. Additionally, experimenters explored whether participants low or high in self-reflection would perform better in the task and whether participants low or high in self-reflection would benefit more from the training. Participants were 68 graduate business students. They individually managed a computer-simulated chocolate production company called CHOCO FINE and answered surveys to assess self-reflection and demographics. Results showed that students trained in DDM made decisions leading to better management performance in CHOCO FINE compared to untrained students. Self-reflection scores also predicted performance in this virtual business, and participants low in self-reflection benefitted the most from training. Organizations could use DDM training to establish and promote a culture that values selfreflective decision making

Chlamydia trachomatis and the risk of spontaneous preterm birth, babies who are born small for gestational age, and stillbirth: A population-based cohort study

Background: Chlamydia trachomatis is one of the most commonly diagnosed sexually transmitted infections worldwide, but reports in the medical literature of an association between genital chlamydia infection and adverse obstetric outcomes are inconsistent. Methods: The Western Australia Data Linkage Branch created a cohort of women of reproductive age by linking records of birth registrations with the electoral roll for women in Western Australia who were born from 1974 to 1995. The cohort was then linked to both chlamydia testing records and the state perinatal registry for data on preterm births and other adverse obstetric outcomes. We determined associations between chlamydia testing, test positivity, and adverse obstetric outcomes using multivariate logistic regression analyses. Findings: From 2001 to 2012, 101558 women aged 15 to 38 years had a singleton birth. Of these women, 3921 (3·9%) had a spontaneous preterm birth, 9762 (9·6% of 101371 women with available data) had a baby who was small for gestational age, and 682 (0·7%) had a stillbirth. During their pregnancy, 21267 (20·9%) of these women had at least one chlamydia test record, and 1365 (6·4%) of those tested were positive. Before pregnancy, 19157 (18·9%) of these women were tested for chlamydia, of whom 1595 (8·3%) tested positive for chlamydia. Among all women with a test record, after adjusting for age, ethnicity, maternal smoking, and history of other infections, we found no significant association between a positive test for chlamydia and spontaneous preterm birth (adjusted odds ratio 1·08 [95% CI 0·91–1·28]; p=0·37), a baby who was small for gestational age (0·95 [0·85–1·07]; p=0·39), or stillbirth (0·93 [0·61–1·42]; p=0·74). Interpretation: A genital chlamydia infection that is diagnosed and, presumably, treated either during or before pregnancy does not substantially increase a woman’s risk of having a spontaneous preterm birth, having a baby who is small for gestational age, or having a stillbirth. Funding: Australian National Health and Medical Research Counci

Media industries and engagement: A dialogue across industry and academia

This article focuses on media engagement within the industry. The article takes the form of a dialogue between industry and academic researchers involved in a collaborative project on production and audience research on engagement (funded by the Wallenberg Foundation and in collaboration with Endemol Shine Group). Speakers from the film and television industry, and academic researchers working on media engagement, discuss how engagement is multifaceted, working across political and public spheres, policy and industry sectors, audiences and popular culture

An investigation of the effects of age and stroke on implicit motor imagery as demonstrated by a hand laterality judgment test

Background Explicit motor imagery is recommended for stroke rehabilitation but can be difficult to practice. Hand Laterality Judgement (HLJ) stimulates implicit motor imagery which may be easier for stroke patients, but its benefits are unknown. Previous studies are inconclusive and have not considered the effects of older age. Objectives. This thesis investigated the effects of older age and stroke on HLJ and the effects of practising HLJ after a stroke. Methods Three experiments were undertaken. The first compared HLJ in twenty young, healthy participants (mean=22(2) years) with twenty aged 60 -70 years (mean=67(3) years) and twenty-two aged ≥ 70 years (mean=77(5) years). The second compared HLJ of eleven stroke survivors aged ≥ 60 years (mean =69 (6)) with age-matched controls. The third examined the effects of practising HLJ in four stroke survivors. Main findings There were no significant differences in HLJ response times between the young and older groups (p=.06) or between the stroke and control group (p=.13). Both older groups were significantly less accurate than the younger group (young group =92%; older groups= 81%-86% p≤ .00). There were no significant differences in accuracy between the two older groups (P=.10) or between the stroke and control groups (p=.59). All groups engaged in implicit motor imagery, but this was impaired by early old age. Visuospatial imagery was impaired in later old age and by stroke. There were no significant relationships between HLJ performance and upper limb impairment post-stroke. There were no significant effects of practising HLJ, but trends towards increased accuracy (d=.24) and slower response times (d=.46). Conclusion. Stroke survivors can perform HLJ as well as similarly aged healthy individuals. Stroke may impair visuospatial imagery, but accuracy improves with practice. Further research is needed to determine if there are any benefits to post-stroke upper limb rehabilitation

The trial is owned by the team, not by an individual:A qualitative study exploring the role of teamwork in recruitment to randomised controlled trials in surgical oncology

BACKGROUND: Challenges exist in recruitment to trials involving interventions delivered by different clinical specialties. Collaboration is required between clinical specialty and research teams. The aim of this study was to explore how teamwork influences recruitment to a multicentre randomised controlled trial (RCT) involving interventions delivered by different clinical specialties. METHODS: Semi-structured interviews were conducted in three centres with a purposeful sample of members of the surgical, oncology and research teams recruiting to a feasibility RCT comparing definitive chemoradiotherapy with chemoradiotherapy and surgery for oesophageal squamous cell carcinoma. Interviews explored factors known to influence healthcare team effectiveness and were audio-recorded and thematically analysed. Sampling, data collection and analysis were undertaken iteratively and concurrently. RESULTS: Twenty-one interviews were conducted. Factors that influenced how team working impacted upon trial recruitment were centred on: (1) the multidisciplinary team (MDT) meeting, (2) leadership of the trial, and (3) the recruitment process. The weekly MDT meeting was reported as central to successful recruitment and formed the focus for creating a ‘study team’, bringing together clinical and research teams. Shared study leadership positively influenced healthcare professionals’ willingness to participate. Interviewees perceived their clinical colleagues to have strong treatment preferences which led to scepticism regarding whether the treatments were being described to patients in a balanced manner. CONCLUSIONS: This study has highlighted a number of aspects of team functioning that are important for recruitment to RCTs that span different clinical specialties. Understanding these issues will aid the production of guidance on team-relevant issues that should be considered in trial management and the development of interventions that will facilitate teamwork and improve recruitment to these challenging RCTs. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN): ISRCTN89052791

Improving adherence to guidelines for the diagnosis and management of pelvic inflammatory disease: a systematic review

Background Evidence suggests adherence to clinical guidelines for pelvic inflammatory disease (PID) diagnosis and management is suboptimal. We systematically reviewed the literature for studies describing strategies to improve the adherence to PID clinical guidelines. Methods. The databases MEDLINE and EMBASE, and reference lists of review articles were searched from January 2000 to April 2012. Only studies with a control group were included. Results. An interrupted time-series study and two randomised controlled trials (RCTs) were included. The interrupted time-series found that following a multifaceted patient and practitioner intervention (practice protocol, provision of antibiotics on-site, written instructions for patients, and active followup), more patients received the recommended antibiotics and attended for followup. One RCT found a patient video on PID self-care did not improve medication compliance and followup. Another RCT found an abbreviated PID treatment guideline for health-practitioners improved their management of PID in hypothetical case scenarios but not their diagnosis of PID. Conclusion. There is limited research on what strategies can improve practitioner and patient adherence to PID diagnosis and management guidelines. Interventions that make managing PID more convenient, such as summary guidelines and provision of treatment on-site, appear to lead to better adherence but further empirical evidence is necessary

Core information sets for informed consent to surgical interventions:baseline information of importance to patients and clinicians

Abstract Background Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. Main body The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. Conclusion The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice