Engaging the public in healthcare decision making: Results from a citizens’ jury on emergency care services

Background: Policies addressing ED crowding have failed to incorporate the public's perspectives; engaging the public in such policies is needed. Objective: This study aimed at determining the public's recommendations related to alternative models of care intended to reduce crowding, optimising access to and provision of emergency care. Methods: A Citizens' Jury was convened in Queensland, Australia, to consider priority setting and resource allocation to address ED crowding. Twenty-two jurors were recruited from the electoral roll, who were interested and available to attend the jury from 15 to 17 June 2012. Juror feedback was collected via a survey immediately following the end of the jury. Results: The jury considered that all patients attending the ED should be assessed with a minority of cases diverted for assistance elsewhere. Jurors strongly supported enabling ambulance staff to treat patients in their homes without transporting them to the ED, and allowing non-medical staff to treat some patients without seeing a doctor. Jurors supported (in principle) patient choice over aspects of their treatment (when, where and type of health professional) with some support for patients paying towards treatment but unanimous opposition for patients paying to be prioritised. Most of the jurors were satisfied with their experience of the Citizens' Jury process, but some jurors perceived the time allocated for deliberations as insufficient. Conclusions: These findings suggest that the general public may be open to flexible models of emergency care. The jury provided clear recommendations for direct public input to guide health policy to tackle ED crowding

Recommendations from Two Citizens’ Juries on the Surgical Management of Obesity

Background: It is important that guidelines and criteria used to prioritise access to bariatric surgery are informed by the values of the tax-paying public in combination with the expertise of healthcare professionals. Citizens’ juries are increasingly used around the world to engage the public in healthcare decision-making. This study investigated citizens’ juries about prioritising patient access to bariatric surgery in two Australian cities. Objectives: The objective of this study is to examine public priorities for government expenditure on the surgical management of obesity developed through either a one or three-day citizen jury. Subjects/Methods: A three-day jury was held in Brisbane and a one-day jury in Adelaide. Jurors were selected in Brisbane (n = 18) and in Adelaide (n = 12) according to pre-specified criteria. Expert witnesses from various medical disciplines and consumers were cross-examined by jurors. Results: The verdicts of the juries were similar in that both juries agreed bariatric surgery was an important option in the management of obesity and related comorbidities. Recommendations about who should receive treatment differed slightly across the juries. Both juries rejected the use of age as a rationing tool, but managed their objections in different ways. Participants’ experiences of the jury process were positive, but our observations suggested that many variables may influence the nature of the final verdict. Conclusions: Citizen’s juries, even when shorter in duration, can be an effective tool to guide the development of health policy and priorities. However, our study has identified a range of variables that should be considered when designing and running a jury and when interpreting the verdict

Science teachers’ experiences of inquiry-based learning through a serious game:a phenomenographic perspective

This study employed a phenomenographic approach to investigate science teachers’ conceptions of inquiry-based learning through a serious game. Simaula is a prototype game designed and used as a virtual practicum for eliciting understandings on how in-game inquiry was appeared to, or experienced by, the participating teachers. Group interviews with 20 secondary education science teachers revealed four qualitatively different ways of experiencing inquiry-based learning through Simaula: (a) as uncovering insights about student’s learning needs, interests and emotions; (b) as generating ideas and concepts for meaningful inquiry; (c) as a set of operations for designing and carrying out scientific research; and (d) as authentic inquiry for enabling knowledge building processes. Seven dimensions of variation have been identified viewed as contextual influences on conceptions of in-game inquiry constituting discernment of: epistemic inquiry-based learning modes; role of teacher; role of student; game-play focus; core mechanics focus; feedback and progress mechanics and game uncertainty. The results illuminated a partial in-game inquiry approach with distinct epistemic modes from developing empathy and meaning making to knowledge construction and knowledge building. The findings also indicated that game design elements played central role in shaping conceptions of in-game inquiry from focusing on rules and logic as means to completing the game’s level to understanding the complexity of core mechanics for developing and transferring in-game inquiry to the real classroom. This insinuates that distinct game design properties may be considered in terms of extending intrinsic in-game inquiry experiences to actual in-class inquiry practice

Frzb, a Secreted Protein Expressed in the Spemann Organizer, Binds and Inhibits Wnt-8

AbstractWe isolated a Xenopus homolog of Frzb, a newly described protein containing an amino-terminal Frizzled motif. It dorsalized Xenopus embryos and was expressed in the Spemann organizer during early gastrulation. Unlike Frizzled proteins, endogenous Frzb was soluble. Frzb was secretable and could act across cell boundaries. In several functional assays, Frzb antagonized Xwnt-8, a proposed ventralizing factor with an expression pattern complementary to that of Frzb. Furthermore, Frzb blocked induction of MyoD, an action reported recently for a dominant-negative Xwnt-8. Frzb coimmunoprecipitated with Wnt proteins, providing direct biochemical evidence for Frzb-Wnt interactions. These observations implicate Frzb in axial patterning and support the concept that Frzb binds and inactivates Xwnt-8 during gastrulation, preventing inappropriate ventral signaling in developing dorsal tissues

Engaging the public in healthcare decision making: Should the Emergency Department Treat Everyone who Presents for Treatment?:Citizens' Jury on Emergency Care Services

Citizens’ Juries (CJ) offer a way of seeking informed public views using a democratic, deliberative process. This report describes the methods, processes, and verdicts of a CJ held in Queensland in June 2012, focussing on public preferences around the provision of emergency care services. This CJ was undertaken as part of larger research study led by Griffith University and funded by an Australian Research Council Linkage Grant, along with partner investigators Queensland Health, Southern Adelaide Local Health Network Inc., the National Institute for Health and Clinical Excellence, Flinders University, and Queensland University of Technology. The larger project aims to facilitate the identification and application of optimal methods for engaging the public in healthcare decision-making, provide guidance on the appropriate population groups to consider when eliciting preferences, and provide direct public input to guide health policy. The project is using two methods to engage the public and address a range of methodological questions: the deliberative CJ and the Discrete Choice Experiment (DCE). The DCE is a quantitative method that can elicit the relative strength of preference of the public around a priority-setting topic, and the trade-offs the public are prepared to make. The electoral roll, obtained with approval from the Electoral Commission of Queensland, was used to develop a sampling frame of the Metro South Health Service District, 1 and a random sample was invited to express interest in being a juror. From those interested, a jury of 22 was purposively selected to reflect the demographic characteristics of Queensland