The Father, the Son and the Holy Ghost:A Grounded Theory approach to the comparative study of decision-making in the NAC and PSC

Studies of the relationship between the EU and NATO often focus on the limitations of cooperation, be it at the political or the operational level. However, little is known about the functioning of the political institutional linkages between the EU and NATO. This article therefore studies the main decision-making bodies of the two organisations at the political, ambassadorial level, namely the Political and Security Committee (PSC) of the EU and the North Atlantic Council (NAC) in NATO, as well as their joint meetings. The article employs an inductive Grounded Theory approach, drawing on open-ended interviews with PSC and NAC ambassadors, which reveal direct insights from the objects of analysis. The findings emphasise the impact of both structural and more agency-related categories on decision-making in these three fora. The article thus addresses both the paucity of study on these bodies more broadly and the complete lacuna on joint PSC–NAC meetings specifically, warranting the inductive approach this article endorses

The role of 99mtechnetium-labelled hepato imino diacetic acid (HIDA) scan in the management of biliary pain

Objective. To assess the outcome of laparoscopic cholecystectomy on the basis of an abnormal provocative 99mtechnetium-labelled hepato imino diacetic acid (HIDA) scan for patients with typical biliary pain and normal trans-abdominal ultrasound (TUS) scan. Patients and methods. Prospective data were collected for 1201 consecutive patients with typical biliary symptoms. Patients who were found to have a normal TUS and upper GI endoscopy subsequently underwent cholescintigraphy (HIDA scan). Patients with an abnormal HIDA scan, i.e.<40% ejection fraction with Sincalide® (cholecystokinin octapeptide) – were offered cholecystectomy. Symptoms and histology were reviewed postoperatively. Results. In all, 48/1201 (4%) patients with typical biliary symptoms had a normal ultrasound and endoscopy; 35/48 patients had an abnormal provocative HIDA scan and all underwent laparoscopic cholecystectomy. Histology in all cases revealed chronic cholecystitis and 18 patients had sludge or microlithiasis within the gallbladder. At 6-week follow-up, 31 of the 35 patients were completely asymptomatic or improved. Furthermore, 79% of patients remained symptom-free or improved at a median follow-up of 28.5 months (range 4–70). Conclusions. HIDA scan is a useful clinical tool as an adjunct to the diagnosis and management of patients who present with typical biliary pain and a normal TUS scan

Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention

Purpose To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Methods In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. Results We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. Conclusions Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit