Decision-making

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Decision-making

  • autonomous decision-making
  • clinical decision-making
  • ethical decision-making
  • group decision-making
  • management decision-making
  • medical decision-making
  • political decision-making
  • risky decision-making
  • shared decision-making
  • strategic decision-making
  • therapeutic decision-making
  • treatment decision-making

  • Terms modified by Decision-making

  • decision-making ability
  • decision-making approach
  • decision-making authority
  • decision-making behavior
  • decision-making capability
  • decision-making capacity
  • decision-making context
  • decision-making framework
  • decision-making literature
  • decision-making mechanism
  • decision-making methods
  • decision-making model
  • decision-making models
  • decision-making power
  • decision-making practice
  • decision-making preference
  • decision-making problem
  • decision-making procedure
  • decision-making process
  • decision-making role
  • decision-making rule
  • decision-making strategy
  • decision-making structure
  • decision-making style
  • decision-making system
  • decision-making task
  • decision-making tool

  • Selected Abstracts


    SOCIAL EXCHANGE AND ORGANIZATIONAL COMMITMENT: DECISION-MAKING TRAINING FOR JOB CHOICE AS AN ALTERNATIVE TO THE REALISTIC JOB PREVIEW

    PERSONNEL PSYCHOLOGY, Issue 3 2002
    YOAV GANZACH
    This field experiment investigated the effects of exchange-inducing treatments on pre- and postentry commitment of military recruits. Behavioral (volunteering for combat service and turnover), intentional (willingness to commit to combat service), and attitudinal (commitment, satisfaction, perceived fairness, and perceived choice variety) outcomes are examined. Two exchange-inducing experimental groups, one receiving realistic job preview and another receiving decisionmaking training, were compared to 3 control groups. Results indicated that preentry commitment was significantly higher among participants in the exchange-inducing conditions. However, the effect of decisionmaking training lasted longer than the effect of realistic job preview. [source]


    Decision-Making on Mega-Projects,Cost-Benefit Analysis, Planning and Innovation , Edited by Hugo Priemus, Bent Flyvbjerg, and Bert van Wee

    GROWTH AND CHANGE, Issue 2 2009
    Simonetta Longhi
    First page of article [source]


    Effectiveness of Corticosteroid Treatment in Acute Pharyngitis: A Systematic Review of the Literature

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2010
    Andrew Wing
    Abstract Objectives:, The objective was to examine the effectiveness of corticosteroid treatment for the relief of pain associated with acute pharyngitis potentially caused by group A beta-hemolytic Streptococcus (GABHS). Methods:, This was a systematic review of the literature. Data sources used were electronic databases (Cochrane Library, MEDLINE, EMBASE, Biosis Previews, Scopus, and Web of Science), controlled trial registration websites, conference proceedings, study references, experts in the field, and correspondence with authors. Selection criteria consisted of randomized controlled trials (RCTs) in which corticosteroids, alone or in combination with antibiotics, were compared to placebo or any other standard therapy for treatment of acute pharyngitis in adult patients, pediatric patients, or both. Two reviewers independently assessed for relevance, inclusion, and study quality. Weighted mean differences (WMDs) were calculated and are reported with corresponding 95% confidence intervals (CIs). Results:, From 272 potentially relevant citations, 10 studies met the inclusion criteria. When compared to placebo, corticosteroids reduced the time to clinically meaningful pain relief (WMD = ,4.54 hours; 95% CI = ,7.19 to ,1.89); however, they provided only a small reduction in pain scores at 24 hours (WMD = ,0.90 on a 0,10 visual analog scale; 95% CI = ,1.5 to ,0.3). Heterogeneity among pooled studies was identified for both outcomes (I2 = 81 and 74%, respectively); however, the GABHS-positive subgroup receiving corticosteroid treatment did have a significant mean reduction in time to clinically meaningful pain relief of 5.22 hours (95% CI = ,7.02 to ,3.42; I2 = 0%). Short-term side effect profiles between corticosteroids and placebo groups were similar. Conclusions:, Corticosteroid administration for acute pharyngitis was associated with a relatively small effect in time to clinically meaningful pain relief (4.5-hour reduction) and in pain relief at 24 hours (0.9-point reduction), with significant heterogeneity in the pooled results. Decision-making should be individualized to determine the risks and benefits; however, corticosteroids should not be used as routine treatment for acute pharyngitis. ACADEMIC EMERGENCY MEDICINE 2010; 17:476,483 © 2010 by the Society for Academic Emergency Medicine [source]


    Decision-making about artificial feeding in end-of-life care: literature review

    JOURNAL OF ADVANCED NURSING, Issue 1 2008
    Els Bryon
    Abstract Title.,Decision-making about artificial feeding in end-of-life care: literature review. Aim., This paper is a report of a review of nurses' roles and their perceptions of these roles in decision-making processes surrounding artificial food and fluid administration in adult patients. Background., Of all caregivers, nurses have the closest and most trusting relationship with severely ill patients and their families during the entire end-of-life care process. As a result, nurses become closely involved in complex ethical decision-making processes concerning artificial administration of food or fluids for these patients. Data sources., We searched seven electronic databases (1990,2007) and examined the reference lists of relevant papers. Review methods., This mixed methods review was conducted with guidance of the United Kingdom Centre for Reviews and Dissemination guidelines on systematic reviews. Results., Although their direct impact is limited, nurses play a significant indirect role during decision-making processes. Because of their unique position, they often initiate decision-making processes, function as patient advocates and provide guidance, information and support to patients and families. Although nurses considered their role to be very valuable, they felt that their role was not always defined clearly or appreciated. Whether nurses experience decision-making processes positively depended on several contextual factors. Conclusion., Given their knowledge and practice skills, nurses are in a prime position to contribute valuably to decision-making processes. Nevertheless, they remain sidelined. For nurses to receive sufficient recognition, their decision-making tasks and responsibilities need to be clarified and made manifest to other participants. [source]


    The development of nurses as managers: the prevalence of the self-development route

    JOURNAL OF NURSING MANAGEMENT, Issue 4 2000
    D. Foster PHD
    Aim This article identifies ways in which hospital sisters and charge nurses (ward managers) are developed as managers in one London teaching hospital.Context Ward managers are practising in the context of increasing management responsibility in which decision-making is being driven to occur as close to the patient as possible. Decision-making about the management development opportunities for ward managers rests with senior nurse managers who have espoused their own preferences about the styles of management development open to ward managers. Methods For this small-scale exploratory-descriptive study, qualitative research methods were used with a postal self-completed questionnaire followed by a focus group. The target population was a group of 22 senior nurse managers. There was a questionnaire response rate of 68% (n=15 respondents, four of whom participated in the focus group). Findings The research exposed and substantiated four styles of management development. The organizational prevalence of these styles and the ward managers' preference for each style were also ascertained. The most prevalent style was the one for which there was the least preference. Conclusions The findings indicated that there was a general mismatch between the style of management development prevalent in the organization and the style of management development preferred by the subjects. This left the ward managers generally to follow an unstructured self-development route. The use of a theoretical framework, expressed as a Reluctance-Readiness to Manage Continuum, is suggested to harness the propensity to self-develop and to link it with the organizational need to develop nurses as managers through the paradox of structuring self-development. [source]


    Influence of Antisocial and Psychopathic Traits on Decision-Making Biases in Alcoholics

    ALCOHOLISM, Issue 5 2009
    Robert Miranda Jr
    Background:, Although decision-making processes have become a principal target of study among addiction researchers, few studies have specifically examined decision-making among individuals with alcohol dependence (AD) and findings to date are mixed. The present study examined the relationship between AD and decision-making, and tested whether different facets of antisocial and psychopathic traits explain this association. Methods:, Participants were men with AD (n = 22), AD and comorbid antisocial personality disorder (AD + ASPD; n = 17), or a history of recreational alcohol use, but no current or lifetime symptoms of a substance use disorder, conduct disorder, or ASPD (n = 21). Decision-making was tested using the Iowa Gambling Task (IGT). Results:, Across groups, participants reported similar levels of awareness of the contingencies of the task, but the AD groups with and without ASPD had poorer IGT performance compared with controls (p < 0.05). A block-by-block analysis revealed that while AD had slow but steady improvement across the task, AD + ASPD exhibited initial improvement followed by a significant decrease in advantageous decision-making during the last 20 trials (p < 0.05). This was further confirmed via evidence that impulsive/antisocial personality traits but not psychopathic traits mediated poor IGT performance beyond ASPD diagnosis. Conclusions:, Alcohol-dependent males favored risky choices regardless of whether they met criteria for ASPD. However, decision-making deficits were more pronounced among those with ASPD, and personality traits characterized by impulsive and antisocial tendencies mediated the relationship between AD and decision-making. [source]


    Decision-making needs of patients with depression: a descriptive study

    JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2008
    D. STACEY rn mscn phd
    The study's purpose was to explore the decision-making needs of patients considering treatment options for their depression. Semi-structured interviews were guided by the Ottawa Decision Support Framework. Of 94 participants, 67 were uncertain about their decision. Common decisions identified were whether or not to take medications, attend support groups, undergo electroconvulsive therapy, and location of care. Those feeling certain were more likely to have made a decision (RR 1.37; 95% CI: 1.05, 1.78). However, 40 patients who had ,made a decision' in the recent past were uncertain about their decision. Compared with those who were certain, the uncertain group felt less informed (2.65 vs. 1.64; P < 0.001), less supported (2.63 vs. 1.88; P < 0.001) and less clear about how they valued the benefits and risks of options (2.57 vs. 1.69; P < 0.001). Other influential factors included concerns about confidentiality, distress from depression, embarrassment, panic attacks and lack of energy. Few patients wanted to defer decision making to their physician (n = 8) or family (n = 1). To support decision making, participants identified the need for: discussions with their psychiatrist, nurse or family doctor; access to printed information; and information provided by health professionals and health societies. [source]


    Decision-making, personhood and dementia; exploring the interface

    AUSTRALASIAN JOURNAL ON AGEING, Issue 1 2010
    Colleen Doyle
    No abstract is available for this article. [source]


    Training scenario prototyping for VR-based simulation of neonatal decision-making

    COMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 4 2007
    A. Holobar
    Abstract This paper presents the design and implementation of a real-time system for virtual reality (VR)-based training in neonatal medicine, with main emphasis on simple creation of various training scenarios. This system combines an articulated 3D model of a virtual newborn with text-based descriptions of its physiological and behavioral responses, enabling medical experts to easily construct, simulate and revise an arbitrary postnatal critical situation. Afterwards, the resulting descriptions of newborn's behavior can be used for technical specifications (and even for automatic generation) of more complex behavioral models, such as finite-state automata. © 2007 wiley Periodicals, Inc. Comput Appl Eng Educ 15: 317,328, 2007; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20121 [source]


    Reference-Free Damage Classification Based on Cluster Analysis

    COMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 5 2008
    Hoon Sohn
    The ultimate goal of this study was to develop an in-site non-destructive testing (NDT) technique that can continuously and autonomously inspect the bonding condition between a carbon FRP (CFRP) layer and a host reinforced concrete (RC) structure, when the CRFP layer is used for strengthening the RC structure. The uniqueness of this reference-free NDT is two-fold: First, features, which are sensitive to CFRP debonding but insensitive to operational and environmental variations of the structure, have been extracted only from current data without direct comparison with previously obtained baseline data. Second, damage classification is performed instantaneously without relying on predetermined decision boundaries. The extraction of the reference-free features is accomplished based on the concept of time reversal acoustics, and the instantaneous decision-making is achieved using cluster analysis. Monotonic and fatigue load tests of large-scale CFRP-strengthened RC beams are conducted to demonstrate the potential of the proposed reference-free debonding monitoring technique. Based on the experimental studies, it has been shown that the proposed reference-free NDT technique may minimize false alarms of debonding and unnecessary data interpretation by end users. [source]


    Board Monitoring, Regulation, and Performance in the Banking Industry: Evidence from the Market for Corporate Control

    CORPORATE GOVERNANCE, Issue 5 2010
    Jens Hagendorff
    ABSTRACT Manuscript Type: Empirical Research Question/Issue: The specific monitoring effect of boards of directors versus industry regulation is unclear. In this paper, we examine how the interaction between bank-level monitoring and regulatory regimes influences the announcement period returns of acquiring banks in the US and twelve European economies. Research Findings/Insights: We study three board monitoring mechanisms , independence, CEO-chair duality, and diversity , and analyze their effectiveness in preventing underperforming merger strategies under bank regulators of varying strictness. Only under strict banking regulation regimes, do board independence and diversity improve acquisition performance. In less strict regulatory environments, corporate governance is virtually irrelevant in improving the performance outcomes of merger activities. Theoretical/Academic Implications: Our results indicate a complementary role between monitoring by boards and bank regulation. This study is the first to report evidence consistent with complementarity by investigating the effectiveness (rather than the prevalence) of governance arrangements across regulatory regimes. Practitioner/Policy Implications: Our work offers insights to policymakers charged with improving the quality of decision-making at financial institutions. Attempts to improve the ability of bank boards to critically assess managerial initiatives are most likely to be successful if internal governance is accompanied by strict industry regulation. [source]


    Accounting for suburban tree information systems

    CORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 5 2006
    Alistair M. Brown
    Abstract Suburban trees are things of wonder and of utility, yet accounting has systematically failed to account for them despite the availability of information technologies that could assist in trees' measurement. Taking a utilitarian view of the value of trees, this paper posits a way of accounting for suburban tree information systems, which not only follows the traditional accounting practices of the Australian Standards Setting Board, but also encompasses the idea of sharing ideas from the disciplines of the environmental sciences and computerized informational systems. By using information technologies, local councils and business entities may be able to account for suburban trees as non-current assets, and thereby improve the lot of conscripted investors who seek information for decision-making and accountability. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source]


    THE MOLECULAR FUTURE IN CYTOLOGY

    CYTOPATHOLOGY, Issue 2006
    M. Salto-Tellez
    Molecular diagnosis is the application of molecular biology techniques and knowledge of the molecular mechanisms of disease to diagnosis, prognostication and treatment of diseases. Molecular Diagnosis is, arguably, the fastest growing area of diagnostic medicine. The US market for molecular testing generated $1.3 billion in 2000, which was predicted to increase to about $4.2 billion by 2007.1 We proposed the term Diagnostic Molecular Cytopathology to define the application of molecular diagnosis to cytopathology2. Diagnostic Molecular Cytopathology is essential for the following reasons: (i) Molecular testing is sometimes indispensable to establish an unequivocal diagnosis on cell preparations; (ii) Molecular testing provides extra information on the prognosis or therapy of diseases diagnosed by conventional cytology; (iii) Molecular testing provides genetic information on the inherited nature of diseases that can be directly investigated in cytology samples, by either exfoliation or by fine needle aspiration; (iv) Sometimes the cytopathology sample is the most convenient (or the only available) source of material for molecular testing; (v). Direct molecular interrogation of cells allows for a diagnostic correlation that would otherwise not be possible. Parallel to this direct diagnostic implication, cytopathology is increasing important in the validation of biomarkers for specific diseases, and in therefore of significant importance in the overall translational research strategies. We illustrate its application in some of the main areas of oncology molecular testing, such as molecular fingerprinting of neoplasms,3 lymphoreticular diseases,2 sarcomas4 and lung cancer,5 as well as translational research using diagnostic cytopathology techniques. The next years will see the consolidation of Diagnostic Molecular Cytopathology, a process that will lead to a change of many paradigms. In general, diagnostic pathology departments will have to reorganize molecular testing to pursue a cost-efficient operation. Sample preparation will have to take into account optimal preservation of nuclear acids. The training of technical staff and the level of laboratory quality control and quality assurance would have to follow strict clinical (not research) laboratory parameters. And, most importantly, those pathologists undertaking molecular diagnosis as a discipline would have to develop their professional expertise within the same framework of fellowships and professional credentials that is offered in other sub-specialties. The price to pay if this effort is not undertaken is too important for the future of diagnostic pathology in general. The increasing characterization of molecular biomarkers with diagnostic, prognostic or therapeutic value is making the analysis of tissue and cell samples prior to treatment a more complex exercise. If cytopathologists and histopathologists allow others to take charge of molecular diagnosis, our overall contribution to the diagnostic process will be diminished. We may not become less important, but we may become less relevant. However, those within the discipline of diagnostic pathology who can combine the clinical background of diseases with the morphological, immunocytochemical and molecular diagnostic interpretation will represent bona fide diagnostic specialists. Such ,molecular cytopathologists' would place themselves at the centre of clinical decision-making. Reference:, 1. Liz Fletcher. Roche leads molecular diagnostics charge. Nature Biotechnol 20, 6,7; 2002 2. Salto-Tellez M and Koay ESC. Molecular Diagnostic Cytopathology - Definitions, Scope and Clinical Utility. Cytopathology 2004; 15:252,255 3. Salto-Tellez M, Zhang D, Chiu LL, Wang SC, Nilsson B, and Koay ESC. Immunocytochemistry Versus Molecular Fingerprinting of Metastases. Cytopathology, 2003 Aug; 14(4):186,90. 4. Chiu LL, Koay SCE, Chan NL and Salto-Tellez M. Molecular Cytopathology: Sequencing of the EWS-WT1 Gene Fusion Transcript in the Peritoneal Effusion of a Patient with Desmoplastic Small Round Cell Tumour. Diagnostic Cytopathology, 2003 Dec; 29(6): 341,3. 5. TM Chin, D Anuar, R Soo, M Salto-Tellez, WQ Li, B Ahmad, SC Lee, BC Goh, K Kawakami, A Segal, B Iacopetta, R Soong. Sensitive and Cost-Effective deptection of epidermal growth factor Receptor Mutations in Small Biopsies by denaturing High Performance Liquid Chromatography. (In press). [source]


    Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment

    DENTAL TRAUMATOLOGY, Issue 2 2000
    T. Kvist
    Abstract , Endodontic retreatment decision-making must include an appraisal of the costs of the different strategies proposed. In addition to direct costs, postoperative discomfort may have other consequences in terms of time off work, unscheduled visits and suffering. To establish a foundation for the appraisal of such indirect and intangible costs the present study was set up in which patients' assessments of pain and swelling after surgical and nonsurgical retreatment procedures were recorded. Ninety-two patients with 95 root-filled incisors and canine teeth exhibiting apical periodontitis were included in the study. The mode of retreatment was randomly assigned. Each day during the first post-treatment week patients assessed their degree of swelling and pain on horizontal 100-mm visual analog scales (VAS). The scales ranged from "no swelling" to "very severe swelling" and "no pain" to "intolerable pain", respectively. Consumption of self-prescribed analgesics and time off work were also recorded. Significantly more patients reported discomfort after surgical retreatment than after nonsurgical procedures. High pain scores were most frequent on the operative day while swelling reached its maximum on the first postoperative day followed by progressive decrease both in frequency and magnitude. Postoperative symptoms associated with nonsurgical retreatment were less frequent but reached high VAS values in single cases. Analgesics were significantly more often consumed after periapical surgery. Patients reported absence from work mainly due to swelling and discoloration of the skin. This was found to occur only after surgical retreatment. Conclusively, surgical retreatment resulted in more discomfort and tended to bring about greater indirect costs than nonsurgical retreatment. [source]


    ETHICAL PROBLEMS IN CONDUCTING RESEARCH IN ACUTE EPIDEMICS: THE PFIZER MENINGITIS STUDY IN NIGERIA AS AN ILLUSTRATION

    DEVELOPING WORLD BIOETHICS, Issue 1 2010
    EMMANUEL R. EZEOME
    ABSTRACT The ethics of conducting research in epidemic situations have yet to account fully for differences in the proportion and acuteness of epidemics, among other factors. While epidemics most often arise from infectious diseases, not all infectious diseases are of epidemic proportions, and not all epidemics occur acutely. These and other variations constrain the generalization of ethical decision-making and impose ethical demands on the individual researcher in a way not previously highlighted. This paper discusses a number of such constraints and impositions. It applies the ethical principles enunciated by Emmanuel et al.1 to the controversial Pfizer study in Nigeria in order to highlight the particular ethical concerns of acute epidemic research, and suggest ways of meeting such challenges. The paper recommends that research during epidemics should be partly evaluated on its own merits in order to determine its ethical appropriateness to the specific situation. Snap decisions to conduct research during acute epidemics should be resisted. Community engagement, public notification and good information management are needed to promote the ethics of conducting research during acute epidemics. Individual consent is most at risk of being compromised, and every effort should be made to ensure that it is maintained and valid. Use of data safety management boards should be routine. Acute epidemics also present opportunities to enhance the social value of research and maximize its benefits to communities. Ethical research is possible in acute epidemics, if the potential challenges are thought of ahead of time and appropriate precautions taken. [source]


    ,EVEN IF YOU'RE POSITIVE, YOU STILL HAVE RIGHTS BECAUSE YOU ARE A PERSON': HUMAN RIGHTS AND THE REPRODUCTIVE CHOICE OF HIV-POSITIVE PERSONS

    DEVELOPING WORLD BIOETHICS, Issue 1 2008
    LESLIE LONDON
    ABSTRACT Global debates in approaches to HIV/AIDS control have recently moved away from a uniformly strong human rights-based focus. Public health utilitarianism has become increasingly important in shaping national and international policies. However, potentially contradictory imperatives may require reconciliation of individual reproductive and other human rights with public health objectives. Current reproductive health guidelines remain largely nonprescriptive on the advisability of pregnancy amongst HIV-positive couples, mainly relying on effective counselling to enable autonomous decision-making by clients. Yet, health care provider values and attitudes may substantially impact on the effectiveness of nonprescriptive guidelines, particularly where social norms and stereotypes regarding childbearing are powerful, and where providers are subjected to dual loyalty pressures, with potentially adverse impacts on rights of service users. Data from a study of user experiences and perceptions of reproductive and HIV/AIDS services are used to illustrate a rights analysis of how reproductive health policy should integrate a rights perspective into the way services engage with HIV-positive persons and their reproductive choices. The analysis draws on recognised tools developed to evaluate health policies for their human rights impacts and on a model developed for health equity research in South Africa to argue for greater recognition of agency on the part of persons affected by HIV/AIDS in the development and content of policies on reproductive choices. We conclude by proposing strategies that are based upon a synergy between human rights and public health approaches to policy on reproductive health choices for persons with HIV/AIDS. [source]


    MODULE ONE: INTRODUCTION TO RESEARCH ETHICS

    DEVELOPING WORLD BIOETHICS, Issue 1 2005
    UDO SCHÜKLENK
    ABSTRACT This module will introduce you to the ethical concepts underlying applied ethical decision-making in the area of research involving human participants. We will also learn what the issues are that people involved in research on research ethics are concerned with. Ethics without an understanding of historical and legal context makes arguably little sense. It is for this reason that this module will begin with a brief history of research ethics and ends with a brief overview of the relevant national and international guidelines pertaining to ethical issues in research involving human participants. [source]


    Exploring the Frontier of Livelihoods Research

    DEVELOPMENT AND CHANGE, Issue 1 2005
    Leo De Haan
    This article discusses the value of livelihoods studies and examines the obstacles which have prevented it from making a greater contribution to understanding the lives of poor people over the past decade. After examining the roots of the livelihoods approach, two major challenges are explored: the conceptualization of the problem of access, and how to achieve a better understanding of the mutual link between livelihood opportunities and decision-making. The article concludes that access to livelihood opportunities is governed by social relations, institutions and organizations, and that power is an important (and sometimes overlooked) explanatory variable. In discussing the issue of access to livelihood opportunities, the authors note the occurrence of both strategic and unintentional behaviour and the importance of structural factors; they discuss concepts of styles and pathways, which try to cater for structural components and regularities; and they propose livelihood trajectories as an appropriate methodology for examining these issues. In this way, the article also sets the agenda for future livelihoods research. [source]


    Unequal Knowledges in Jharkhand, India: De-Romanticizing Women's Agroecological Expertise

    DEVELOPMENT AND CHANGE, Issue 5 2000
    Sarah Jewitt
    Taking the Jharkhand region of India as a case study, this article uses empirical data to intervene in ,women, environment and development' and ecofeminist debates regarding women's environmental knowledge. The article first outlines the adoption of gender/environmental issues into development planning and considers the dangers of overestimating women's agroecological knowledges and assuming that they can easily participate in development projects. It then highlights the local complexities of environmental knowledge possession and control with reference to gender and other variations in agricultural participation, decision-making and knowledge transfers between villagers' natal and marital places. Particular emphasis is placed on the economic, socio-cultural and ,actor' related factors that supplement gender as an influence on task allocation, decision-making, knowledge distribution and knowledge articulation. The article concludes that given the socio-cultural constraints women face in accumulating and vocalizing environmental knowledge, simplistic participatory approaches are unlikely to empower them. Instead, more flexible, site-specific development initiatives (coupled with wider structural change) are required if opportunities are to be created for women to develop and use their agroecological knowledges. [source]


    The Logic of African Neopatrimonialism: What Role for Donors?

    DEVELOPMENT POLICY REVIEW, Issue 5 2007
    Diana Cammack
    Today a number of sub-Saharan African countries display the outward signs of modern, democratic states. International aid agencies often treat them as though power and decision-making reside within government institutions and that they function as designed. When they do not they are labelled dysfunctional though their action is actually quite logical when viewed through a ,neopatrimonial lens'. This article outlines a number of neopatrimonial practices observed in Africa in the past two decades and attempts to explain the ,logic' that underpins them. It provides several recommendations about the way donors should assist states where deeply rooted anti-democratic and non-developmental behaviour dominates. [source]


    Clinical practice recommendations for bipolar disorder

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 2009
    G. S. Malhi
    Objective:, To provide clinically relevant evidence-based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision-making. Method:, A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. These preliminary recommendations underwent extensive consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. Results:, The clinical practice recommendations for bipolar disorder (bipolar CPR) summarise evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. Conclusion:, These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation. [source]


    Mechanical ventilation for respiratory failure in children with severe neurological impairment: is it futile medical treatment?

    DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2010
    JOSEPHUS PJ VAN GESTEL
    Aim, To assess outcome for children with severe neurological impairment receiving invasive mechanical ventilation for respiratory failure. Method, Medical charts for all such children treated in our intensive care unit (ICU) between January 2003 and July 2008 were reviewed. Outcomes were compared with those for children with moderate neurological impairment. Results, Twenty-two children with severe neurological impairment were included (nine females, 13 males; median age 7y 10mo; range 4mo,17y). The median duration of mechanical ventilation was 16 days. Six children had an uneventful 1-year survival, the others required reintubation or readmission to the ICU, or died. Eleven children were still alive 1 year after discharge from the ICU. Nine patients died of respiratory failure. None of the children in the severe group died of a heart defect. Eleven children with moderate neurological impairment were included (eight females, three males; median age 1y 1mo, range 4mo,13y). Four children had an uneventful 1-year survival. Eight children were still alive 1 year after discharge from the ICU. Two of the three non-survivors died of their heart defects. Interpretation, Mechanical ventilation for respiratory failure in children with severe neurological impairment is complex and associated with limited survival. However, it cannot be regarded as futile medical treatment. Further studies are urgently needed for the rational guidance of clinical decision-making. [source]


    Management of scoliosis in Duchenne muscular dystrophy: a large 10-year retrospective study

    DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2006
    M Kinali MD
    Scoliosis affects 75 to 90% of patients with non-ambulant Duchenne muscular dystrophy (DMD). Spinal surgery is the treatment of choice but the indication varies among centres. Some offer surgery to all non-ambulant patients, irrespective of scoliosis severity. Early surgery has the advantage of targeting DMD when cardiorespiratory function is preserved, but not all patients develop scoliosis. We report our 10-year experience of scoliosis management in 123 patients with DMD who were at least 17 years old at the time of the study. Scoliosis was absent in 10%, and mild, non-progressive (at least 30°) in 13% of patients. Another 13% had moderate scoliosis (31,50°) and were managed conservatively. Surgery was considered in 57% (70/123) of patients with scoliosis greater than 50° and eventually performed in 35%. The remaining patients either refused surgery (9%) or were unfit because of cardiorespiratory compromise (13%). In a further 7%, scoliosis (greater than 50°), first noted after 14 years of age, was progressing slowly and surgery was not performed. At 17 years there was no difference in survival, respiratory impairment, or sitting comfort among patients managed conservatively or with surgery. One-third (44/123) of our patients were managed satisfactorily without receiving spinal surgery. We provide insight into the natural history of scoliosis in DMD that should help families and clinicians with decision-making when surgery is considered. [source]


    The effects of age and sex on mental rotation performance, verbal performance, and brain electrical activity

    DEVELOPMENTAL PSYCHOBIOLOGY, Issue 4 2002
    Jonathan E. Roberts
    Abstract This study examined the effects of age and sex on mental rotation performance, verbal performance, and brain-wave activity. Thirty-two 8-year-olds (16 boys) and 32 college students (16 men) had EEG recorded at baseline and while performing four computerized tasks: a two-dimensional (2D) gingerbread man mental rotation, a 2D alphanumeric mental rotation, of three-dimensional (3D) basketball player mental rotation, and lexical decision making. Additionally, participants completed a paper- and pencil water level task and an oral verbal fluency task. On the 2D alphanumeric and 3D basketball player mental rotation tasks, men performed better than boys, but the performance of women and girls did not differ. On the water level task, men performed better than women whereas there was no difference between boys and girls. No sex differences were found on the 2D gingerbread man mental rotation, lexical decision-making, and verbal fluency tasks. EEG analyses indicated that men exhibited left posterior temporal activation during the 2D alphanumeric task and that men and boys both exhibited greater left parietal activation than women and girls during the 2D gingerbread man task. On the 3D basketball player mental rotation task, all participants exhibited greater activation of the right parietal area than the left parietal area. These data give insight into the brain activity and cognitive development changes that occur between childhood and adulthood. © 2002 Wiley Periodicals, Inc. Dev Psychobiol 40: 391,407, 2002. Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/dev.10039 [source]


    Lipid-lowering therapy in patients with type 2 diabetes: the case for early intervention

    DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2008
    Armin Steinmetz
    Abstract Chronic complications of type 2 diabetes, in particular, macrovascular complications, confer substantial morbidity and mortality and adversely affect a patient's quality of life. Early intensive intervention to control cardiovascular risk factors is essential in clinical management. Atherogenic dyslipidaemia characterized by elevated triglycerides, a low level of high-density lipoprotein cholesterol (HDL-C), and an increase in the preponderance of small, dense low-density lipoprotein (LDL) particles, is a key modifiable risk factor for macrovascular diabetic complications. Lowering low-density lipoprotein cholesterol (LDL-C) with a statin (or the combination of statin and ezetimibe) is the main focus for reducing cardiovascular risk in patients with diabetes. However, statins fail to address the residual cardiovascular risk associated with low HDL-C. Fibrates are effective against all components of the atherogenic dyslipidaemia associated with type 2 diabetes. Secondary analyses of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study suggest a role for early treatment with fenofibrate in improving cardiovascular risk reduction in type 2 diabetes and provide safety data supporting the use of fenofibrate in combination with a statin. Data from the FIELD study suggest that fenofibrate may also have potential to impact on microvascular diabetic complications associated with type 2 diabetes. Data are awaited from the ongoing Action to Control Cardiovascular Risk in Diabetes (ACCORD) study to evaluate the outcome benefits of combining fenofibrate with a statin in patients with type 2 diabetes. Finally, in view of divergent study results and outstanding data, assessment of the risk of the individual with type 2 diabetes is mandatory to assist clinical decision-making when initiating lipid therapy. Copyright © 2008 John Wiley & Sons, Ltd. [source]


    Randomized controlled trials in schizophrenia: a critical perspective on the literature

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2002
    S. Gilbody
    Objective:,The randomized trial provides an opportunity to minimize the inclusion of biases in the evaluation of interventions in psychiatry. Difficulties arise, however, when applying their results to `real world' clinical practice and decision-making. We, therefore, examined the real world applicability of schizophrenia trials. Method:,A narrative overview of the content and quality of the randomized trials relevant to the care of those with schizophrenia is provided. Results:,Complex, explanatory, under-powered randomized drug trials dominate evaluative research in schizophrenia. Conclusion:,Explanatory designs are a necessary but insufficient step in establishing the true worth of interventions in schizophrenia. Research from other spheres of mental health and wider health care suggest that pragmatic trials are feasible. This design allows large scale trials to be conducted which include patients which we would recognize from routine practice and which record outcomes which are of genuine interest to decision-makers. [source]


    The 2004 Madrid train bombings: an analysis of pre-hospital management

    DISASTERS, Issue 1 2008
    Alejandro López Carresi
    The terrorist train bombings in Madrid, Spain, on 11 March 2004 triggered a swift and massive medical response., This paper analyses the pre-hospital response to the attacks to gain insight into current trends in disaster management among Madrid's Emergency Medical Services (EMSs). To this end, the existing emergency planning framework is described, the basic structures of the different EMSs are presented, and the attacks are briefly depicted before consideration is given to pre-hospital management. Finally, an explanation of the main underlying misconceptions in emergency planning and management in Madrid is provided to aid understanding of the origins of some of the problems detected during the response. These are attributable mainly to inappropriate planning rather than to mistakes in field-level decision-making. By contrast, many of the successes are attributable to individual initiatives by frontline medics who compensated for the lack of clear command by senior managers by making adaptive and flexible decisions. [source]


    Using Evidence to Improve Reproductive Health Quality along the Thailand-Burma Border

    DISASTERS, Issue 3 2004
    Tara M. Sullivan
    The Mae Tao Clinic, located on the Thailand-Burma border, has provided health services for illegal migrant workers in Thailand and internally displaced people from Burma since 1989. In 2001, the clinic launched a project with the primary aim of improving reproductive health services and the secondary aim of building clinic capacity in monitoring and evaluation (M&E). This paper first presents the project's methods and key results. The team used observation of antenatal care and family-planning sessions and client exit interviews at baseline and follow-up, approximately 13 months apart, to assess performance on six elements of quality of care. Findings indicated that improving programme readiness contributed to some improvement in the quality of services, though inconsistencies in findings across the methods require further research. The paper then identifies lessons learned from introducing M&E in a resource-constrained setting. One key lesson was that a participatory approach to M&E increased people's feelings of ownership of the project and motivated staff to collect and use data for programme decision-making to improve quality. [source]


    From Disaster to Sustainable Civil Society: The Kobe Experience

    DISASTERS, Issue 1 2004
    Rajib Shaw
    Nine years after the Kobe earthquake in Japan, social issues are still prominent, and the rehabilitation process is still ongoing. The earthquake caused two major changes in Japanese society: an increase in voluntary and non-government activities, and the enhancement of cooperation between local government and the residents' association. People's participation in the decision-making process was a significant achievement. To sustain the efforts generated after the earthquake, the Kobe Action Plan was formulated and tested in different disaster scenarios. The current study suggests that civil societies in urban areas are sustainable if, first, the activities related to daily services are provided by the resident's associations; and second, these are linked to economic incentives. Leadership plays a crucial role in collective decision-making. Creation of the support system is essential for long-term sustainability of civil-society activities. These observations are exemplified in the case study in Nishi Suma, one of the worst-affected areas in the Kobe city. [source]


    The Application of Geographic Information Systems and Global Positioning Systems in Humanitarian Emergencies: Lessons Learned, Programme Implications and Future Research

    DISASTERS, Issue 2 2003
    Reinhard Kaiser
    Geographic information systems (GIS), global positioning systems and remote sensing have been increasingly used in public health settings since the 1990s, but application of these methods in humanitarian emergencies has been less documented. Recent areas of application of GIS methods in humanitarian emergencies include hazard, vulnerability, and risk assessments; rapid assessment and survey methods; disease distribution and outbreak investigations; planning and implementation of health information systems; data and programme integration; and programme monitoring and evaluation. The main use of GIS in these areas is to provide maps for decision-making and advocacy, which allow overlaying types of information that may not normally be linked. GIS is also used to improve data collection in the field (for example, for rapid health assessments or mortality surveys). Development of GIS methods requires further research. Although GIS methods may save resources and reduce error, initial investment in equipment and capacity building may be substantial. Especially in humanitarian emergencies, equipment and methodologies must be practical and appropriate for field use. Add-on software to process GIS data needs to be developed and modified. As equipment becomes more user-friendly and costs decrease, GIS will become more of a routine tool for humanitarian aid organisations in humanitarian emergencies, and new and innovative uses will evolve. [source]