scholarly journals Gynecologists’ perspectives on two types of uterus-preserving surgical repair of uterine descent; sacrospinous hysteropexy versus modified Manchester

2020 ◽  
Author(s):  
Rosa A. Enklaar ◽  
Brigitte A. B. Essers ◽  
Leanne ter Horst ◽  
Kirsten B. Kluivers ◽  
Mirjam Weemhoff
Keyword(s):  
Decision Making ◽  
Uterine Prolapse ◽  
Final Decision ◽  
Evidence Based ◽  
Patient Counseling ◽  
Structured Interviews ◽  
Sacrospinous Hysteropexy ◽  
Uterosacral Ligaments ◽  
Choice Of Procedure ◽  
Uterine Descent

Abstract Introduction and hypothesis The modified Manchester (MM) and sacrospinous hysteropexy (SSH) are the most common uterus-preserving surgical procedures for uterine descent. Little is known about gynecologists’ preferences regarding the two interventions. The study’s aim was to identify which factors influence Dutch (uro)gynecologists when choosing one of these techniques. Methods This qualitative study consists of ten semi-structured interviews with Dutch (uro)gynecologists using predetermined, open explorative questions, based on a structured topic list. An inductive content analysis was performed using Atlas.ti. Results For SSH, the majority (6/10 gynecologists) reported the more dorsal change of direction of the vaginal axis as a disadvantage and expected more cystocele recurrences (7/10). The most reported disadvantage of MM was the risk of cervical stenosis (7/10). Four gynecologists found MM not to be appropriate for patients with higher stage uterine prolapse. The quality of the uterosacral ligaments was related to the chance of recurrence according to five gynecologists. Patient counseling was biased toward one of the uterus-preserving operations (7/10). Four gynecologists stated they make the final decision while two let patient-preference lead the final decision. Conclusions Preference for one of the uterus-preserving interventions is mainly based on the gynecologist’s own experience and background. The lack of information regarding these two uterus-preserving procedures hampers evidence-based decision making, which explains the practice pattern variation. In conclusion, further research is needed to improve evidence-based counseling and shared decision making regarding the choice of procedure.

Information Technology Process Improvement Decision-Making

2012 ◽  
Vol 3 (2) ◽  
pp. 18-35
Author(s):  
Sandy A. Lamp ◽  
Kathleen M. Hargiss ◽  
Caroline Howard
Keyword(s):  
Decision Making ◽  
Process Improvement ◽  
Cost Benefit Analysis ◽  
Investment Decision ◽  
Cost Benefit ◽  
Final Decision ◽  
Insurance Company ◽  
Senior Leadership ◽  
Structured Interviews ◽  
Process Managers

This article is derived from a qualitative multicase study with two settings that explored the way decisions are made in two IT organizations regarding process improvement initiatives by using face-to-face semi-structured interviews with 20 IT process owners and managers. The two participating organizations are a healthcare insurance company and a manufacturer of electronic interconnects. The study sought to uncover (a) how IT process improvements are prioritized and how approvals are attained, (b) how senior leadership is involved in decision making, (c) how security and risk are considered, (d) if and how formal process improvement methodologies are used, (e) if and how estimated and actual cost benefit analysis are conducted associated with decisions, and (f) how alignment with organizational goals is attained. The topic of IT governance was narrowed to explore the perspective of IT process owners and process managers, and their approaches and methodologies used with IT process improvement initiatives. The study found that pre-decision stages take place in IT investment decision making, and that process owners and process managers, participants other than senior leadership, and executive level decision makers are involved in these pre-decision stages and may be involved in the final decision stages.

scholarly journals FORMAL AND DAILY CARE DECISION-MAKING INVOLVEMENT IN AFRICAN-AMERICAN DEMENTIA DYADS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S915-S915
Author(s):  
Kalisha Bonds ◽  
MinKyoung Song ◽  
Karen Lyons ◽  
Martha Driessnack
Keyword(s):  
Decision Making ◽  
African American ◽  
Decision Maker ◽  
Sense Of Self ◽  
Final Decision ◽  
The Novel ◽  
Structured Interviews ◽  
Daily Care ◽  
Care Decision

Abstract Decision-making involvement (e.g., verbal and/or nonverbal communication) of persons with dementia (PWD) has been associated with quality of life of PWDs and their caregivers, underscores personhood, and reduces ethical dilemmas for caregivers regarding the PWD’s care. Yet, no study has explored the decision-making involvement in formal and daily care of both members of African-American dementia dyads (i.e., African-American PWDs and their African-American caregivers), limiting our understanding of how these dyads navigate decision-making during the dementia trajectory. This study took a closer look through in-depth, semi-structured interviews with African-American dementia dyads as they reflected on their decision-making surrounding formal and daily care. A pilot study of five dyadic interviews, each averaging 45 minutes, was completed. We used a combination of quantitative content analysis, decision-making matrices and I-poems created from I-statements of the dyad regarding their decision-making involvement. Decision-making matrices (i.e., diagrams of the degree of sharing, the balance of power within the dyad, and the final decision maker in formal and daily care) were constructed across interviews. The pairing of traditional analyses with the novel use of I-poems traces participants’ sense of self, ensuring their voice is retained. There was agreement within all five dyads regarding the final decision maker(s) in formal and daily care. Between dyads, daily decision-making involvement was led by African American PWDs; whereas, formal care decision-making involvement of African American PWDs varied. Findings highlight the importance of a deeper understanding of formal and daily care decision-making involvement within and between African-American dementia dyads and potential clinical implications.

scholarly journals The use of coproduction to inform an evidence-based service delivery model for mental health service users with complex needs

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S286-S286
Author(s):  
Pooja Saini ◽  
Rajan Nathan ◽  
Laura Sambrook ◽  
Sam Burton ◽  
Hana Roks ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Economic Evaluation ◽  
Social Care ◽  
Evidence Based ◽  
Care Pathways ◽  
Service Users ◽  
Service Delivery Model ◽  
Structured Interviews ◽  
Complex Needs

AimsCo-production recognises that people who use social care services (and their families) and third sector organisations within community settings have knowledge and experience that can be used to help make services better for services users and those who care for them. This study shares the coproduction that took place in the design of a mixed methods study that aims to understand: the profile and history of service users currently defined as having complex needs; the decision-making processes by clinicians that lead to these individuals entering this complex group; service users and carers experience of service use; and, the associated costs. This study involves a comprehensive evaluation that aims to inform an evidence-based service delivery model for mental health service users with complex needs.MethodA study stakeholder group, including clinicians, academics, service users, housing associations, health economists, and statisticians was formed from the outset to inform the mixed methods design, combining quantitative (in-depth analysis of patient records and economic evaluation) and qualitative (written medical notes and in-depth interviews with service users, carers, and clinicians) methods. The study included five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of direct medical costs, direct non-medical costs, and indirect costs for each patient; (3) semi-structured interviews about patients and carers experiences; (4) data from components 1-3 was used to co-produce vignettes jointly with the stakeholders group; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group by using the vignettes as example case studies.ResultCoproduction took place at each stage of the study, including the design, development of data collection tools, data analysis and formation of the vignettes required for stage five. The results demonstrated how co-production and multiagency working have been evident throughout the process of designing the study, the continuous engagement throughout the analysis, dissemination and implementation of the findings.ConclusionThe findings support the application of the core principles of co-production in the design, set-up and implementation of research within an NHS Trust as demonstrable by the acceptability and collaborative working within the study. The study's key outcomes were to: examine the resource use and cost impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how decisions are made in their treatment to inform how services are delivered in the future and made more person-centred and consistent.

Evidence-based management – healthcare manager viewpoints

2018 ◽  
Vol 31 (5) ◽  
pp. 436-448 ◽  
Author(s):  
Ali Janati ◽  
Edris Hasanpoor ◽  
Sakineh Hajebrahimi ◽  
Homayoun Sadeghi-Bazargani
Keyword(s):  
Decision Making ◽  
Hospital Management ◽  
Personal Characteristics ◽  
Evidence Based ◽  
Structured Interviews ◽  
Healthcare Organizations ◽  
Good Tool ◽  
Content Type ◽  
Evidence Based Decision Making ◽  
Hospital Manager

Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework. Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers’ professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers’ personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

scholarly journals Informed Decision Making on the Uptake of Evidence-Based Smoking Cessation Assistance by Individuals Motivated to Quit Smoking

2022 ◽  
Vol 3 (1) ◽  
pp. 1-30
Author(s):  
Thomas Gültzow ◽  
Eline S. Smit ◽  
Raesita Hudales ◽  
Carmen D. Dirksen ◽  
Ciska Hoving
Keyword(s):  
Decision Making ◽  
Smoking Cessation ◽  
Decision Aids ◽  
End Users ◽  
Evidence Based ◽  
Informed Decision Making ◽  
Structured Interviews ◽  
Quit Smoking ◽  
Scientific Experts ◽  
Delphi Studies

Evidence-based cessation assistance increases cessation rates. Activating preferences during decision making could improve effectiveness further. Decision aids (DAs) facilitate deciding by taking preferences into account. To develop effective DAs, potential end users' (i.e., individuals motivated to quit) needs and experts' viewpoints should be considered. Therefore, the aim of this needs assessment was: (1) To explore end users' needs and (2) to obtain consensus among smoking cessation counsellors and scientific experts to develop a self-administered DA to support end users in choosing cessation assistance. Data was gathered via two approaches: (1) twenty semi-structured interviews with potential end users and (2) two three-round Delphi studies with 61 counsellors and 44 scientific experts. Interview data and the first Delphi rounds were analysed qualitatively, the other Delphi rounds were analysed quantitatively. Potential end users acquired information in different ways, e.g., via own experiences. Important characteristics to decide between tools varied, however effectiveness and costs were commonly reported. Experts reached consensus on 38 and 40 statements, e.g., tools should be appropriate for users' addiction level. Although some trends emerged, due to the variation among stakeholders, a 'one size fits all'-approach is undesirable. This heterogeneity should be considered, e.g., by enabling users to customise the DA.

Abstraction: An alternative neurocognitive account of recognition, prediction, and decision making

2020 ◽  
Vol 43 ◽  
Author(s):  
Valerie F. Reyna ◽  
David A. Broniatowski
Keyword(s):  
Decision Making ◽  
Software Engineering ◽  
Systems Engineering ◽  
Evidence Based ◽  
Extensive Literature ◽  
Trace Theory ◽  
Fuzzy Trace Theory ◽  
Abstract Representations ◽  
Technical Systems

Abstract Gilead et al. offer a thoughtful and much-needed treatment of abstraction. However, it fails to build on an extensive literature on abstraction, representational diversity, neurocognition, and psychopathology that provides important constraints and alternative evidence-based conceptions. We draw on conceptions in software engineering, socio-technical systems engineering, and a neurocognitive theory with abstract representations of gist at its core, fuzzy-trace theory.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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