Criminalization of Care: Drug Testing Pregnant Patients

2021 ◽  
pp. 002214652110581
Author(s):  
Katharine McCabe
Keyword(s):  
Decision Making ◽  
Drug Testing ◽  
Qualitative Interviews ◽  
Medical Professionals ◽  
Clinical Settings ◽  
Race And Class ◽  
The Third ◽  
Clinical Terminology ◽  
Forensic Tools ◽  
Tools And Methods

This article reveals how law and legal interests transform medicine. Drawing on qualitative interviews with medical professionals, this study shows how providers mobilize law and engage in investigatory work as they deliver care. Using the case of drug testing pregnant patients, I examine three mechanisms by which medico-legal hybridity occurs in clinical settings. The first mechanism, clinicalization, describes how forensic tools and methods are cast in clinical terminology, effectively cloaking their forensic intent. In the second, medical professionals informally rank the riskiness of illicit substances using both medical and criminal-legal assessments. The third mechanism describes how gender, race, and class inform forensic decision-making and criminal suspicion in maternal health. The findings show that by straddling both medical and legal domains, medicine conforms to the standards and norms of neither institution while also suspending meaningful rights for patients seeking care.

STRATEGI MAKSIMALISASI ANGGARAN BELANJA PADA BALAI PENELITIAN DAN PENGEMBANGAN LINGKUNGAN HIDUP DAN KEHUTANAN MANOKWARI

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Arif Hasan ◽  
Dedi Budiman Hakim ◽  
Irdika Mansur
Keyword(s):  
Decision Making ◽  
Descriptive Analysis ◽  
Secondary Data ◽  
Primary Data ◽  
Fiscal Year ◽  
The Third ◽  
Swot Matrix ◽  
Three Stages ◽  
Using Data

This study aims to analyze causes of the low uptake of the budget and formulate a strategy of maximizing the absorption of expenditure on Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari. Respondents involved are 20 people that consist of: treasury officials and holder output of activity. The data used were secondary data in the form of reports on budget realization (LRA) quarter I, II, III and IV of the fiscal year 2011 to 2015, and the primary data were in the form of interviews with the help of a questionnaire. While the analysis of the data used was descriptive analysis using data tabulation, and the analysis of the three stages strategy of the decision making used IFE and EFE matrix, SWOT matrix and QSPM matrix.The results showed that there are 19 factors causing low of budget absorption until the end of the third quarter, and there were 10 drafts of policy as a strategy for maximizing the absorption of the budget on Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari.ABSTRAKPenelitian ini bertujuan untuk menganalisis penyebab rendahnya penyerapan anggaran belanja dan merumuskan strategi maksimalisasi penyerapan anggaran belanja pada Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari. Responden yang terlibat adalah 20 orang yaitu pejabat perbendaharaan dan pemegang output kegiatan. Data yang digunakan adalah data sekunder berupa laporan realisasi anggaran (LRA) triwulan I, II, III dan IV tahun anggaran 2011 sampai 2015, dan data primer berupa wawancara dengan bantuan kuesioner. Sedangkan analisis data yang digunakan adalah analisis deskriptif menggunakan analisis tabulasi, dan analisis analisis strategi tiga tahap pengambilan keputusan menggunakan matriks IFE dan EFE, matriks SWOT dan matriks QSPM. Hasil penelitian menunjukkan bahwa terdapat 19 faktor penyebab rendahnya penyerapan anggaran belanja sampai akhir triwulan III, dan terdapat 10 rancangan kebijakan sebagai strategi maksimalisasi penyerapan anggaran belanja di Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari.

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

scholarly journals Competing interests, clashing ideas and institutionalizing influence: insights into the political economy of malaria control from seven African countries

2020 ◽  
Author(s):  
Justin Parkhurst ◽  
Ludovica Ghilardi ◽  
Jayne Webster ◽  
Robert W Snow ◽  
Caroline A Lynch
Keyword(s):  
Decision Making ◽  
Malaria Control ◽  
Qualitative Interviews ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Health Community ◽  
Control Programmes ◽  
Control Decision ◽  
Sub Saharan ◽  
Economic Considerations

Abstract This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development.

The use and non-use of the government financial report by Maltese Members of Parliament

2018 ◽  
Vol 31 (4) ◽  
pp. 1124-1144 ◽  
Author(s):  
Josette Caruana ◽  
Brady Farrugia
Keyword(s):  
Decision Making ◽  
Information Overload ◽  
Qualitative Interviews ◽  
Financial Reports ◽  
Content Type ◽  
Financial Report ◽  
Members Of Parliament ◽  
The Government ◽  
And Performance ◽  
Questionnaire Research

Purpose The purpose of this paper is to examine the use and non-use of the Government Financial Report by Maltese Members of Parliament (MPs). It refers to information overload theory to analyse the gap between financial reports and their relevance for decision making. Design/methodology/approach A mix of qualitative (interviews) and quantitative (questionnaire) research tools are applied, with the Maltese MPs being the research participants. This method is acclaimed to be comprehensive, but this study highlights certain disadvantages when applied in the political arena. Findings The characteristics of the information itself could be the main cause of information overload, resulting in the non-use of the financial report for decision making. Politicians refer to financial data for their decision making, but not to the data presented in the financial report. Irrespective of the politician’s professional background, the data in the financial report is perceived as incomplete and outdated. Practical implications The cause of information overload and its effects are important considerations for preparers of financial information and accounting standard setters, if they wish that their production is relevant for decision makers. Originality/value There is an increase in research concerning politicians’ use of budgetary and performance information, at local and regional levels of government. This study investigates exclusively the use of the financial report by politicians at central level, in a politically stable environment.

scholarly journals Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Emily B. H. Treichler ◽  
Borsika A. Rabin ◽  
William D. Spaulding ◽  
Michael L. Thomas ◽  
Michelle P. Salyers ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Service Delivery ◽  
Serious Mental Illness ◽  
Qualitative Interviews ◽  
Skills Training ◽  
Mental Illnesses ◽  
Open Trial ◽  
Collaborative Decision Making ◽  
Collaborative Decision

Abstract Background Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans. Methods In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness. Discussion This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs. Trial registration ClinicalTrials.gov Identifier: NCT04324944

scholarly journals Avoidant Coping of the Decision-Making Process on the Location of Care in Old Age: A Possible Conspiracy of Silence?

2021 ◽  
Vol 18 (24) ◽  
pp. 12940
Author(s):  
Gema Serrano-Gemes ◽  
Isabel Gil ◽  
Adriana Coelho ◽  
Rafael Serrano-del-Rosal
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Comparative Analysis ◽  
Old Age ◽  
Qualitative Interviews ◽  
Avoidant Coping ◽  
Decision Making Process ◽  
Older Person ◽  
High Incidence ◽  
Conspiracy Of Silence

The conspiracy of silence is extremely important due to both its high incidence and its consequences. This process usually occurs in situations of palliative care, or death; however, this concept is also mentioned in the literature linked to other contexts. Therefore, our objective was to study whether the conspiracy of silence may be extrapolated to the context of decision-making on the location of care in old age. To this end, we first analyzed the in-depth semi structured qualitative interviews conducted with older people, caregivers, and professionals, about decision-making on the location of care in old age. Subsequently, a comparative analysis was performed between the basic elements of the conspiracy of silence and this decision-making. Our findings revealed an avoidance process developed by all three groups. Furthermore, this decision-making presents similarities with the conspiracy of silence in the process of avoidance coping and denial that is developed. However, there are significant differences, as information is not withheld from the older person, who has an active attitude in the process of avoidance. Decision-making on the location of care in old age does not exactly match the conspiracy of silence process, but it does seem to correspond to a pact of silence.

scholarly journals How to Improve Sharia Accountability for Sovereign Sukuk in Indonesia

2020 ◽  
Vol 13 (1) ◽  
pp. 53
Author(s):  
Erny Arianty
Keyword(s):  
Decision Making ◽  
Human Resources ◽  
Financial Reporting ◽  
Analytical Hierarchy Process ◽  
The Third ◽  
Contract Structure ◽  
Hierarchy Process ◽  
Level Of Importance

<pre><em>The</em><em> study entitled How to Improve Sharia Accountability for Sovereign Sukuk in Indonesia aims to analyze </em><em>the factor that has the highest level of importance</em><em> in realizing sharia accountability.</em> <em>The analysis of this research is conducted by applying</em><em>  </em><em>Analytical Hierarchy Process (AHP) approach </em><em>with a hierarchy structure consisting of the first level, namely objectives, sharia accountability for Sovereign Sukuk/Sovereign Sharia Securities (SBSN), then the second level is shariah accountability parameters, consist of structural contract (akad) SBSN, the use of SBSN funds by maqashid sharia, and SBSN accounting and financial reporting. Each criterion is determined by sub-criteria, which are the third level. The last level is the supporting factors for the realization of sharia accountability for SBSN. </em><em>The results showed that human resources competency factor had the highest importance </em><em>level in realizing the sharia accountability for the use of the contract structure (aqad) SBSN parameter, the supervisory function factor had the highest importance level for the parameters of using SBSN funds following the shariahmaqashid, and the decision making authority factor had the highest importance level for the parameters of accounting and financial reporting.  As for the results of the level of importance of the parameters, the parameter of the use of the contract structure has the highest importance level among other parameters. </em></pre>

scholarly journals Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

2020 ◽  
Author(s):  
Martha J. Decker ◽  
Noelle Pineda ◽  
Abigail Gutmann-Gonzalez ◽  
Claire D. Brindis
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Qualitative Comparison ◽  
Latina Adolescents ◽  
Provider Perspectives ◽  
Centered Care ◽  
Delivery Options

Abstract Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

scholarly journals Clinicians’ experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Carlisle ◽  
H. A. Watson ◽  
J. Carter ◽  
K. Kuhrt ◽  
P. T. Seed ◽  
...  
Keyword(s):  
Decision Making ◽  
Preterm Birth ◽  
Cultural Context ◽  
Clinical Decision Making ◽  
Qualitative Interviews ◽  
Scale Up ◽  
Clinical Decision ◽  
Clinical Trial Registry ◽  
Support Tool ◽  
The Impact

Abstract Background As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth. Methods Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians’ (obstetricians’ and midwives’) experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach. Results Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: ‘experience of using the app’, ‘how QUiPP risk changes practice’ and ‘successfully adopting QUiPP: context is everything’. With these final themes we appeared to have achieved our aim of exploring the clinicians’ experiences of using and implementing the QUiPP app. Conclusion This study explored different clinician’s experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL. Clinical trial registry and registration number ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337.

scholarly journals Multidisciplinary teams caring for people with variations of sex characteristics: a scoping review

2021 ◽  
Vol 5 (1) ◽  
pp. e001257
Author(s):  
Martin Gramc ◽  
Jürg Streuli ◽  
Eva de Clercq
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Ethical Principles ◽  
Care Process ◽  
Future Research ◽  
Medical Professionals ◽  
Sex Characteristics ◽  
Multidisciplinary Teams ◽  
Shared Decision

BackgroundIn 2006 the Chicago consensus statement on the management of people with variations of sex characteristics (VSC) acknowledged the importance of a multidisciplinary team (MDT) approach. The consensus update from 2016 reinforced the call for multidisciplinary collaborations between medical professionals, parents and support groups, and proposed guidelines to improve shared decision making and patient-centred care embedded in ethical principles of self-determination and child participation. But there is little evidence that successfully MDTs have been implemented in clinical practice.Methods and aimsA scoping review was conducted to identify studies that address the collaboration and decision making process of MDTs providing care of people with VSC to identify ideal and actual (1) team composition; (2) models of collaboration and (3) ethical principles that MDTs follow. Six databases were systematically searched: CINAHIL, Medline, Psychinfo, Scopus, Socindex and Web of Science. No restriction was placed on the type of methodology used in the studies. To frame the research, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used.ResultsThe MDTs in the literature include mainly medical professionals: endocrinologists, urologists and surgeons. The collaboration among medical professionals in MDTs lacks cooperation as one team member sets the tasks of the team while each professional works separately. Despite the importance of psycho-social support the involvement of psychologists remains secondary. The implementation of ethical principles tends to exclude people with VSC.ConclusionThe care of people with VSC described in the papers is medically oriented as the team members are mainly medical professionals working separately. MDT tend to exclude people with VSC despite references to shared decision making processes and informed consent. There was no mention of adult care and lack of inclusion of patient’s perspective in the care process. The future research should do more empirical research of MDTs.

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