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Crisis decision making

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https://www.readbyqxmd.com/read/29094662/the-duty-of-mind-ethical-capacity-in-a-time-of-crisis
#1
Caitlin Ryus, Jay Baruch
In a disaster, physicians are forced to make challenging and heartbreaking ethical decisions under conditions of physical and emotional exhaustion. Evidence shows that the conditions of stress that mark disasters can undermine the process of ethical decision-making. This results in biased allocation of scarce resources, fewer utilitarian and altruistic decisions, and a wider variation in decisions. Stress also predisposes clinicians to decision strategy errors, such as premature closure, that lead to poor outcomes...
November 2, 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/29092694/reducing-antibiotic-prescribing-in-australian-general-practice-time-for-a-national-strategy
#2
REVIEW
Christopher B Del Mar, Anna Mae Scott, Paul P Glasziou, Tammy Hoffmann, Mieke L van Driel, Elaine Beller, Susan M Phillips, Jonathan Dartnell
In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult...
November 6, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/29040811/mobile-emergency-simulation-training-for-rural-health-providers
#3
Douglas Martin, Brent Bekiaris, Gregory Hansen
INTRODUCTION: Mobile emergency simulation offers innovative continuing medical educational support to regions that may lack access to such opportunities. Furthermore, satisfaction is a critical element for active learning. Together, the authors evaluated Canadian rural healthcare providers' satisfaction from high fidelity emergency simulation training using a modified motorhome as a mobile education unit (MEU). METHODS: Over a 5-month period, data was collected during 14 educational sessions in nine different southern Manitoban communities...
July 2017: Rural and Remote Health
https://www.readbyqxmd.com/read/28974071/impact-of-sleep-deprivation-on-anaesthesia-residents-non-technical-skills-a-pilot-simulation-based-prospective-randomized-trial
#4
A Neuschwander, A Job, A Younes, A Mignon, C Delgoulet, P Cabon, J Mantz, A Tesniere
Background: Sleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the operating room. The impact of sleep deprivation on non-technical skills is unknown. We tested the hypothesis that in anaesthesia residents sleep deprivation is associated with impaired non-technical skills...
July 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28967323/effect-of-crisis-response-planning-on-patient-mood-and-clinician-decision-making-a-clinical-trial-with-suicidal-u-s-soldiers
#5
Craig J Bryan, Jim Mintz, Tracy A Clemans, T Scott Burch, Bruce Leeson, Sean Williams, M David Rudd
OBJECTIVE: The study examined the immediate effect of crisis interventions on the emotional state of acutely suicidal soldiers and clinician decision making. METHODS: Soldiers (N=97) presenting to a military emergency department or behavioral health clinic were randomly assigned to receive a contract for safety (N=32), standard crisis response plan (S-CRP; N=32), or enhanced crisis response plan (E-CRP; N=33). Soldiers completed self-report scales before and after the intervention...
October 2, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28949838/the-interactions-of-canadian-ethics-consultants-with-health-care-managers-and-governing-boards-during-times-of-crisis
#6
Chris Kaposy, Victor Maddalena, Fern Brunger, Daryl Pullman, Richard Singleton
BACKGROUND: Health care organizations can be very complex, and are often the setting for crisis situations. In recent years, Canadian health care organizations have faced large-scale systemic medical errors, a nation-wide generic injectable drug shortage, iatrogenic infectious disease outbreaks, and myriad other crises. These situations often have an ethical component that ethics consultants may be able to address. Organizational leaders such as health care managers and governing boards have responsibilities to oversee and direct the response to crisis situations...
April 2017: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/28903810/effective-crisis-decision-making
#7
Holger Kaschner
When an organisation's reputation is at stake, crisis decision-making (CDM) is challenging and prone to failure. Most CDM schemes are strong at certain aspects of the overall CDM process, but almost none are strong at all of them. This paper defines criteria for good CDM schemes, analyses common approaches and introduces an alternative, stakeholder-driven scheme. Focusing on the most important stakeholders and directing any actions to preserve the relationships with them is crucial. When doing so, the interdependencies between the stakeholders must be identified and considered...
January 1, 2017: Journal of Business Continuity & Emergency Planning
https://www.readbyqxmd.com/read/28903809/decision-making-in-crisis-applying-a-healthcare-triage-methodology-to-business-continuity-management
#8
Bethany Moore, Eric A Bone
The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions...
January 1, 2017: Journal of Business Continuity & Emergency Planning
https://www.readbyqxmd.com/read/28870193/mapping-infectious-disease-hospital-surge-threats-to-lessons-learnt-in-singapore-a-systems-analysis-and-development-of-a-framework-to-inform-how-to-decide-on-planning-and-response-strategies
#9
Shweta R Singh, Richard Coker, Hubertus J-M Vrijhoef, Yee Sin Leo, Angela Chow, Poh Lian Lim, Qinghui Tan, Mark I-Cheng Chen, Zoe Jane-Lara Hildon
BACKGROUND: Hospital usage and service demand during an Infectious Disease (ID) outbreak can tax the health system in different ways. Herein we conceptualize hospital surge elements, and lessons learnt from such events, to help build appropriately matched responses to future ID surge threats. METHODS: We used the Interpretive Descriptive qualitative approach. Interviews (n = 35) were conducted with governance and public health specialists; hospital based staff; and General Practitioners...
September 4, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28808090/the-wisdom-of-crowds-regulating-cell-function-through-condensed-states-of-living-matter
#10
REVIEW
Simon Alberti
Our understanding of cells has progressed rapidly in recent years, mainly because of technological advances. Modern technology now allows us to observe molecular processes in living cells with high spatial and temporal resolution. At the same time, we are beginning to compile the molecular parts list of cells. However, how all these parts work together to yield complex cellular behavior is still unclear. In addition, the established paradigm of molecular biology, which sees proteins as well-folded enzymes that undergo specific lock-and-key type interactions, is increasingly being challenged...
September 1, 2017: Journal of Cell Science
https://www.readbyqxmd.com/read/28802695/scarce-resource-allocation-during-disasters-a-mixed-method-community-engagement-study
#11
E Lee Daugherty Biddison, Howard S Gwon, Monica Schoch-Spana, Alan C Regenberg, Chrissie Juliano, Ruth R Faden, Eric S Toner
BACKGROUND: During a catastrophe, health-care providers may face difficult questions regarding who will receive limited life-saving resources. The ethical principles that should guide decision-making have been considered by expert panels but have not been well explored with the public or front-line clinicians. The objective of this study was to characterize the public's values regarding how scarce mechanical ventilators should be allocated during an influenza pandemic, with the ultimate goal of informing a statewide scare resource allocation framework...
August 9, 2017: Chest
https://www.readbyqxmd.com/read/28760153/an-overview-of-forensic-drug-testing-methods-and-their-suitability-for-harm-reduction-point-of-care-services
#12
REVIEW
Lane Harper, Jeff Powell, Em M Pijl
Given the current opioid crisis around the world, harm reduction agencies are seeking to help people who use drugs to do so more safely. Many harm reduction agencies are exploring techniques to test illicit drugs to identify and, where possible, quantify their constituents allowing their users to make informed decisions. While these technologies have been used for years in Europe (Nightlife Empowerment & Well-being Implementation Project, Drug Checking Service: Good Practice Standards; Trans European Drugs Information (TEDI) Workgroup, Factsheet on Drug Checking in Europe, 2011; European Monitoring Centre for Drugs and Drug Addiction, An Inventory of On-site Pill-Testing Interventions in the EU: Fact Files, 2001), they are only now starting to be utilized in this context in North America...
July 31, 2017: Harm Reduction Journal
https://www.readbyqxmd.com/read/28732754/what-is-the-quality-of-online-resources-about-pain-control-after-total-knee-arthroplasty
#13
William W Schairer, Cynthia A Kahlenberg, Peter K Sculco, Benedict U Nwachukwu
BACKGROUND: With the growing opioid crisis in the United States, there has been a push to reduce the utilization of opioids in favor of multimodal analgesia options. The purpose of this study was to evaluate the quality of online resources that patients may use to learn about pain control after total knee arthroplasty (TKA). METHODS: We identified websites using a combination of search terms about TKA and pain control. A novel grading rubric was created with 25 maximum points, consisting of items that were deemed important for patients to know about the subject...
June 24, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28724005/human-resources-for-health-global-crisis-and-international-cooperation
#14
Gustavo Zoio Portela, Amanda Cavada Fehn, Regina Lucia Sarmento Ungerer, Mario Roberto Dal Poz
From the 1990s onwards, national economies became connected and globalized. Changes in the demographic and epidemiological profile of the population highlighted the need for further discussions and strategies on Human Resources for Health (HRH). The health workforce crisis is a worldwide phenomenon. It includes: difficulties in attracting and retaining health professionals to work in rural and remote areas, poor distribution and high turnover of health staff particularly physicians, poor training of health workforces in new sanitation and demographic conditions and the production of scientific evidence to support HRH decision making, policy management, programs and interventions...
July 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28715239/parental-self-efficacy-to-support-teens-during-a-suicidal-crisis-and-future-adolescent-emergency-department-visits-and-suicide-attempts
#15
Ewa K Czyz, Adam G Horwitz, Carlos E Yeguez, Cynthia J Ewell Foster, Cheryl A King
This study of adolescents seeking emergency department (ED) services and their parents examined parents' self-efficacy beliefs to engage in suicide prevention activities, whether these beliefs varied based on teens' characteristics, and the extent to which they were associated with adolescents' suicide-related outcomes. Participants included 162 adolescents (57% female, 81.5% Caucasian), ages 13-17, and their parents. At index visit, parents rated their self-efficacy to engage in suicide prevention activities and their expectations regarding their teen's future suicide risk...
July 17, 2017: Journal of Clinical Child and Adolescent Psychology
https://www.readbyqxmd.com/read/28704284/evaluation-of-a-simpler-tool-to-assess-nontechnical-skills-during-simulated-critical-events
#16
Scott C Watkins, David A Roberts, John R Boulet, Matthew D McEvoy, Matthew B Weinger
INTRODUCTION: Management of critical events requires teams to employ nontechnical skills (NTS), such as teamwork, communication, decision making, and vigilance. We sought to estimate the reliability and provide evidence for the validity of the ratings gathered using a new tool for assessing the NTS of anesthesia providers, the behaviorally anchored rating scale (BARS), and compare its scores with those of an established NTS tool, the Anaesthetists' Nontechnical Skills (ANTS) scale. METHODS: Six previously trained raters (4 novices and 2 experts) reviewed and scored 18 recorded simulated pediatric crisis management scenarios using a modified ANTS and a BARS tool...
April 2017: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/28698825/the-earth-is-flat-p%C3%A2-%C3%A2-0-05-significance-thresholds-and-the-crisis-of-unreplicable-research
#17
Valentin Amrhein, Fränzi Korner-Nievergelt, Tobias Roth
The widespread use of 'statistical significance' as a license for making a claim of a scientific finding leads to considerable distortion of the scientific process (according to the American Statistical Association). We review why degrading p-values into 'significant' and 'nonsignificant' contributes to making studies irreproducible, or to making them seem irreproducible. A major problem is that we tend to take small p-values at face value, but mistrust results with larger p-values. In either case, p-values tell little about reliability of research, because they are hardly replicable even if an alternative hypothesis is true...
2017: PeerJ
https://www.readbyqxmd.com/read/28677220/a-qualitative-study-of-factors-in-nurses-and-physicians-decision-making-related-to-family-presence-during-resuscitation
#18
Renee Twibell, Debra Siela, Cheryl Riwitis, Alexis Neal, Nicole Waters
AIMS AND OBJECTIVES: To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. BACKGROUND: Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations...
July 5, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28676492/local-emergency-medical-response-after-a-terrorist-attack-in-norway-a-qualitative-study
#19
Aleidis S Brandrud, Michael Bretthauer, Guttorm Brattebø, May Jb Pedersen, Kent Håpnes, Karin Møller, Trond Bjorge, Bjørnar Nyen, Lars Strauman, Ada Schreiner, Gro S Haldorsen, Maria Bergli, Eugene Nelson, Tamara S Morgan, Per Hjortdahl
INTRODUCTION: On 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to the local Ringerike community hospital. All victims survived. The local emergency medical service (EMS), despite limited resources, was evaluated by three external bodies as successful in handling this crisis. This study investigates the determinants for the success of that EMS as a model for quality improvement in healthcare...
July 4, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28673217/validity-evidence-of-non-technical-skills-assessment-instruments-in-simulated-anaesthesia-crisis-management
#20
T Jirativanont, K Raksamani, N Aroonpruksakul, P Apidechakul, S Suraseranivongse
We sought to evaluate the validity of two non-technical skills evaluation instruments, the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and the Ottawa Global Rating Scale (GRS), to apply them to anaesthesia training. The content validity, response process, internal structure, relations with other variables and consequences were described for validity evidence. Simulated crisis management sessions were initiated during which two trained raters evaluated the performance of postgraduate first-, second- and third-year (PGY-1, PGY-2 and PGY-3) anaesthesia residents...
July 2017: Anaesthesia and Intensive Care
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