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Crisis decision making

Fabrizio Bracco, Gabriele de Tonetti, Michele Masini, Marcello Passarelli, Francesca Geretto, Danilo Celleno
Human factors are the most relevant issues contributing to adverse events in obstetrics. Specific training of Crisis Resource Management (CRM) skills (i.e., problem solving and team management, resource allocation, awareness of environment, and dynamic decision-making) is now widespread and is often based on High Fidelity Simulation. In order to be used as a guideline in simulated scenarios, CRM skills need to be mapped to specific and observable behavioral markers. For this purpose, we developed a set of observable behaviors related to the main elements of CRM in the delivery room...
March 3, 2018: International Journal of Environmental Research and Public Health
Jeremy K Ward, James Colgrove, Pierre Verger
France is one of the countries with the highest prevalence of vaccine hesitancy in the world. In an attempt to raise vaccination coverages, the French government made on January 1, 2018 eight more vaccines mandatory in addition to the three required until then. The process that led to this policy choice is of particular interest. We describe how vaccines became contentious in France and how French authorities came to view mandatory vaccination as the solution to the rise in vaccine hesitancy. In a bold move, French public health authorities turned to a new type of institutional device grounded in the ideal of democracy and public participation to political decision-making: "a citizen consultation"...
March 2, 2018: Vaccine
Katrina Kimport, Rebecca Kriz, Sarah C M Roberts
OBJECTIVES: Investigations into Crisis Pregnancy Centers (CPCs) have documented the provision of deceptive information about abortion, but it is unclear how many pregnant women actually visit CPCs and what impact visits have on their pregnancy decision-making. STUDY DESIGN: We conducted a mixed methods study. We surveyed patients at one of two local abortion clinics and three prenatal clinics in Southern Louisiana about whether they had visited a CPC for this pregnancy and conducted in-depth interviews with prenatal patients who reported a CPC visit about their experience...
March 2, 2018: Contraception
Ashley Szabo Eltorai
Though aviation is practiced in airplanes and anesthesiology in operating rooms, the two professions have substantial parallels. Both require readiness to manage a crisis situation, where lives are at stake, at a moment's notice and with incomplete information. The determinants of quality performance in both professions extend far beyond knowledge base and formal training. The science of human factors, a prominent cornerstone of the aviation industry, has not yet found the same place in medicine, but it could change the understanding and execution of medical decision-making in profound ways...
February 23, 2018: Journal of Anesthesia
Gabriel Birgand, Enrique Castro-Sánchez, Sonja Hansen, Petra Gastmeier, Jean-Christophe Lucet, Ewan Ferlie, Alison Holmes, Raheelah Ahmad
Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones - antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany...
2018: Antimicrobial Resistance and Infection Control
Eric Green, Rhea M Chase, John Zayzay, Amy Finnegan, Eve S Puffer
Background: This paper uses data from a cohort of parents and guardians of young children living in Monrovia, Liberia collected before and after the 2014 outbreak of Ebola virus disease (EVD) to estimate the impact of EVD exposure on implicit preferences for harsh discipline. We hypothesized that parents exposed to EVD-related sickness or death would exhibit a stronger preference for harsh discipline practices compared with non-exposed parents. Methods: The data for this analysis come from two survey rounds conducted in Liberia as part of an intervention trial of a behavioral parenting skills intervention...
2018: Global Mental Health
Luis Fernandez-Luque, Muhammad Imran
INTRODUCTION: According to the World Health Organization (WHO), over 130 million people are in constant need of humanitarian assistance due to natural disasters, disease outbreaks, and conflicts, among other factors. These health crises can compromise the resilience of healthcare systems, which are essential for achieving the health objectives of the sustainable development goals (SDGs) of the United Nations (UN). During a humanitarian health crisis, rapid and informed decision making is required...
January 25, 2018: International Journal of Medical Informatics
Kathleen C Thomas, Hillary Owino, Sana Ansari, Leslie Adams, Julianne M Cyr, Bradley N Gaynes, Seth W Glickman
Little is known about what patients value in psychiatric crisis services or how they compare community-based services with those received in the emergency department. Three focus groups (n = 27) were held of participants who had received psychiatric crisis services in emergency departments or a community mental health center. Participants described care experiences and preferences. Focus groups were audio recorded, transcribed, and coded using a value-based lens. Themes included appreciation for feeling respected, basic comforts, and shared decision-making as foundations of quality care...
January 30, 2018: Administration and Policy in Mental Health
Emilie Renahy, Christiane Mitchell, Agnes Molnar, Carles Muntaner, Edwin Ng, Farihah Ali, Patricia O'Campo
Background: Since the global economic crisis in 2007, unemployment rates have escalated in most European and North American countries. Unemployment protection policies, particularly the unemployment insurance (UI) system, have become a weighty issue for many modern welfare states. Decades of research have established concrete findings on the adverse impacts of unemployment on poverty- and health-related outcomes. This provided a foundation for further exploration into the potential protective effects of UI in offsetting these adverse outcomes...
January 18, 2018: European Journal of Public Health
Johanna Hanefeld, Susannah Mayhew, Helena Legido-Quigley, Frederick Martineau, Marina Karanikolos, Karl Blanchet, Marco Liverani, Esther Yei Mokuwa, Gillian McKay, Dina Balabanova
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more 'resilient'. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013-16; and the recent refugee and migration crisis in Europe...
January 9, 2018: Health Policy and Planning
Sophie Witter, Justine Namakula, Haja Wurie, Yotamu Chirwa, Sovanarith So, Sreytouch Vong, Bandeth Ros, Stephen Buzuzi, Sally Theobald
It is well known that the health workforce composition is influenced by gender relations. However, little research has been done which examines the experiences of health workers through a gender lens, especially in fragile and post-conflict states. In these contexts, there may not only be opportunities to (re)shape occupational norms and responsibilities in the light of challenges in the health workforce, but also threats that put pressure on resources and undermine gender balance, diversity and gender responsive human resources for health (HRH)...
December 1, 2017: Health Policy and Planning
Andrea J Adams, Allan P Pessier, Cheryl J Briggs
As extinctions continue across the globe, conservation biologists are turning to species reintroduction programs as one optimistic tool for addressing the biodiversity crisis. For repatriation to become a viable strategy, fundamental prerequisites include determining the causes of declines and assessing whether the causes persist in the environment. Invasive species-especially pathogens-are an increasingly significant factor contributing to biodiversity loss. We hypothesized that Batrachochytrium dendrobatidis (Bd), the causative agent of the deadly amphibian disease chytridiomycosis, was important in the rapid (<10 years) localized extirpation of a North American frog (Rana boylii) and that Bd remains widespread among extant amphibians in the region of extirpation...
December 2017: Ecology and Evolution
Tiago Correia, Graça Carapinheiro, Helena Carvalho, José Manuel Silva, Gilles Dussault
BACKGROUND: The European Union member countries reacted differently to the 2008 economic and financial crisis. However, few countries have monitored the outcomes of their policy responses, and there is therefore little evidence as to whether or not savings undermined the performance of health systems. We discuss the situation in Portugal, where a financial adjustment program was implemented between 2011 and 2014, and explore the views of health workers on the effects of austerity measures on quality of care delivery...
December 12, 2017: Human Resources for Health
Papathanasiou Vasileios, Orfanidis Sotiris
The variation of eleven Cymodocea nodosa metrics was studied along two anthropogenic gradients in the North Aegean Sea, in two separate periods (July 2004 and July 2013). The aim was to specify existing monitoring programs on different kind of human-induced or natural stress for a better decision-making support. Key water variables (N-NO2 , N-NO3 , N-NH4 , P-PO4 , Chl-a, attenuation coefficient-K, and suspended solids) along with the stress index MALUSI were also estimated in each sampling effort. All metrics (except one) showed significant differences (p<0...
December 7, 2017: Marine Pollution Bulletin
Jeremy Ciporen, Haley Gillham, Michele Noles, Dawn Dillman, Mark Baskerville, Caleb Haley, Donn Spight, Ryan C Turner, Brandon P Lucke-Wold
BACKGROUND: Simulation training has been shown to be an effective teaching tool. Learner management of an intraoperative crisis such as a major cerebrovascular bleed requires effective teamwork, communication, and implementation of key skill sets at appropriate time points. This study establishes a first of a kind simulation experience in a neurosurgery/anesthesia resident (learners) team working together to manage an intraoperative crisis. METHODS: Using a cadaveric cavernous carotid injury perfusion model, 7 neurosurgery and 6 anesthesia learners, were trained on appropriate vascular injury management using an endonasal endoscopic technique...
January 2018: Journal of Neurosurgical Anesthesiology
Tim Luckett, Jane Phillips, Miriam Johnson, Maja Garcia, Priyanka Bhattarai, Virginia Carrieri-Kohlman, Anne Hutchinson, Rebecca T Disler, David Currow, Meera Agar, Serra Ivynian, Richard Chye, Phillip J Newton, Patricia M Davidson
OBJECTIVES: Breathlessness 'crises' in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED 'near misses' where they considered going to the ED but successfully self-managed instead. DESIGN AND METHODS: A qualitative approach was used with a phenomenological orientation...
December 6, 2017: BMJ Open
Erica Duh, Sheyla P Medina, Nathan Coppersmith, Naomi Adjei, Mary B Roberts, Susanna Magee
BACKGROUND AND OBJECTIVES: Risky sexual behavior among adolescents is a public health crisis. We describe a novel approach to sexual health education where medical students manage a curriculum for an entire seventh grade in one Rhode Island city to better equip students with comprehensive knowledge about sexual health. METHODS: Medical students were trained to teach 12 sessions to seventh-grade students under the supervision of the classroom teacher using a curriculum designed by medical students and faculty (modeled on the Family Life and Sexual Health [FLASH] curriculum but tailored to meet the community's needs)...
November 2017: Family Medicine
Léa Roger, Simon Otjes, Harmen van der Veer
The left-right line of conflict has been the dominant dimension of decision-making in the European Parliament since 1979. A pro-/anti-European Union integration dimension is of secondary importance. Limited evidence exists on the conditions under which these different dimensions matter. This study examines parliamentary decision-making about the so-called Two-Pack, which moved responsibilities about budgetary decision-making to the European Commission. The article uses in-depth interviews, textual analysis of committee debates and roll call voting analysis in order to determine which lines of conflict matter at which stage of decision-making...
December 2017: European Union Politics
Brennan K Berg, Kathryn Winsley, Rhema D Fuller, Michael Hutchinson
Preventing the use of performance enhancing drugs in sport has long been a concern for policymakers. In the United States, amidst national attention the state of Texas constructed the country's largest steroid testing program for high school athletes. However, resource allocation steadily declined until the program was defunded in 2015. Using escalation of commitment theory as a framework, this conceptual paper examines the critical, but less studied, role of politics and de-escalation behavior that directed this distinct sport situation...
2017: International Journal of Exercise Science
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
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