Journal articles: 'Medicine, Preventive – Australia – Decision making'

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Logeman, Charlotte, Yeoungjee Cho, Benedicte Sautenet, Gopala K. Rangan, Talia Gutman, Jonathan Craig, Albert Ong, et al. "‘A sword of Damocles’: patient and caregiver beliefs, attitudes and perspectives on presymptomatic testing for autosomal dominant polycystic kidney disease: a focus group study." BMJ Open 10, no. 10 (October 2020): e038005. http://dx.doi.org/10.1136/bmjopen-2020-038005.

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Background and objectivesPresymptomatic testing is available for early diagnosis of hereditary autosomal dominant polycystic kidney disease (ADPKD). However, the complex ethical and psychosocial implications can make decision-making challenging and require an understanding of patients’ values, goals and priorities. This study aims to describe patient and caregiver beliefs and expectations regarding presymptomatic testing for ADPKD.Design, setting and participants154 participants (120 patients and 34 caregivers) aged 18 years and over from eight centres in Australia, France and Korea participated in 17 focus groups. Transcripts were analysed thematically.ResultsWe identified five themes: avoiding financial disadvantage (insecurity in the inability to obtain life insurance, limited work opportunities, financial burden); futility in uncertainty (erratic and diverse manifestations of disease limiting utility, taking preventive actions in vain, daunted by perplexity of results, unaware of risk of inheriting ADPKD); lacking autonomy and support in decisions (overwhelmed by ambiguous information, medicalising family planning, family pressures); seizing control of well-being (gaining confidence in early detection, allowing preparation for the future, reassurance in family resilience); and anticipating impact on quality of life (reassured by lack of symptoms, judging value of life with ADPKD).ConclusionsFor patients with ADPKD, presymptomatic testing provides an opportunity to take ownership of their health through family planning and preventive measures. However, these decisions can be wrought with tensions and uncertainty about prognostic implications, and the psychosocial and financial burden of testing. Healthcare professionals should focus on genetic counselling, mental health and providing education to patients’ families to support informed decision-making. Policymakers should consider the cost burden and risk of discrimination when informing government policies. Finally, patients are recommended to focus on self-care from an early age.

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Atkinson, Jo-An, Adam Skinner, Sue Hackney, Linda Mason, Mark Heffernan, Dianne Currier, Kylie King, and Jane Pirkis. "Systems modelling and simulation to inform strategic decision making for suicide prevention in rural New South Wales (Australia)." Australian & New Zealand Journal of Psychiatry 54, no. 9 (June 17, 2020): 892–901. http://dx.doi.org/10.1177/0004867420932639.

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Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government’s 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87−6.42%) and 5.45% (4.68−6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23−3.46%; suicide deaths: 4.38%, 95% interval 3.78−5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources.

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Jansen, Jesse, Shannon McKinn, Carissa Bonner, Danielle Marie Muscat, Jenny Doust, and Kirsten McCaffery. "Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice." BMJ Open 9, no. 3 (March 2019): e026342. http://dx.doi.org/10.1136/bmjopen-2018-026342.

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ObjectivesTo explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.Design, setting and participantsSemi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol)orhad received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis.ResultsTwenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication.ConclusionsResults demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.

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Dalziel, Kim, Leonie Segal, and Rachelle Katz. "Cost-effectiveness of mandatory folate fortification v. other options for the prevention of neural tube defects: results from Australia and New Zealand." Public Health Nutrition 13, no. 4 (September 17, 2009): 566–78. http://dx.doi.org/10.1017/s1368980009991418.

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AbstractObjectiveTo provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD).DesignStandard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand.ResultsPopulation-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12 500 per disability-adjusted life year (DALY) averted ($US 9893, £5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138 500 per DALY ($US 109 609, £56 216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD.ConclusionsSeveral options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base.

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Ruegg, Leanne, Mark Faucett, Andrew Clawson, and Shradha Subedi. "Reducing the prevalence of antecubital fossa peripheral intravenous cannulation." Journal of the Association for Vascular Access 27, no. 2 (June 1, 2022): 47–51. http://dx.doi.org/10.2309/1557-1289-27.2.47.

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ABSTRACT Observational studies have found that placement of peripheral intravenous cannulas (PIVCs) in the antecubital fossa (ACF) is associated with increased risks of infection, including healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB). Avoiding placement of the PIVC in the ACF area along with other preventive measures such as aseptic technique, staff education on documentation, standardised insertion packs and alerts for timely removal, may reduce the overall risk of acquiring an HA-SAB. Aim: To implement a multimodal awareness programme on ACF cannulas and the risk of infection, and to reduce PIVC-associated HA-SAB in one hospital in Australia. Method: The authors performed a baseline digital survey to identify root causes for clinical decision making related to PIVCs and to raise awareness of the project. The authors performed weekly audits and provided feedback on four key wards over 12 weeks. Simple linear regression was used to look at the trend of ACF cannulation rates overtime. HA-SAB rates were calculated per 10000 occupied bed days. Findings: Improved insertion documentation was observed during the intervention period. The ACF cannulation rates decreased by 0.03% per day during the study, although this did not quite reach statistical significance (P=0.06). There were no PIVC-associated SAB events during the intervention period. The SAB rates decreased by 0.02% per day over the period of the study.

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Silverstein, Marc D. "Decision Making in Clinical Preventive Medicine." Primary Care: Clinics in Office Practice 16, no. 1 (March 1989): 9–30. http://dx.doi.org/10.1016/s0095-4543(21)01306-3.

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McCaffery, Kirsten J., Heather L. Shepherd, Lyndal Trevena, Ilona Juraskova, Alexandra Barratt, Phyllis N. Butow, Karen Carey Hazell, and Martin HN Tattersall. "Shared decision-making in Australia." Zeitschrift für ärztliche Fortbildung und Qualität im Gesundheitswesen - German Journal for Quality in Health Care 101, no. 4 (May 2007): 205–11. http://dx.doi.org/10.1016/j.zgesun.2007.02.025.

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Pels, R. J., D. H. Bor, and R. S. Lawrence. "Decision Making for Introducing Clinical Preventive Services." Annual Review of Public Health 10, no. 1 (May 1989): 363–83. http://dx.doi.org/10.1146/annurev.pu.10.050189.002051.

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Ananthapavan, Jaithri, Gary Sacks, Marj Moodie, Phuong Nguyen, and Rob Carter. "Preventive health resource allocation decision-making processes and the use of economic evidence in an Australian state government—A mixed methods study." PLOS ONE 17, no. 9 (September 19, 2022): e0274869. http://dx.doi.org/10.1371/journal.pone.0274869.

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Context Recommended best practice for resource allocation decisions by governments include a stepwise process guided by economic evidence. However, the use of economic evidence in preventive health decision-making, which often impacts on multiple sectors of government, is under-researched. This study aimed to explore the resource allocation decision-making processes for preventive health interventions in the New South Wales (NSW) Government in Australia, and specifically examined the barriers and facilitators to the use of economic evidence from the perspective of multiple government departments. Methods This mixed methods study was conducted using semi-structured interviews with NSW Treasury representatives (n = 4), a focus group of NSW Ministry of Health representatives (n = 9), and a quantitative questionnaire of all participants. The schedule for the interviews and focus group was based on resource allocation guidance documents from Australian government agencies. Deductive content analysis was undertaken, guided by the Multiple Streams Framework. Findings NSW Treasury participants believed that decision-making processes where economic efficiency was the key guiding principle was the ideal approach. However, the NSW Ministry of Health participants identified that for preventive health decision-making, economic evidence was not used to inform their own choices but was typically only used to convince other agencies of the merits of proposed initiatives when seeking approval. The key barriers to the use of economic evidence were the lack of capacity within the NSW Ministry of Health to understand and undertake economic evaluations; a lack of collaboration between NSW Treasury and preventive health decision-makers within the NSW Ministry of Health; and deficient processes and governance mechanisms that do not facilitate or incentivise effective inter-sectoral decision-making. Conclusions Institutional structures for resource allocation decision-making regarding preventive health result in processes that contrast with best practice recommendations. The multiple challenges to collaborative decision-making across agencies require organisational change to promote a whole-of-government approach.

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KEEFE, CAROLE W., MARGARET E. THOMPSON, and MARY MARGARET NOEL. "Medical Students, Clinical Preventive Services, and Shared Decision-Making." Academic Medicine 77, no. 11 (November 2002): 1160–61. http://dx.doi.org/10.1097/00001888-200211000-00026.

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Levine-Ariff, June. "Preventive Ethics: The Development of Policies to Guide Decision-Making." AACN Advanced Critical Care 1, no. 1 (May 1, 1990): 169–77. http://dx.doi.org/10.4037/15597768-1990-1017.

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Ethics as a discipline and certainly morals as a force in decision-making is not new. However, the remarkable advances in science and technology that have occurred during the past 30 years have brought to the bedside unforseen dilemmas, forcing health care professionals to take an ethical look at the care they deliver. Powerful diagnostic techniques, sophisticated surgical procedures, effective drugs, and worthwhile therapeutic interventions have enabled health care practitioners to eliminate many diseases and minimize disability. This progress has brought enormous human benefit. Unfortunately, coupled with these dramatic results is a reality that sometimes the quality of life produced is much less than what was desired. Our capacity to prolong life has not coincided with our ability to restore some level of health. Medical interventions have been able to maintain vital functions without always benefiting the underlying disease process. The rapidity with which technology has perpetuated ethical issues within the clinical setting has often lead to hasty and arbitrary decision-making. It is only with a thrust toward preventive ethics that decisions can be thoughtful and beneficial to patients and families. Thus, this article focuses on the implementation of policies that minimize and/or prevent ethical conflicts.

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Onwuteaka-Philipsen, Bregje D. "End-of-Life Decision Making in Europe and Australia." Archives of Internal Medicine 166, no. 8 (April 24, 2006): 921. http://dx.doi.org/10.1001/archinte.166.8.921.

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Nakayama, Kazuhiro, Yuki Yonekura, Hitomi Danya, and Kanako Hagiwara. "COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study." JMIR Formative Research 6, no. 1 (January 24, 2022): e34966. http://dx.doi.org/10.2196/34966.

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Background Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence. Objective We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions. Methods A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable. Results A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: β=.11; information evaluation: β=.13; decision-making: β=.18) showed that decision-making process contributed the most. Conclusions Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times.

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Moritz, Dominique. "Children’s Developmental (Im)maturity: Aligning Conflicting Decisional Capacity Assessment Approaches in Australia." Laws 12, no. 1 (January 13, 2023): 10. http://dx.doi.org/10.3390/laws12010010.

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Children’s decision-making is complex. There are many factors that contribute to children’s decisional capacity including cognitive reasoning, developmental maturity, upbringing and circumstances. For healthcare decisions, Australian law acknowledges children’s autonomy, and permits mature children to consent to beneficial healthcare. Yet, it also protects them from making life-changing decisions that could contravene their best interests. The criminal law approaches to children’s decision-making in Australia’s jurisdictions involves holding older children fully responsible for their decision-making, regardless of circumstances or maturity. The two approaches conflict because health law offers a protective mechanism for children yet criminal law imposes a punitive approach to children’s decision-making. This article considers whether the dichotomous approaches for children’s capacity assessments in Australian law can be reconciled.

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Belmonte, J., F. Mas, A. Lattour, D. Orozco, V. Gil, and J. Merino. "W15.403 Assessment and reliability of clinical decision making in preventive cholesterol screening." Atherosclerosis Supplements 5, no. 1 (April 2004): 93. http://dx.doi.org/10.1016/s1567-5688(04)90402-9.

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Gil, V., D. Orozco, A. Lattour, J. Belmonte, F. Mas, and J. Merino. "VALIDITY AND AGREEMENT OF CLINICAL DECISION MAKING IN PREVENTIVE BLOOD PRESSURE MEASURES." Journal of Hypertension 22, Suppl. 2 (June 2004): S158—S159. http://dx.doi.org/10.1097/00004872-200406002-00541.

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BELMONTE, J. "W15.403 Assessment and reliability of clinical decision making in preventive cholesterol screening." Atherosclerosis 5, no. 1 (April 2004): 93. http://dx.doi.org/10.1016/s0021-9150(04)90402-9.

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Krassuski, Lisa Marlene, Sibylle Kautz-Freimuth, Vera Vennedey, Kerstin Rhiem, Rita K. Schmutzler, and Stephanie Stock. "Decision Aids for Preventive Treatment Alternatives for BRCA1/2 Mutation Carriers: a Systematic Review." Geburtshilfe und Frauenheilkunde 81, no. 06 (June 2021): 679–98. http://dx.doi.org/10.1055/a-1326-1792.

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Abstract Introduction Women with a pathogenic BRCA1/2 mutation have a markedly increased lifetime risk of developing breast and/or ovarian cancer. The current preventive treatment alternatives that are offered are an intensified breast cancer screening programme and risk-reducing operations. Before deciding on one option, medical and personal factors such as life situation and individual preferences must be weighed carefully. Decision aids are used internationally to support BRCA1/2 mutation carriers during their decision-making process. In this study these are analysed structurally for the first time and their applicability to the German context is examined. Material and Methods A systematic literature search in five electronic databases and a manual search were performed. The identified decision aids were evaluated with regard to formal criteria, medical content and quality. The qualitative assessment used the criteria of the International Patient Decision Aid Standards Collaboration (IPDASi v4.0), which examined various dimensions (e.g., information, probabilities, values). Results Twenty decision aids, which were published between 2003 and 2019 in Australia (n = 4), the United Kingdom (n = 3), Canada (n = 2), the Netherlands (n = 2) and the USA (n = 9), were included. Nine focus on BRCA1/2 mutation carriers and eleven include other risk groups. Eighteen include risk-reducing operations as decision options, 14 list screening methods for breast and/or ovarian cancer, and 13 describe the possibility of pharmacological prevention by means of selective oestrogen receptor modulators or aromatase inhibitors. Nine of the 20 decision aids meet fundamental quality criteria (IPDASi v4.0 qualification criteria). Conclusion International decision aids can serve formally as a basis for a German decision aid for BRCA1/2 mutation carriers. Some of them differ markedly in content from the recommendations of German guidelines. Only a few achieve a high quality.

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Xu, Xianpeng, Qingjie Ji, and Min Shen. "Patient Preferences and Values in Decision Making for Migraines: A Systematic Literature Review." Pain Research and Management 2021 (September 16, 2021): 1–9. http://dx.doi.org/10.1155/2021/9919773.

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Objective. To comprehensively summarize the evidence on the preferences and values of migraine patients. Methods. We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Sino-Med, Chongqing VIP, and Wanfang Data for studies on the preferences and values of migraine patients. A qualitative review was performed, but no quantitative synthesis. Results. Twenty‐one studies were finally included, involving a total of 8701 participants. Patients expected a cure, to be symptom-free, a reduction in frequency of headaches, a reduction in severity of headaches, and an improved quality of life from their preventive treatment. Patients expected rapid pain relief, complete pain relief, return to normal activities, no recurrence, and no adverse events from their acute symptomatic treatment. Conclusion. Efficacy is the primary consideration in the treatment of migraine. Specifically, the most important embodiment of patient preferences and values is the reduced frequency of attacks with preventive treatment as well as prompt analgesia with acute symptomatic treatment.

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Makridakis, Spyros, Richard Kirkham, Ann Wakefield, Maria Papadaki, Joanne Kirkham, and Lisa Long. "Forecasting, uncertainty and risk; perspectives on clinical decision-making in preventive and curative medicine." International Journal of Forecasting 35, no. 2 (April 2019): 659–66. http://dx.doi.org/10.1016/j.ijforecast.2017.11.003.

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Zhang, Lixin, and Zhanliang Liu. "Research on Intelligent Decision-Making of Asphalt Pavement Maintenance in Offshore Soft Soil Area." Journal of Asian Research 7, no. 1 (December 23, 2022): p1. http://dx.doi.org/10.22158/jar.v7n1p1.

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The performance of roads in offshore soft soil areas is different from ordinary pavement. In view of this feature, and based on the summary of the existing intelligent decision-making research on the maintenance of asphalt pavement, this study has selected Ningbo as the survey area. The changes in the performance characterization index of asphalt pavement in offshore soft soil areas were compared and analyzed. The influencing factors of decision-making in the maintenance were analyzed, and the pavement maintenance standards and intelligent decision-making process in offshore soft soil areas were determined, including the timing of preventive maintenance, road section under maintenance, maintenance plan, etc. The conclusions in this study can promote the scientific decision-making on asphalt pavement maintenance in offshore soft soil areas and promote the healthy and sustainable development of highway maintenance.

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Kraatz, J. A., S. Reid, L. Rowlinson, and S. Caldera. "Housing as critical social and economic infrastructure: A decision-making framework." IOP Conference Series: Earth and Environmental Science 1101, no. 4 (November 1, 2022): 042023. http://dx.doi.org/10.1088/1755-1315/1101/4/042023.

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Abstract Housing is an important social and economic asset for society. However, increasing costs of living and demand for affordable housing is outpacing supply in Australia. Governments and housing providers, particularly community housing providers, are grappling with these challenges. This paper discusses steps towards building a more rigorous, evidence-based approach for social and affordable housing provision in Australia. It is proposed that housing be considered like other critical social and economic infrastructure such as schools, hospitals and civil infrastructure (i.e., roadways). The paper presents findings of Australian industry-led social and affordable housing research undertaken between 2014 to 2020. Past and current research findings inform the decision-making framework, including: (i) a productivity-based conceptual framework; (ii) the establishment of nine impact domains including meaningful and measurable outcomes and indicators; (iii) a composite return on investment approach which addresses the broader benefits of access to safe and secure housing; and (iv) thirteen elements being used to map the complex and integrated social and affordable housing network. The emergent decision-making framework resulting from this longitudinal study will be a critical tool for government and social and affordable housing providers to achieve economically and socially sustainable outcomes.

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Phan, Yen Hoang Le, Richard De Abreu Lourenco, Marion Haas, and Naomi van der Linden. "Key considerations in reimbursement decision-making for multiple sclerosis drugs in Australia." Multiple Sclerosis and Related Disorders 25 (October 2018): 144–49. http://dx.doi.org/10.1016/j.msard.2018.07.020.

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Davidson, Karina W., Carol M. Mangione, Michael J. Barry, Wanda K. Nicholson, Michael D. Cabana, Aaron B. Caughey, Esa M. Davis, et al. "Collaboration and Shared Decision-Making Between Patients and Clinicians in Preventive Health Care Decisions and US Preventive Services Task Force Recommendations." JAMA 327, no. 12 (March 22, 2022): 1171. http://dx.doi.org/10.1001/jama.2022.3267.

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Davidson, Karina W., Carol M. Mangione, Michael J. Barry, Wanda K. Nicholson, Michael D. Cabana, Aaron B. Caughey, Esa M. Davis, et al. "Collaboration and Shared Decision-Making Between Patients and Clinicians in Preventive Health Care Decisions and US Preventive Services Task Force Recommendations." Obstetrical & Gynecological Survey 77, no. 9 (September 2022): 519–21. http://dx.doi.org/10.1097/01.ogx.0000872656.20675.48.

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Larionova, Regina. "INTELLIGENT DECISION-MAKING SUPPORT ALGORITHMS FOR HEALTH-CARE INSTITUTIONS." Applied Mathematics and Control Sciences, no. 1 (April 14, 2021): 81–94. http://dx.doi.org/10.15593/2499-9873/2021.1.05.

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The aim of the article is to develop algorithms of intellectual support for managerial decision-making in a preventive medical institution by medical staff on loading/reserving the number of patients to be served. The article substantiates the relevance of improving the mechanisms of management of non-stationary processes of medical services by health care institution (HCP) on the basis of subject-oriented modeling of its activities as a system of mass service. The article offers tools for an integrated assessment of the current state of LPI as a socio-economic system for the substantiation of necessary measures to ensure the required level of readiness of LPI. The article touches upon the problem of determining the functional completeness of LFU, and in this connection, the range of seasonal planning is considered. The paper highlights the issues of the coordination procedure in the formation of a comprehensive assessment of LPF on the reserve/loading issues. The author proposes a mechanism for processing the data coming from LPFs according to the predicate, on the basis of which an automated data processing procedure can be built as an addition in the formation of a comprehensive assessment of LPF load/reserve. These algorithms are scientifically new and make it possible to monitor the current state of the mass service system and predict the functional completeness/incompleteness of the system with justification of necessary correction of its parameters. In the article the analysis of occurrence of typical problems of identification of typical situations and recommended actions for bringing LRC to a new state, in the best way, corresponding to the task of the guaranteed granting of medical services to the population before the moment of the new primary information is resulted. The author has proposed the use of simulation results in the formation of a functional management of the state of health care facilities. The proposed intelligent control mechanisms ergonomically well match the capabilities of the personnel of usual qualification.

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Curryer, Bernadette, Roger J. Stancliffe, Angela Dew, and Michele Y. Wiese. "Choice and Control Within Family Relationships: The Lived Experience of Adults With Intellectual Disability." Intellectual and Developmental Disabilities 56, no. 3 (June 1, 2018): 188–201. http://dx.doi.org/10.1352/1934-9556-56.3.188.

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Abstract Increased choice and control is a driving force of current disability policy in Australia for people with disability and their families. Yet little is known of how adults with intellectual disability (ID) actually experience choice and control within their family relationships. We used interpretative phenomenological analysis of individual, semistructured interviews conducted with 8 Australian adults with ID to understand the meaning given to their experience of family support received around choice and decision making. Three themes were identified: (1) centrality of family, (2) experience of self-determination, and (3) limitations to choice and control. The participants identified trusted family members from whom guidance around choice and decision making was both sought and received, often involving mutual decision making and limitations to control.

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Wong, Gabriel T. W., and Matthew Manning. "Adolescent Illicit Drug Use and Policy Options in Australia: A Multicriteria Decision Analysis." Journal of Drug Issues 47, no. 4 (July 14, 2017): 638–64. http://dx.doi.org/10.1177/0022042617719444.

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The etiology of illicit substance involvement is a multidimensional problem shaped by factors across individual, social, and environmental domains. In this study, a multicriteria framework is employed to incorporate the input of specialists regarding risk and protective factors and the effectiveness of alternative interventions to mitigate the adverse harms and consequences associated with adolescent drug initiation and subsequent use. Using a seven-stage drug use continuum (nonuse, priming, initial use, experimental use, occasional use, regular use, and dysfunctional use), experts rate social and environmental factors as the most important from nonuse to occasional use. Experts often support preventive and harm-minimizing strategies to interrupt the progression of drug involvement and accumulation of drug-related harms among adolescents. Compared with preferable interventions, less preferable options (e.g., drug testing/monitoring) are considered to have a negative policy impact on key social, environmental, and drug dimension domains, which tend to override their positive impacts on other areas.

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Harz, Markus. "Cancer, Computers and Complexity: Decision Making for the Patient." European Review 25, no. 1 (February 2017): 96–106. http://dx.doi.org/10.1017/s106279871600048x.

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In health care, a trend may be noted to fundamentally question some of today’s assumptions about the traditional roles of medical disciplines, the doctor–patient relationship, the feasibility of medical studies, and about the role of computers as an aid or replacement of doctors. Diagnostics and therapy decision-making become more complex, and no end is in sight. Amounts of health-related data are being collected individually, and through the health care systems. On the example of breast cancer care, technological advances and societal changes can be observed as they take place concurrently, and patterns and hypotheses emerge that will be the focus of this article. In particular, three key changes are to be considered: (1) the growing appreciation of the uniqueness of diseases and the impact of this notion on the future of evidence-based medicine; (2) the acknowledgment of a ‘big data’ problem in today’s medical practice and science, and the role of computers; and (3) the societal demand for ‘P4 medicine’ (predictive, preventive, participatory, personalized), and its impact on the roles of doctors and patients.

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Hughes, Gareth, and Fiona J. Burnett. "Integrating Experience, Evidence and Expertise in the Crop Protection Decision Process." Plant Disease 99, no. 9 (September 2015): 1197–203. http://dx.doi.org/10.1094/pdis-02-15-0197-fe.

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Generically, farm-scale crop protection decision making may be characterized as a process beginning with an initial assessment of disease risk followed by the accumulation of evidence related to current risk factors, leading to a risk prediction. What action is then taken depends on the response of the decision owner, taking into account previous experience, advice from trusted sources, alongside policy or legislative constraints on crop protection practice that are intended to mitigate any impacts that may transcend the farm scale. This process has commonalities with decision-making in the strategy of preventive medicine. This article delves into the clinical literature in order to provide a perspective on some recent discussions of shared decision making presented there, discussions that relate to issues also faced in sustainable crop protection.

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Tmsley, Barbara J., David R. Holtgrave, Steven P. Reise, Cynthia Erdley, and Robert G. Cupp. "Developmental Status, Gender, Age, and Self-Reported Decision-Making Influences on Students' Risky and Preventive Health Behaviors." Health Education Quarterly 22, no. 2 (July 1995): 244–59. http://dx.doi.org/10.1177/109019819502200211.

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Santos, Paulo. "The Role of Cardiovascular Risk Assessment in Preventive Medicine: A Perspective from Portugal Primary Health-Care Cardiovascular Risk Assessment." Journal of Environmental and Public Health 2020 (January 30, 2020): 1–7. http://dx.doi.org/10.1155/2020/1639634.

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The cardiovascular diseases are the leading cause of death in the world, especially because of myocardial infarction and stroke. Their beginning, however, starts many years earlier with the atherosclerotic process due to the cardiovascular risk factors, with different weights in the global risk. Our aim is to review the utilization of risk estimators in primary health care, through a comprehensive review of the literature and official national and international health data (OECD and WHO). The risk estimators aim to integrate the partial information of each factor in a global calculation able to help towards a better clinical reasoning in primary prevention. Besides the variables in the mathematical algorithm, estimators must consider also the factors not in the equation, but significant for decision making. Risk estimators are crucial in prevention, allowing to classify the risk in practical categories easy to use and to benefit the decision-making, more than trying to guess what will happen to the patient.

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Vemuri, Sidharth, Jenny Hynson, Katrina Williams, and Lynn Gillam. "Conceptualising paediatric advance care planning: a qualitative phenomenological study of paediatricians caring for children with life-limiting conditions in Australia." BMJ Open 12, no. 5 (May 2022): e060077. http://dx.doi.org/10.1136/bmjopen-2021-060077.

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ObjectivesAdvance care planning (ACP) helps families and paediatricians prepare and plan for end-of-life decision-making. However, there remains inconsistency in its practice with the limited literature describing what this preparation involves, and whether paediatricians recognise a difference between the process of ACP and its outcomes, such as resuscitation plans. This study aims to understand how paediatricians conceptualise ACP when caring for children with life-limiting conditions (LLC) who are unable to participate in decision-making for his/herself.DesignIndividual, semistructured, vignette-based qualitative interviews.SettingAcute inpatient and long-term outpatient paediatric care in three secondary and two tertiary centres in Victoria, Australia.Participants25 purposively sampled paediatricians who treat children with LLC, outside the neonatal period. Paediatricians were excluded if they worked within specialist palliative care teams or assisted in this study’s design.ResultsFour key themes were identified when approaching end-of-life decision-making discussions: (1) there is a process over time, (2) there are three elements, (3) the role of exploring parental values and (4) the emotional impact. The three elements of this process are: (1) communicating the child’s risk of death, (2) moving from theoretical concepts to practice and (3) documenting decisions about resuscitation or intensive technologies. However, not all paediatricians recognised all elements as ACP, nor are all elements consistently or intentionally used. Some paediatricians considered ACP to be only documentation of decisions in advance.ConclusionThere is a preparatory process of discussions for end-of-life decision-making, with elements in this preparation practised within therapeutic relationships. Complexity in what constitutes ACP needs to be captured in guidance and training to include intentional exploration of parental values, and recognition and management of the emotional impact of ACP could increase its consistency and value.

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Bruton, Crystal, and Danielle Tyson. "Leaving violent men: A study of women’s experiences of separation in Victoria, Australia." Australian & New Zealand Journal of Criminology 51, no. 3 (December 7, 2017): 339–54. http://dx.doi.org/10.1177/0004865817746711.

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Despite decades of feminist efforts to educate the community about, and improve responses to, domestic violence, public attitudes towards domestic violence continue to misunderstand women’s experiences of violence. Underlying such responses is the stock standard question, ‘Why doesn’t she leave?’ This question points to a lack of understanding about the impacts and threat of violence from an abusive partner on women’s decisions to leave the relationship. Moreover, it places sole responsibility for ending the relationship squarely upon women, assuming women are presented with numerous opportunities to leave a violent relationship and erroneously assumes the violence will cease once they do leave. This study explores women’s experiences of separating from an abusive, male partner through women’s narratives (n = 12) in Victoria, Australia. Findings reveal that fear was a complex influencing factor impacting upon women’s decision-making throughout the leaving process. The findings show that women seek to exercise agency within the context of their abusers’ coercively controlling tactics by strategically attempting to manage the constraints placed on their decision-making and partner’s repeated attempts to reassert dominance and control.

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Mihalopoulos, Cathrine, Mary Lou Chatterton, Lidia Engel, Long Khanh-Dao Le, and Yong Yi Lee. "Whither economic evaluation in the case of COVID-19: What can the field of mental health economics contribute within the Australian context?" Australian & New Zealand Journal of Psychiatry 54, no. 12 (October 2, 2020): 1157–61. http://dx.doi.org/10.1177/0004867420963724.

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COVID-19 has resulted in broad impacts on the economy and aspects of daily life including our collective mental health and well-being. The Australian health care system already faces limitations in its ability to treat people with mental health diagnoses. Australia has responded to the COVID-19 outbreak by, among other initiatives, providing reimbursement for telehealth services. However, it is unclear if these measures will be enough to manage the psychological distress, depression, anxiety and post-traumatic distress shown to accompany infectious disease outbreaks and economic shocks. Decision making has focused on the physical health ramifications of COVID-19, the avoidance of over-burdening the health care system and saving lives. We propose an alternative framework for decision making that combines life years saved with impacts on quality of life. A framework that simultaneously includes mental health and broader economic impacts into a single decision-making process would facilitate transparent and accountable decision making that can improve the overall welfare of Australian society as we continue to address the considerable challenges that the COVID-19 pandemic is creating.

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Kryukov, Oleg, Igor Gulyayev, and Dmitriy Teplukhov. "The Bayesian Decision Models During the Maintenance of Automated Electric Drives." Известия высших учебных заведений. Электромеханика 65, no. 3 (2022): 49–55. http://dx.doi.org/10.17213/0136-3360-2022-3-49-55.

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An analytical approach is proposed for the predictive control of technical condition of complex automated electric drive systems using forecasting, which makes it possible to increase the efficiency of maintenance and repair systems implementation based on the actual state. Based on the utilization coefficient use, a condition prediction efficiency criterion is proposed that provides reliable information on the state of AC electric drives in on-line mode. A method for preventive decision making for predicting failures of various automated electric drive systems based on the Bayesian approach has been developed. The proposed method has been tested on synchronous machines of the STD-12500-2 type, which operate as drive electric motors for gas-pumping units at linear compressor stations of the main gas transport.

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Muscat, Danielle Marie, Edward Hoi-fan Chang, Rachel Thompson, Erin Cvejic, Marguerite Tracy, Joshua Zadro, Jessica Kathleen Smith, Robyn Lindner, and Kirsten McCaffery. "Evaluation of the Choosing Wisely Australia 5 Questions resource and a shared decision-making preparation video: protocol for an online experiment." BMJ Open 9, no. 11 (November 2019): e033126. http://dx.doi.org/10.1136/bmjopen-2019-033126.

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IntroductionChoosing Wisely, an international effort to reduce low value care worldwide, considers communication between clinicians and patients during routine clinical encounters a key mechanism for change. In Australia, Choosing Wisely has developed a 5 Questions resource to facilitate better conversations. The primary aim of this study is to evaluate the impact of the Choosing Wisely Australia 5 Questions resource and a video designed to prepare patients for question-asking and participation in shared decision-making on (a) self-efficacy to ask questions and participate in shared decision-making, (b) intention to participate in shared decision-making and (c) a range of secondary outcomes. The secondary aim of this study is to determine whether participants’ health literacy modifies the effects of the interventions.Methods and analysisWe will use 2×2×2 between-subjects factorial design (preparation video: yes, no × Choosing Wisely 5 Questions resource: yes, no × health literacy: adequate, inadequate). Participants will be recruited by an online market research company, presented with a hypothetical non-specific low back pain scenario, and randomised to study groups stratified by health literacy. Quantitative primary and secondary outcome data will be analysed as intention-to-treat using appropriate regression models (ie, linear regression for continuous outcomes, logistic regression for dichotomous categorical outcomes).Ethics and disseminationEthical approval for this study was obtained from the University of Sydney Human Research Ethics Committee (protocol number: 2018/965). The results from this work will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies. Resources developed for this study will be made available to patients and clinicians following trial completion.Trial registration numberThis trial has been registered with the Australia New Zealand Clinical Trials Registry (trial number: 376477) and the stage is Pre-results.

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Breusov, Aleksey, Stanislav Otstavnov, and Dmitrii Breusov. "PROBLEMATIC ISSUES OF INFORMATION SUPPORT FOR MANAGEMENT DECISION-MAKING IN HEALTHCA." Archiv Euromedica 11, no. 6 (December 12, 2021): 6–9. http://dx.doi.org/10.35630/2199-885x/2021/11/6.1.

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— The purpose of the work is to analyze the main problem areas and the possibilities of introducing an information support system for making management decisions (controlling) in the activities of managers of modern medical organizations. The work used bibliographic, descriptive-analytical, general scientific, methods of system and content analysis. As a result of the study, the prospects for the use of controlling tools in preventive and clinical medicine, including in activities directly related to the treatment of patients, have been substantiated; a number of indicators have been proposed for monitoring and assessing the health status of the population; an assessment was made of the possibilities of using the decision-making information support system in the management of a medical organization; the main directions of further implementation of IT-technologies in healthcare practice are presented. The results obtained in the course of the study will significantly improve the quality of management decisions made and the effectiveness of the activities of modern medical organizations.

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Asensio-Martínez, Ángela, Alejandra Aguilar-Latorre, Olga García-Sanz, Bárbara Oliván-Blázquez, Yolanda López-del-Hoyo, and Rosa Magallón-Botaya. "Associations between Psychological Variables, Knowledge, Attitudes, Risk Perceptions and Health Behaviours towards COVID-19 among Adolescents." Journal of Clinical Medicine 11, no. 16 (August 16, 2022): 4793. http://dx.doi.org/10.3390/jcm11164793.

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There is currently little scientific evidence available that allows us to understand patterns of knowledge, risk perception, attitudes, and behaviours among adolescents in relation to COVID-19. This study aims to analyse the relationship between knowledge about COVID-19, risk perception, and psychological variables and the adherence to preventive measures among the adolescent population. It is a descriptive cross-sectional study, which included adolescents between the ages of 12 and 18 (n = 354). The questionnaire was sent to several secondary schools chosen by convenience sampling and following a non-probabilistic snowball sampling. Descriptive, univariate, and multivariate analyses were carried out in order to determine whether knowledge about COVID-19, risk perception, tolerance of frustration, planning and decision-making, family functionality, self-efficacy, self-esteem, and social skills are related to preventive measures. The adoption among adolescents of behaviours which protect them against COVID-19 depends on knowledge about the disease, the perception of the risk it poses to them, as well as their tolerance of frustration and planning and decision-making abilities. The relationship between the individual variables among adolescents with the adoption of behaviours which protect them against COVID-19 has been confirmed. The development of intervention and communication strategies that take the psychosocial situation of adolescents into account will help to increase the adoption of protective health behaviours in the context of a pandemic.

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Mikelionyte, M., and A. Lezgovko. "HOW FEMALE DIFFER IN DECISION MAKING FOR PERSONAL INVESTMENT STRATEGY." Financial and credit activity problems of theory and practice 5, no. 40 (November 8, 2021): 92–98. http://dx.doi.org/10.18371/fcaptp.v5i40.244902.

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Abstract. This study investigates Lithuanian females’ personal investment peculiarities in line with Australia’s case analysis and application as a good practice method. Based on many publicly available research females tend to have less knowledge about finances in general and particularly investment processes; hence, it leads to their lack of interest into investing and the possibility of poor money management. This issue might be solved by investigating why it appears first and adopting the practical example from countries with developed investment market. In the case of comparison of personal investment strategies among Lithuanian and Australian females the two sets of questionnaires have been used to collect the data for further analysis. The main findings revealed by the survey were, that women in Australia had a higher financial literacy level, invested more often, and chose broader variety of investment instruments compared to Lithuanian females. Moreover, the significant discovery of the article disclosed that Lithuanian females chose not to invest due to the lack of additional funds and the shortage of financial knowledge. The main limitation occurred during the research was the lack of the available data on personal investment topic in Lithuania’s official statistic sources such as The Lithuanian Department of Statistics. The results of the research contribute towards improving Lithuanian female personal finance and investment areas and could be applied to further studies or used for the education program dedicated to financial literacy among women in Lithuania creation. Furthermore, this article creates an original value to personal finance, investment, and financial literacy areas in Lithuania by introducing an idea to not only conduct more studies in these fields, but also to use comparative analysis and good practice method from the countries that demonstrates high achievements in personal finance and gender equality areas. Keywords: personal investment management, female investment, financial literacy, investor’s profile, investing, investment options, investment strategies. JEL Classification G51, G53 Formulas: 1; fig.: 5; tabl.: 1; bibl.: 15.

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Kissné Horváth, Ildikó. "Patient registries from the view of health policy." Orvosi Hetilap 155, no. 19 (May 2014): 729–31. http://dx.doi.org/10.1556/oh.2014.29917.

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Integrated health data management and disease registries which are able to support evidence-based decision making are of critical importance for health policy. Data provided by disease registries are used for the development of health strategy, planning of preventive activities, capacity-building in health care provision, improving health care quality, and planning clinical trials. Disease registries monitoring epidemiology, natural history of diseases, treatment outcomes and the detection of adverse reactions are requested not only by policy-makers, but public health authorities and health care providers, too. Registries for rare diseases are of critical importance for developing network between reference centres and developing and evaluating new drugs. Data and information need for decision-making in public services and the protection of health data of individuals require a careful balance that needs to be taken into account when considering disease registries. Orv. Hetil., 2014, 155(19), 729–731.

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Evison, Hugo, Mercedes Carrington, Gerben Keijzers, Nicole M. Marsh, Amy Lynn Sweeny, Joshua Byrnes, Claire M. Rickard, Peter J. Carr, and Jamie Ranse. "Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study." BMJ Open 12, no. 3 (March 2022): e054927. http://dx.doi.org/10.1136/bmjopen-2021-054927.

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ObjectivesRates of unused (‘idle’) peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians’ decision-making on whether to insert or use a PIVC in the emergency care setting.DesignA qualitative descriptive study using in-depth semistructured interviews and thematic analysis.SettingGold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service.ParticipantsParticipants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs.ResultsFrom the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course.ConclusionThe decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician’s own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.

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Meadmore, Katie, Kathryn Fackrell, Alejandra Recio-Saucedo, Abby Bull, Simon D. S. Fraser, and Amanda Blatch-Jones. "Decision-making approaches used by UK and international health funding organisations for allocating research funds: A survey of current practice." PLOS ONE 15, no. 11 (November 5, 2020): e0239757. http://dx.doi.org/10.1371/journal.pone.0239757.

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Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.

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Bunzli, Samantha, Penny O'Brien, Will Aston, Miguel A. Ayerza, Lester Chan, Stephane Cherix, Jorge de las Heras, et al. "Life or limb: an international qualitative study on decision making in sarcoma surgery during the COVID-19 pandemic." BMJ Open 11, no. 9 (September 2021): e047175. http://dx.doi.org/10.1136/bmjopen-2020-047175.

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ObjectivesThe COVID-19 pandemic is unprecedented as a global crisis over the last century. How do specialist surgeons make decisions about patient care in these unprecedent times?DesignBetween April and May 2020, we conducted an international qualitative study. Sarcoma surgeons from diverse global settings participated in 60 min interviews exploring surgical decision making during COVID-19. Interview data were analysed using an inductive thematic analysis approach.SettingParticipants represented public and private hospitals in 14 countries, in different phases of the first wave of the pandemic: Australia, Argentina, Canada, India, Italy, Japan, Nigeria, Singapore, Spain, South Africa, Switzerland, Turkey, UK and USA.ParticipantsFrom 22 invited sarcoma surgeons, 18 surgeons participated. Participants had an average of 19 years experience as a sarcoma surgeon.Results17/18 participants described a decision they had made about patient care since the start of the pandemic that was unique to them, that is, without precedence. Common to ‘unique’ decisions about patient care was uncertainty about what was going on and what would happen in the future (theme 1: the context of uncertainty), the impact of the pandemic on resources or threat of the pandemic to overwhelm resources (theme 2: limited resources), perceived increased risk to self (theme 3: duty of care) and least-worst decision making, in which none of the options were perceived as ideal and participants settled on the least-worst option at that point in time (theme 4: least-worst decision making).ConclusionsIn the context of rapidly changing standards of justice and beneficence in patient care, traditional decision-making frameworks may no longer apply. Based on the experiences of surgeons in this study, we describe a framework of least-worst decision making. This framework gives rise to actionable strategies that can support decision making in sarcoma and other specialised fields of surgery, both during the current crisis and beyond.

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Woodman, Peter A., Kaye N. Ballantyne, Roberta Julian, and Caroline Spiranovic. "The forensic examination of structural fires in Victoria, Australia: Decision-making processes and impact on judicial outcomes." Science & Justice 61, no. 4 (July 2021): 369–77. http://dx.doi.org/10.1016/j.scijus.2021.03.009.

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Blair, Emilie M., Darin B. Zahuranec, Kenneth M. Langa, Jane Forman, Bailey K. Reale, Colleen Kollman, Bruno Giordani, and Deborah A. Levine. "Impact of Patient Mild Cognitive Impairment on Physician Decision-Making for Treatment." Journal of Alzheimer's Disease 78, no. 4 (December 8, 2020): 1409–17. http://dx.doi.org/10.3233/jad-200700.

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Background: Older patients with mild cognitive impairment (MCI) should receive evidence-based treatments when clinically indicated. However, patients with MCI appear less likely than cognitively normal patients to receive evidence-based treatments. Objective: To explore the influence of a patient’s MCI diagnosis on physician decision-making. Methods: Qualitative study of 18 physicians from cardiology, neurology, and internal medicine using semi-structured interviews. We sought to understand whether and how a patient’s having MCI has influenced physicians’ decisions about five categories of treatments or tests (surgery, invasive tests, non-invasive tests, rehabilitation, and preventive medication). We used qualitative content analysis to identify the unifying and recurrent themes. Results: Most physician participants described MCI as influencing their recommendations for at least one treatment or test. We identified two major themes as factors that influenced physician recommendations in patients with MCI: Physicians assume that MCI patients’ decreased cognitive ability will impact treatment; and physicians assume that MCI patients have poor health status and physical functioning that will impact treatment. These two themes were representative of physician beliefs that MCI patients have impaired independent decision-making, inability to adhere to treatment, inability to communicate treatment preferences, and increased risk and burden from treatment. Conclusion: A patient’s MCI diagnosis influences physician decision-making for treatment. Some physician assumptions about patients with MCI were not evidence-based. This phenomenon potentially explains why many patients with MCI get fewer effective treatments or tests than cognitively normal patients. Interventions that improve how physicians understand MCI and make decisions for treatments in patients with MCI are needed.

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Bonner, Carissa, Carys Batcup, Julie Ayre, Erin Cvejic, Lyndal Trevena, Kirsten McCaffery, and Jenny Doust. "The Impact of Health Literacy–Sensitive Design and Heart Age in a Cardiovascular Disease Prevention Decision Aid: Randomized Controlled Trial and End-User Testing." JMIR Cardio 6, no. 1 (April 15, 2022): e34142. http://dx.doi.org/10.2196/34142.

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Background Shared decision-making is an essential principle for the prevention of cardiovascular disease (CVD), where asymptomatic people consider lifelong medication and lifestyle changes. Objective This study aims to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. Methods We developed a standard DA based on international standards. The standard DA was based on our existing general practitioner DA. The literacy-sensitive DA included simple language, supporting images, white space, and a lifestyle action plan. The control DA used Heart Foundation materials. A randomized trial included 859 people aged 45-74 years using a 3 (DA: standard, literacy-sensitive, control) ×2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions and behaviors, gist and verbatim knowledge of risk, credibility, emotional response, and decisional conflict. We iteratively improved the literacy-sensitive version based on end-user testing interviews with 20 people with varying health literacy levels. Results Immediately after the intervention (n=859), there were no differences in any outcome among the DA groups. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist and verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA group had better gist knowledge of percentage risk than the control group. The literacy-sensitive DA group had higher fruit consumption, and the standard DA group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than for percentage risk among those who received both. Conclusions The literacy-sensitive DA resulted in increased knowledge of CVD risk and increased fruit consumption in participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behavior but did affect psychological outcomes, consistent with previous findings. This tool will be integrated with additional resources to improve other lifestyle outcomes. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000806965; https://tinyurl.com/226yhk8a

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Calderon, Susana J., Caroline Mallory, and Michelle Malin. "Parental Consent and Access to Oral Health Care for Adolescents." Policy, Politics, & Nursing Practice 18, no. 4 (November 2017): 186–94. http://dx.doi.org/10.1177/1527154418763115.

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While most states allow minors 12 years and older to consent to services for contraception, prenatal care, or sexually transmitted infections, the same adolescents are required to have parental consent for even preventive oral health care. Many adolescents are denied access to preventive oral health care because of the challenge of securing parental consent for care when parents are unwilling, unable, or unavailable to consent. Our purpose is to examine the barriers to preventive oral health care for U.S. adolescents related to parental consent laws, explore the issues surrounding these laws, and recommend policy changes. We explain the current range and status of consent laws across the country and arguments for parental consent law as it now stands. We discuss the difficulty of applying general medical consent law to preventive oral health care, neuroscience research on cognitive capacity among adolescents, and the distinction between parental consent and adolescent assent. We recommend replacing required “opt-in” consent with simpler “opt-out” consent; developing a tool for assessing adolescent decision-making capacity; advocating for consent laws that apply specifically to preventive oral health care; and empowering school nurses to lead local, state, and nationwide policy and legislation efforts.

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Obolentsev, Valery F., Oleh M. Hutsa, and Dmytro B. Yelchaninov. "AUTOMATED DECISION-MAKING SUPPORT SYSTEM FOR QUALIFICATION OF CRIMINAL OFFENSES AS AN ELEMENT OF HUMAN RIGHTS HEALTH PROTECTION SYSTEMS." Wiadomości Lekarskie 74, no. 11 (2021): 2884–90. http://dx.doi.org/10.36740/wlek202111204.

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The aim: 1) To develop an informative model of the process of automated qualification of criminal offenses against human health for countries with a continental legal system; 2) on the basis of information model to create a decision support system in the form of a software product in terms of qualification of a criminal offense against human health. Materials and methods: The information model of the process of automated qualification of a criminal offense against human health was developed using the BPMN method on the basis of European countries’ legislation with a continental legal system. According to the information model, a decision support system was developed in the form of a software product. Results: 1. An information model of the process of automated qualification of criminal offenses against human health for countries with a continental legal system has been developed. 2. A system of decision support in the form of a software product as an element of law enforcement in terms of qualification of a criminal offense against human health. Conclusions: The proposed decision support system for automated qualification is a means of preventing unreasonable qualification of committed offenses as it minimizes the errors of this process. As a result, it will increase the preventive effect and the quality of law enforcement work to prevent crimes against human health.

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Jones, Stuart, Peter Lacey, and Terry Walshe. "A dynamic hydrological Monte Carlo simulation model to inform decision-making at Lake Toolibin, Western Australia." Journal of Environmental Management 90, no. 5 (April 2009): 1761–69. http://dx.doi.org/10.1016/j.jenvman.2008.11.027.

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Journal articles on the topic 'Medicine, Preventive – Australia – Decision making'

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