Life Helper: Don’t Make Major Decisions When Hungry

New research from Scotland supports the notion that hunger can influence our thoughts — and suggesting that we delay making important decisions when we are hungry. Read PsychCentral article here

How chronic inflammation may drive down dopamine and motivation

A new computational method will allow scientists to measure the effects of chronic inflammation on energy availability and effort-based decision-making. The method may yield insights into how chronic, low-grade inflammation contributes to motivational impairments in some cases of depression, schizophrenia and other medical disorders.  Click here to read further.

How commissioners use research evidence

Researchers want their work to be used and useful, but may not always understand the context in which decisions are made. Most health and care organisations aim to base decisions on the best available evidence, but accessing and interpreting the right evidence at the right time is hard. Researchers need to do what they can to make their research as useful as possible to those making decisions under pressure


https://www.dc.nihr.ac.uk/highlights/health-commissioners-research-evidence/


From the NIHR dissemination Centre

Support people to make decisions if they have capacity but find it difficult, NICE says

Health and social care professionals should support people to make decisions who find it difficult, NICE says in new draft guidance.

They should support people even if they make a decision that they may disagree with. Making an ‘unwise’ or ‘risky’ choice does not mean that a person lacks capacity and decisions need to be made on their behalf, the draft guidance on decision making and mental capacity says.

Using visual aids or involving friends and family can help a person communicate their wishes, NICE says.

NIHR Signal Computerised decision support can improve antibiotic prescribing in hospitals

Using a computerised decision support tool (software used by hospital prescribers) improved the adequacy of antibiotic coverage and adherence to guidelines, and may have reduced the risk of people dying. Only four studies reported on resistance to antibiotics, so no conclusions can be drawn about the impact of this tool on resistance.

Antibiotic stewardship programmes aim to get prescribers to think before they decide to prescribe antibiotics, then consider the type and dose of antibiotic. Computerised decision support aims to support this practice by embedding these principles into everyday practice.

From the NIHR Dissemination Centre

Surgeons asked to staff hospital front doors to head off emergency pressures this winter

The leaders of the Royal College of Surgeons (RCS) have written to surgeons in England, encouraging them to provide support at hospital front doors (e.g. rapid outpatient clinics and A&E) over the coming months as the NHS faces arguably its toughest winter in modern times. The surgeons have also called on government to make further funding available to the NHS in next week’s Budget.

The RCS says there is strong evidence that having more senior decision-makers at the front door of hospitals reduces unnecessary emergency admissions and delayed discharges, thereby freeing up beds for genuine emergencies and patients needing planned operations.

Decisions regarding admission to the ICU and international initiatives to improve the decision-making process

Critical care (London, England) 21.1: 174. (July 4, 2017)

Whether a critically ill patient should or should not be offered life-supporting treatment in the intensive care unit (ICU) is arguably the most important decision that is regularly made on behalf of a patient; deciding not to admit somebody may mean that their death is inevitable. Yet these decisions are often made in the face of uncertain information, time constraints and without the patient being able to participate in discussions. In this context it is perhaps surprising that more research and guidance has not addressed this area of practice.

There are three overarching considerations that must influence the decision not to admit a patient to ICU. Firstly, that an individual patient’s preference may be to decline intensive care treatments. Secondly, that the burden of invasive and distressing treatments on the ICU may outweigh any potential benefit. Thirdly, that the ICU is a labour and resource-intensive endeavour: resources are not available for every patient to be admitted. Intensivists are provided with a limited amount of resources and are, usually implicitly, charged with doing as much good as possible with what is available. This means that at times of high demand or limited resource availability, patients who have less clear-cut potential to benefit from the ICU may not be admitted [1, 2]. Managing resources is an unavoidable part of the intensivist’s job.

In this issue Nicolas Chin-Yee and colleagues shine more light on the interaction of these three issues by studying the impact of admission to the ICU for older patients.

UHCW Research: Bassford, Christopher

Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis.

Cochrane Systematic Review to determine the effectiveness of interventions that promote Shared Decision Making for children and adolescents with CF aged four to 18 years.

Implementing shared decision making in the NHS: lessons from the MAGIC programme

This review summarises the MAGIC programme for adopting shared decision making, and details the common challenges associated with implementation. Key messages include the fact that skills and attitudes are more valuable than specific tools, and that organisation support is vital

BMJ 2017;357:j1744

How to achieve best practice in supported decision-making

There is a real connection between the Mental Capacity Act 2005 and the Care Act 2014 regarding supported decision-making. The shared duties and themes reinforce the absolute importance of working with all people from the presumption they have mental capacity to make their own decisions and are best placed to do so. Also of fundamental significance are the principles that all people must be provided with the information and support necessary to enable them to participate, and that any decisions affecting them must be built upon their wishes, feelings, beliefs and values to achieve the best outcome for them. Read more about supported decision-making HERE.

Decision tree and random forest models for outcome prediction in antibody incompatible kidney transplantation

Biomedical Signal Processing and Control Available online 9 February 2017

Clinical datasets are commonly limited in size, thus restraining applications of Machine Learning (ML) techniques for predictive modelling in clinical research and organ transplantation. We explored the potential of Decision Tree (DT) and Random Forest (RF) classification models, in the context of small dataset of 80 samples, for outcome prediction in high-risk kidney transplantation. The DT and RF models identified the key risk factors associated with acute rejection: the levels of the donor specific IgG antibodies, the levels of IgG4 subclass and the number of human leucocyte antigen mismatches between the donor and recipient. Furthermore, the DT model determined dangerous levels of donor-specific IgG subclass antibodies, thus demonstrating the potential of discovering new properties in the data when traditional statistical tools are unable to capture them. The DT and RF classifiers developed in this work predicted early transplant rejection with accuracy of 85%, thus offering an accurate decision support tool for doctors tasked with predicting outcomes of kidney transplantation in advance of the clinical intervention.

UHCW Research: Robert Higgins and Sunil Daga

A million decisions campaign

Health Education England and the Chartered Institute of Library and Information Professionals have launched a joint campaign for decisions in the healthcare sector to be fully evidence-based. Every day more than a million decisions are made that have a profound and lasting impact on people's lives and which influence the quality of healthcare and the cost of services. The #milliondecisions campaign calls for everyone involved in policy making and care delivery to use the skills of librarians and knowledge specialists in meeting their obligations under the Health and Social Care Act 2012

Uncertainty and risk in HTA decision making

The quality of decision-making in key public sector bodies dealing with resource allocation is a major determinant of their efficiency. One of the most difficult and contentious areas of decision-making is the way that uncertainty is dealt with. This report from the Office of Health Economics is concerned with uncertainty as it affects the cost effectiveness aspects of health HTA.

STP checklist for governance and engagement

Sustainability and Transformation Plans (STPs) are the latest mechanism to drive system-wide collaboration and planning and bring with them an important opportunity to improve the way the whole system works together to deliver high quality and sustainable services across a place. Since STPs do not change the statutory responsibilities of individual organisations they raise important questions for how governance and engagement will be managed to support collective decision-making.

This checklist is for CCG lay members, provider non-executive directors (NEDs), councillors, local Healthwatch organisations, the voluntary sector, and other key community partners. It provides a series of questions that can be asked locally and within boards to support effective dialogue and decision-making within ‘STP footprints’.

Patients’ decision making in total knee arthroplasty: a systematic review of qualitative research

Bone and Joint Research DOI: 10.1302/2046-3758.410.2000420 Published 8 October 2015 

A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review’s objective is to systematically examine the qualitative literature surrounding patients’ decision making in knee arthroplasty.

UHCW Research: T. Barlow and A Realpe

Discordance between patients' stated values and treatment preferences for end-of-life care: results of a multicentre survey

Background: Medical orders for the use of life-supports should be informed by patients' values and treatment preferences. The purpose of this study was to explore the internal consistency of patients' (or their family members') stated values, and the relationship between these values and expressed preferences. 

Conclusions: Decision-making regarding medical treatments at the EOL is inadequate. To reduce decisional conflict, patients and their families need more support to clarify their values and ensure that their preferences are grounded in adequate understanding of their illness and treatment options.

BMJ Support Palliat Care bmjspcare-2015-001056. Published Online First: 6 October 2016 

Request full article from the library.

Calibrating how doctors think and seek information to minimise errors in diagnosis

Information gathering is a foundational step of the diagnostic process. However, evidence over the last several decades suggests that failures in information gathering are common and feature prominently in analyses of diagnostic errors. 

In this issue of BMJ Quality and Safety, Sheringham et al used simulated patient vignettes to understand the role that patient characteristics (including demographics and symptomatology) play in physicians' decisions to investigate for possible diagnosis of lung cancer.

Awareness and understanding of EHRC guidance on the Public Sector Equality Duty

The Public Sector Equality Duty (PSED) is a duty on public authorities to consider how their policies or decisions affect people who are protected under the Equality Act. This research from the Equality and Human Rights Commission explores the effectiveness of some of the guidance the Commission has produced on the PSED.

NHSCC launch new report to support CCGs in making difficult decisions

NHS Clinical Commissioners has launched a new publication to support CCGs in making difficult decisions about prioritisation of resources and changes to local services.

Produced in collaboration with the University of Birmingham, ‘Making Difficult Decisions’ sets out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes. It draws on both academic research and practical insight from commissioners, patient groups and NHS England.

Making Difficult Decisions: Commissioning Healthcare In Changing Times

This report by NHS Clinical Commissioners aims to support CCGs in making difficult decisions about prioritisation of resources and changes to local services. 

It sets out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes.