scholarly journals Who Is Making Decisions? An Open Letter to Healthcare Professionals in the Developing World

2021 ◽  
Author(s):  
Rasheed Ofosu-Poku
Keyword(s):  
Decision Making ◽  
Healthcare Professional ◽  
Healthcare Professionals ◽  
Developing World ◽  
Ethical Issues ◽  
Informed Decision Making ◽  
Open Letter ◽  
Middle Income ◽  
Middle Income Countries ◽  
Educational Standard

The educational standard of people living in low- and middle-income countries (LMICs) such as Ghana is relatively low. Thus, most resources of information about health available on electronic and print media remain to a large extent non-beneficial to them. They rely mostly on healthcare professionals to discuss about their health, illnesses, resources available for care, and how and to what extent the available resources can meet their needs and expectations. Some healthcare professionals in these LMICs, instead of taking the opportunity to carry out these educational and empowering discussions with patients and their families, assume a paternalistic role, making decisions unilaterally and involving them only minimally in providing care. This article, instead of being written as a scholarly referenced paper exploring ethical issues of autonomy and informed decision making, has been worded as a letter to healthcare professionals. Although it addresses healthcare professional in LMICs in general, it does not in any way imply that none adheres to these important ethical principles.

scholarly journals Turning ‘evidence for development’ on its head: A view from Africa

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ruth Stewart
Keyword(s):  
Decision Making ◽  
Global South ◽  
African Philosophy ◽  
Informed Decision Making ◽  
Middle Income ◽  
Middle Income Countries ◽  
The North ◽  
Poverty And Inequality ◽  
Resource Poor ◽  
Global North

The ‘evidence for development’ community aims to produce research that is useful and used to address issues of poverty and inequality, largely in low- and middle-income countries (often referred to as the ‘global South’). The unspoken norm, however, is that much of the engagement, funding and attention is focused on organizations and individuals in the global North, with the assumption that they are effective in supporting the needs of the global South. In this research paper, I explore the initiatives and the individuals and organizations that are working within the ‘evidence for development’ community in Africa, using the lens of the African philosophy of ubuntu. I present findings from a programme of work undertaken across Africa to identify and better understand the innovation in evidence-informed decision-making taking place across the continent. I demonstrate that, while resource-poor and not well publicized, the evidence community in Africa is world leading in a number of respects. These include the interconnections within its continent-wide network, and the engagement of some governments within its ecosystem. Reflecting on these findings, I discuss and critique the underlying foundations of patriarchy, development and coloniality that shape the field of ‘evidence for development’. I highlight how, in an era of decoloniality, post-‘development’ and antipatriarchy, the ‘evidence for development’ community risks becoming outdated and being ineffective if it does not engage with the challenges inherent within these concepts. I argue that using the alternative lens of ubuntu enables us to celebrate the successes of Southern evidence communities, and to work together on a level footing with the North to tackle the challenges of poverty and inequality through better use of evidence.

EP.TH.602Exploring decision-making of healthcare professionals in patients with benign large non-pedunculated colonic polyps (BLNPCP) virtually using combined focus group and nominal group technique

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
L Wheldon ◽  
J Morgan ◽  
MJ Lee ◽  
S Riley ◽  
SR Brown ◽  
...  
Keyword(s):  
Decision Making ◽  
Healthcare Professional ◽  
Patient Preference ◽  
Healthcare Professionals ◽  
Nominal Group Technique ◽  
Colonic Polyps ◽  
Nominal Group ◽  
Shared Decision ◽  
Patient Factors ◽  
Group Technique

Abstract Aim We aimed to elicit key factors that influence healthcare professional decision-making when deciding treatment for BLNPCP. Background Benign large non-pedunculated colonic polyps (BLNPCP) may harbour covert malignancy and opinions differ about the optimal treatment modality. There are several options available, including endoscopic mucosal resection, endoscopic submucosal resection, combined endoscopic laparoscopic surgery and surgical resection. Despite widespread availability of endoscopic resection techniques, there are high rates of surgery in the UK. Methods Three focus groups of healthcare professionals, comprised of either consultant colorectal surgeons, nurse endoscopists and consultant gastroenterologists, were conducted virtually utilising the Nominal Group Technique. Meetings were recorded and transcribed verbatim. Themes were devolved using the framework approach for qualitative analysis. A priority-ranked list of factors influencing healthcare professional decision-making in this setting was generated. Results Five main themes were identified as influencing decision-making: Shared decision making (patient preference, informed consent); Patient factors (co-morbidity, age, life-expectancy); Polyp factors (Location, size, morphology, risk of cancer); Healthcare professionals (skill-set, personal preference); System factors (techniques availability locally, regional referral networks). Nominal Group Technique generated 55 items across the three focus groups. Nurses and gastroentologists ranked patient factors (particularly drug history and tolerance of procedure) and shared decision making (patient preference) more highly then surgeons. Surgeons placed greater emphasis on polyp factors particularly location and the risk of submucosal invasive carcinoma. Conclusion Decision making is complex and multifactorial. These results support the benefits of complex polyp MDTs and patient involvement in the decision-making. The complexity of decision-making may underpin wide variation in practice.

Social and Ethical Concerns of Biomedical Engineering Research and Practice

2011 ◽  
pp. 54-80 ◽  
Author(s):  
Snehasish Mishra
Keyword(s):  
Decision Making ◽  
Biomedical Engineering ◽  
Healthcare Professionals ◽  
Ethical Issues ◽  
Healthcare Sector ◽  
Technological Advancement ◽  
Ethical Values ◽  
Medical Sciences ◽  
Engineering Research ◽  
Bioethical Issues

Biomedical engineering is an advanced and relatively new field in the healthcare sector. Owing to the very nature of the various professional challenges faced by healthcare professionals, the moral and ethical values seem to have taken the backburner. The factors contributing to it may include a sound knowledge of the healthcare professional on the legally-permissible ethical values, and the desperate situations requiring precise split-moment decision-making. No technological advancement without a human face is worth it, and hence, during the course of the degree, a biomedical engineering student needs to be exposed to various ethical issues through theory, live cases and demonstrations. Being intrinsically multi- and inter-disciplinary, biomedical engineering lacks precise ethical rules that delineate and delimit professional responsibility, thus blurring the ethical understanding of biomedical engineering. The solution seems to lie in giving due place to human virtues. In the coming days, bioethical issues are expected to be increasingly complicated and dominating the decision-making process owing to the advancements in sciences, and the ever-complicated cases handled by healthcare professionals. A global healthcare and ethics-related online open-access portal may serve as a common platform for all the stakeholders in the interest and ethical growth of biomedical engineering in particular and medical sciences in general.

scholarly journals Prevalence and factors associated with poor mental health among healthcare professionals in low- and lower-middle-income countries: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Healthcare Professionals ◽  
Health Workers ◽  
Poor Mental Health ◽  
Psychological Wellbeing ◽  
Health Issues ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Mental Health Issues

Abstract Background A healthy and productive health workforce is central to a well-functioning health system. However, health workers are at high risk of poor psychological wellbeing due to their particularly strenuous work demands. While mental health of health workers is a well-researched issue in high-income countries, research from low- and lower-middle-income countries (LLMIC) has begun to emerge only recently. The review aims to synthesize this body of research, specifically to assess the prevalence of mental health issues among health workers in LLMIC, to identify factors associated with good or poor mental health, and to highlight gaps in knowledge. Methods We will perform a systematic search of the published English and French language literature (from inception onwards) in MEDLINE, EMBASE, and PsycINFO. Eligible for inclusion are observational studies (e.g., cross-sectional, case-control, or cohort) and control arms of randomized controlled trials reporting investigations on the nature, prevalence, and factors associated with mental health or psychological wellbeing among formally trained health professionals and health associate professionals delivering health services in formal healthcare facilities in LLMIC. The primary outcomes will be burnout, depression, and general psychological wellbeing. Secondary outcomes include other specific mental health diagnoses, as well as general psychological stress, distress and/or trauma if work-related and explicitly framed as a mental health issue. Two authors will independently examine the studies against the eligibility criteria in the stages of title, abstract, and full-text study selection, as well as assess the risk of bias in included studies using standard checklists depending on study design. Disagreements will be resolved in discussion with the third author. Data will be extracted from included studies using a predefined and piloted coding framework. Given the anticipated heterogeneity of studies, we do not expect to be able to conduct meta-analysis and plan to summarize the extracted data in narrative form. The framework method will be used to organize narrative data by subthemes and explore patterns. Discussion In assessing the prevalence of mental health issues among healthcare professionals in LLMIC and identifying factors associated with positive or poor mental health, the review aims to synthesize all possible available information for policy makers and health system managers on a potentially highly important but not yet much-discussed issue and to highlight gaps in currently available knowledge. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42019140036)

scholarly journals Election Administration, Resource Allocation, and Turnout: Evidence From Kenya

2020 ◽  
pp. 001041402093808
Author(s):  
J. Andrew Harris
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Political Behavior ◽  
Large Scale ◽  
Regression Discontinuity ◽  
Regression Discontinuity Design ◽  
Middle Income ◽  
Election Administration ◽  
Middle Income Countries ◽  
Policy Choices

Decisions about how to organize and run an election can shape political participation. Policy choices may distribute election resources unequally, skewing voting outcomes. In low- and middle-income countries where electoral capacity and resources are scarce and decision-making highly centralized, election administration has the potential to shape results on a large scale. In the context of Kenya’s August 2017 elections, I study the consequences of a legislated threshold that determines the capacity of polling centers to quickly serve voters by reducing election-day lines. Using a regression discontinuity design, I find that turnout is 2.4% lower in congested polling places just below the threshold relative to polling places above the threshold. Relative to other hypothetical thresholds, the chosen threshold benefits the incumbent president, as incumbent strongholds receive more polling resources than opposition areas. The results demonstrate how electoral resource allocation shapes political behavior and election outcomes.

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