BACKGROUND: The challenges of evidence-informed decision-making in a public health emergency have never been so notable as during the COVID-19 pandemic. Questions about the decision-making process, including what forms of evidence were used, and how evidence informed-or did not inform-policy have been debated.
METHODS: We examined decision-makers\' observations on evidence-use in early COVID-19 policy-making in British Columbia (BC), Canada through a qualitative case study. From July 2021- January 2022, we conducted 18 semi-structured key informant interviews with BC elected officials, provincial and regional-level health officials, and civil society actors involved in the public health response. The questions focused on: (1) the use of evidence in policy-making; (2) the interface between researchers and policy-makers; and (3) key challenges perceived by respondents as barriers to applying evidence to COVID-19 policy decisions. Data were analyzed thematically, using a constant comparative method. Framework analysis was also employed to generate analytic insights across stakeholder perspectives.
RESULTS: Overall, while many actors\' impressions were that BC\'s early COVID-19 policy response was evidence-informed, an overarching theme was a lack of clarity and uncertainty as to what evidence was used and how it flowed into decision-making processes. Perspectives diverged on the relationship between \'government\' and public health expertise, and whether or not public health actors had an independent voice in articulating evidence to inform pandemic governance. Respondents perceived a lack of coordination and continuity across data sources, and a lack of explicit guidelines on evidence-use in the decision-making process, which resulted in a sense of fragmentation. The tension between the processes involved in research and the need for rapid decision-making was perceived as a barrier to using evidence to inform policy.
CONCLUSIONS: Areas to be considered in planning for future emergencies include: information flow between policy-makers and researchers, coordination of data collection and use, and transparency as to how decisions are made-all of which reflect a need to improve communication. Based on our findings, clear mechanisms and processes for channeling varied forms of evidence into decision-making need to be identified, and doing so will strengthen preparedness for future public health crises.

Health systems in high-resource countries recognize the importance of making decisions about the services offered to the population based on scientific evidence. Producing this evidence is especially challenging in areas such as newborn care where the frequency of conditions is rare. However, methodological advances in the field of economic evaluation could change how this evidence is used in decision-making. This study aimed to investigate how decision-makers in the Canadian province of Quebec perceive the value of recent advances in economic evaluations for perinatal studies and how these advances might affect the offer of neonatal interventions in the public health care system. A qualitative study was conducted. A total of 10 policymakers were interviewed. A neo-institutional conceptual framework highlighting three dimensions, structure, power, and interpretive schemes, was used for data collection and analyses. Structural factors, interpretative schemes, and power management between the groups concerned concur to ensure that providing services to newborns is not hindered by the difficulty of producing evidence. They also ensure that the decisions regarding which disease to screen for take into consideration the specificity of neonatology, in particular, the social value given to children not captured by available evidence.

The COVID-19 pandemic has brought about significant changes to the life of most individuals, worldwide. This study explores the cultural factors influencing decision-making during the pandemic, and is part of the CORNER Project, funded by the Research Council of Norway, aimed at understanding institutional response in the early phases of the Covid-19 emergency in Norway, Sweden, and Italy. Semi-structured interviews with key political-administrative leaders in Italy (N = 35) were conducted and content-analyzed, allowing the identification of the underlying cultural dynamics that played a role in these decisions. Thematic analysis was used to assess the influence of cultural factors on the crisis management and early reaction of institutions and citizens to the spread of Covid. In line with previous studies, and as expected, the individualism vs. collectivism dimension can explain differential health outcomes during the outbreak. In this paper we argue that individualism-collectivism cultural values can also play a pivotal role in public compliance with Covid-19 restrictions, and psychological responses during the pandemic.

Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a \'sense of knowing\' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.

Landfill site selection is an essential aspect of sustainable solid waste management as it ensures that the waste generated by a community or region is disposed of in an environmentally friendly and safe manner. The approach for selecting landfill sites seeks to choose locations that provide the least risk to the environment and public health while still satisfying the demands of the local community. This research aims to use a multi-criteria assessment to determine a landfill location in Al-Balqa Governorate in Jordan to ensure that the chosen site meets the needs of all stakeholders while minimizing the negative impact on the environment and the community. This research developed a hierarchy structure to make landfill site selection decisions, which involves identifying parameters such as distance to surface water, land cover, distance from urban and rural areas, distance to roads, slope, and soil permeability. A rating system was used to evaluate each criterion, and weights were assigned to reflect their relative importance. An overlay weighting technique was then used to assess site suitability based on expert opinions from related fields. In this studied area, about 204,283 m2 is required to address 25 years of municipal solid waste volume, whereas this technique identified around 79,210,000 m2 of potential landfill sites. Overall, the research highlights the importance of using a multi-criteria assessment approach for landfill site selection to ensure that the chosen site meets the needs of all stakeholders while minimizing negative impacts on the environment and public health. The study provides insights that can be useful for decision-makers involved in sustainable solid waste management in Jordan and other similar regions. -How to Find the suitable landfills to achieve sustainable development.-What aspects and criteria were comsidered in choosing the landfill site.

OBJECTIVE: The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention.
METHODS: A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom.
RESULTS: Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery.
CONCLUSIONS: There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time.

Understanding that good decision-making is paramount for the success of an organization and recognizing that strategic decision-making inside museums is a topic that has been over-passed by researchers, this paper intends to contribute to the relevance of the subject through the implementation of an innovative tool. Decision-making in museums is normally focused on the intuition, subjectivity, and experience of the curator, who brings all his knowledge to the exhibition programming. However, museums\' management and environment are constantly changing, thus the application of this tool would aim to make decisions in a more democratic, transparent, inclusive, and accurate manner. Besides, it will be easier to understand how distinct subjects can work together, demonstrating successful results to improve the decision-making process when programming and measuring temporary exhibition seasons in museums. This paper describes the design and implementation of the Multi-Attribute Utility Theory (MAUT) for the Museu Nacional d\'Art de Catalunya (MNAC). It also analyzes and evaluates the decision-making process when scheduling exhibitions for a season.

It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts\' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations.

Background Clinical case vignettes are a widely adopted pedagogical approach in medical education. The cases may be presented to students with a closed response option for objectivity. While solving clinical cases has demonstrated its effectiveness in enhancing medical students\' clinical reasoning, there is an ongoing debate regarding the most effective approach: individual problem-solving or team-based problem-solving. Objective To observe and compare the score obtained from individual clinical problem-solving approaches versus team-based clinical problem-solving approaches. Methods After obtaining consent, a total of 100 students were randomly selected for the study. The participants were divided into two groups: an individual approach group (IAG) (n=25) and a team-based approach group (TAG) comprising 25 groups of three students each. Both groups were presented with a set of 10 clinical problems, each requiring a closed-answer response of \"yes\", \"no\", or \"don\'t know\". The participants\' responses were recorded and analyzed to evaluate their problem-solving efficacy. Results A total of 25 responses were obtained from 25 students from the IAG group and 25 responses from 25 groups from the TAG group. There was no difference between the score in IAG (7.44±1.12) and TAG (7.52 1.66) p-value=0.58. There was no difference between individual scores in 10 questions between IAG and TAG groups. Conclusion The study found no significant score differences between individual and team-based clinical case-solving groups. Hence, for the objective type of case-solving pattern used in this study, a team-based approach may not be necessary. Further research is needed to explore factors for such findings in future studies.

BACKGROUND: The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education.
OBJECTIVE: This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis.
METHODS: In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants\' proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out.
RESULTS: A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%).
CONCLUSIONS: Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care.