Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making

The study aimed to examine the factors influencing referral to rehabilitation following traumatic brain injury (TBI) by using social problems theory as a conceptual model to focus on practitioners and the process of decision-making in two Australian hospitals. The research design involved semi-structured interviews with 18 practitioners and observations of 10 team meetings, and was part of a larger study on factors influencing referral to rehabilitation in the same settings. Analysis revealed that referral decisions were influenced primarily by practitioners' selection and their interpretation of clinical and non-clinical patient factors. Further, practitioners generally considered patient factors concurrently during an ongoing process of decision-making, with the combinations and interactions of these factors forming the basis for interpretations of problems and referral justifications. Key patient factors considered in referral decisions included functional and tracheostomy status, time since injury, age, family, place of residence and Indigenous status. However, rate and extent of progress, recovery potential, safety and burden of care, potential for independence and capacity to cope were five interpretative themes, which emerged as the justifications for referral decisions. The subsequent negotiation of referral based on patient factors was in turn shaped by the involvement of practitioners. While multi-disciplinary processes of decision-making were the norm, allied health professionals occupied a central role in referral to rehabilitation, and involvement of medical, nursing and allied health practitioners varied. Finally, the organizational pressures and resource constraints, combined with practitioners' assimilation of the broader efficiency agenda were central factors shaping referral. (C) 2004 Elsevier Ltd. All rights reserved.

Collaborative decision-making processes for maintaining biodiversity: Two Australian case studies

There have been many models developed by scientists to assist decision-makers in making socio-economic and environmental decisions. It is now recognised that there is a shift in the dominant paradigm to making decisions with stakeholders, rather than making decisions for stakeholders. Our paper investigates two case studies where group model building has been undertaken for maintaining biodiversity in Australia. The first case study focuses on preservation and management of green spaces and biodiversity in metropolitan Melbourne under the umbrella of the Melbourne 2030 planning strategy. A geographical information system is used to collate a number of spatial datasets encompassing a range of cultural and natural assets data layers including: existing open spaces, waterways, threatened fauna and flora, ecological vegetation covers, registered cultural heritage sites, and existing land parcel zoning. Group model building is incorporated into the study through eliciting weightings and ratings of importance for each datasets from urban planners to formulate different urban green system scenarios. The second case study focuses on modelling ecoregions from spatial datasets for the state of Queensland. The modelling combines collaborative expert knowledge and a vast amount of environmental data to build biogeographical classifications of regions. An information elicitation process is used to capture expert knowledge of ecoregions as geographical descriptions, and to transform this into prior probability distributions that characterise regions in terms of environmental variables. This prior information is combined with measured data on the environmental variables within a Bayesian modelling technique to produce the final classified regions. We describe how linked views between descriptive information, mapping and statistical plots are used to decide upon representative regions that satisfy a number of criteria for biodiversity and conservation. This paper discusses the advantages and problems encountered when undertaking group model building. Future research will extend the group model building approach to include interested individuals and community groups.