Shared decision making development in Switzerland: room for improvement!

In Switzerland there is a strong movement at a national policy level towards strengthening patient rights and patient involvement in health care decisions. Yet, there is no national programme promoting shared decision making. First decision support tools (prenatal diagnosis and screening) for the counselling process have been developed and implemented. Although Swiss doctors acknowledge that shared decision making is important, hierarchical structures and asymmetric physician-patient relationships are still prevailing. The last years have seen some promising activities regarding the training of medical students and the development of patient support programmes. Swiss direct democracy and the habit of consensual decision making and citizen involvement in general may provide a fertile ground for SDM development in the primary care setting.

Eliciting preferences for collectively financed health programmes : the "willingness to assign" approach

Improving public involvement in health system decision making stands as a primary goal in health systems reform. However, still limited evidence is found on how best to elicit preferences for health care programs. This paper examines a contingent choice technique to elicit preferences among health programs so called, willingness to assign (WTAS): Moreover, we elicited contingents rankings as well as the willingness to pay extra taxes for comparative purposes. We argue that WTAS reveals relative ( monetary-based) values of a set of competing public programmes under a hypothetical healthcare budget assessment. Experimental evidence is reported from a delibertive empirical study valuing ten health programmes in the context of the Catalan Health Services. Evidence from a our experimental study reveals that perferences are internally more consistent and slightly less affected by "preference reversals" as compared to values revealed from the willingness to pay (WTP) extra taxes approach. Consistent with prior studies, we find that the deliberative approach helped to avoid possible misunderstandings. Interestingly, although programmes promoting health received the higher relative valuation, those promoting other health benefits also ranked highly

Choix thérapeutique dans les tumeurs costales primaires [Therapeutic choice in primary costal tumors].

Primary rib tumors constitute a rare entity and have only seldom been studied separately. In a retrospective study based on 21 cases, with the help of the literature, we try to specify the specific problems encountered with rib tumors and the therapeutic consequences that follow. Our series comprises 10 benign tumors, 3 malignant tumors and 8 cartilaginous tumors. The benign tumors were resected and all the patients recovered uneventfully. One of the patients died of a plasmocytoma 92 months after resection. Among the cartilaginous tumors, we observed two recurrences after 9 and 24 months from which the patient died eventually at 20 and 72 months after resection. The histologic diagnosis of a rib tumor must be made through an excisional biopsy. Cartilaginous tumors are potentially malignant. They must be treated as malignant tumors by radical resection and primary reconstruction. The long-term follow-up of every patient carrying a rib tumor is mandatory because of the risk of late recurrence.

A LIBRARY IN THE MAKING: Pioneer History of the Territorial and State Library of Iowa,October 1912

The discovery of early manuscript reports of Territorial and State Librarians, buried in the mass of old official papers transferred from the several departments of State to the new Department of Archives in the Historical Building, has suggested the propriety of completing as far as possible, the historical record of Iowa's State Library, "from the earliest period to the present time." After a thorough research through the papers on file in the Archives Department, the published Journals and departmental reports in the State Library and documents and private papers loaned me by Mr. Newton R. Parvin, librarian of the Iowa Masonic Library, Cedar Rapids. I am now able to present the following historical sketch, Supplemented by the hitherto unpublished papers referred to this filling a gap in the history of a State institution which from very small beginnings has grown to large proportions and has made for itself a firm place in the respect and esteem of every citizen of Iowa.

Design de biblioteca virtual centrado no usuário: a abordagem do Sense-Making para estudos de necessidades e procedimentos de busca e uso da informação

Analisa a abordagem do Sense-Making na busca e uso da informação.

Ecological-economic optimization of biodiversity conservation under climate change

Substantial investment in climate change research has led to dire predictions of the impacts and risks to biodiversity. The Intergovernmental Panel on Climate Change fourth assessment report(1) cites 28,586 studies demonstrating significant biological changes in terrestrial systems(2). Already high extinction rates, driven primarily by habitat loss, are predicted to increase under climate change(3-6). Yet there is little specific advice or precedent in the literature to guide climate adaptation investment for conserving biodiversity within realistic economic constraints(7). Here we present a systematic ecological and economic analysis of a climate adaptation problem in one of the world's most species-rich and threatened ecosystems: the South African fynbos. We discover a counterintuitive optimal investment strategy that switches twice between options as the available adaptation budget increases. We demonstrate that optimal investment is nonlinearly dependent on available resources, making the choice of how much to invest as important as determining where to invest and what actions to take. Our study emphasizes the importance of a sound analytical framework for prioritizing adaptation investments(4). Integrating ecological predictions in an economic decision framework will help support complex choices between adaptation options under severe uncertainty. Our prioritization method can be applied at any scale to minimize species loss and to evaluate the robustness of decisions to uncertainty about key assumptions.