On 21 July the Technology and Construction Court handed down judgment in relation to two applications made in the case of Perinatal Institute v Healthcare Quality Improvement Partnership. This interesting judgment highlights two potential pitfalls f...

Summary The High Court has recently handed down its judgment in R (Critchley) v Financial Ombudsman Service and two others [2019] EWHC 3036 (Admin).  The applicant, Mrs Critchley sought to challenge FOS’s rejection of her PPI complaint on...

The law relating to industrial action is complicated and many aspects are unclear, mainly because of conflicting court decisions, complex statutory rules or because of the absence of judicial interpretation. In particular, uncertainty exists over th...

The law relating to industrial action is complicated and many aspects are unclear, mainly because of conflicting court decisions, complex statutory rules or because of the absence of judicial interpretation. In particular, uncertainty exists over th...

In

The Supreme Court’s decision in Zurich Insurance PLC UK Branch v International Energy Group Limited provides some clarity to the position of Clubs who face long-tail work related illness claims where multiple employers or insurers were involve...

Government plans to ensure that workers don't have to take Bank Holidays as part of their annual leave will see the UK start to catch up with its European counterparts in terms of holiday provision. Currently up to two million workers in the UK hav...

Many employers offer flexible benefits packages to their workforce. But the Age Discrimination Regulations have cast a shadow over some schemes, leaving employers and providers unsure as to how benefits such as private medical insurance should be ac...

Pension Ombudsman determinations are a snap shot of issues which can and do arise in relation to the LGPS. This speedbrief looks at two recent determinations relating to the construction of the LGPS Regulations and the effect of in...

Opinion on the way forward regarding the fate of the PSL campaign is still divided and the Amakhosi legend has weighed in with his views ......

There has long been discussion as to whether the use of cookies and other technologies for the purposes of web analysis, tracking and individualised advertising requires the explicit consent of those concerned or whether this can also be based on le...

Following the unsuccessful “save the library” challenge against Brent Council in 2011, comes another  High Court judgment in judicial review proceedings involving a Council’s decision to achieve spending cuts by reducing its l...

Intro / Summary The Supreme Court has refused to grant Emirates permission to appeal the Court of Appeal’s decision in the joint case of Gahan v Emirates and Buckley and ors v Emirates meaning the Court of Appeal’s decision to award comp...

In its decision of 27. June 2019 (Ref. 6 U 6/19), the Higher Regional Court of Frankfurt am Main ruled that participation in a sweepstakes can be made dependent on participants giving their consent to receive future marketing via e-mail or calls. In...

The General Court of the European Union annulled on 14 February the European Commission’s decision of 11 January 2016 (Decision (EU) 2016/1699), in which it had found that Belgium’s excess profit exemption scheme was incompatible with EU...

  On 21 January 2020, the Court of Appeal (‘CoA’) upheld the Competition Appeal Tribunal (‘CAT’) judgment, finding that Ping Europe Ltd (‘Ping’) breached competition law by prohibiting its retailers from sell...

On 2 December 2019, the Information Commissioner’s Office (“ICO”) and the Alan Turing Institute (the UK’s national institute for data science and artificial intelligence) (“Turing”) launched a consultation seeking...

This briefing is intended to provide an update on two recent developments under the US sanctions regime. • The first one is the introduction of US sanctions in relation to the Nord Stream 2 pipeline project, which threaten to widen a rift betwe...

[Dalsan Radio] The African Union Mission in Somalia, AMISOM, expresses its heartfelt condolences to the families of those who perished in the plane crash of 4th May, 2020. The aircraft which left Baidoa, had six people on board and was approaching Bardale, south of Somalia and 300km northwest of the capital Mogadishu when it crashed.

Bank branches attacked with gunfire, petrol bombs.

Ocean Park could run out of cash by September, its CEO warned on Friday as he estimated the Hong Kong attraction had missed out on nearly 1 million visitors over three months of its coronavirus shutdown.With the health crisis intensifying the resort’s financial woes, Matthias Li Sing-chung said no decision had been made on when the park would emerge from the shutdown imposed on January 26, but said it could return within two weeks once conditions were deemed suitable, even if some social…

LAHORE: The Punjab Food Authority has turned a deaf ear to the decisions of the Council of Common interests on the manufacturing and sale of Banaspati in the province by imposing a ban on it with...

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Data-driven decision making can be a powerful tool in the world of international development but it requires careful planning and management. 

The Trump administration is defending its decision not to release a detailed coronavirus reopening plan for the U.S., maintaining they would have been too narrowly-focused for the country's 50 states.The administration's defense comes in response to an Associated Press report that it shelved a repor...

NEW DELHI: As more Indians log online to seek information before entering into property deals, Internet today is estimated to be influencing decisions worth about USD 43 billion, search engine giant Google said. According to a study commissioned by the US-based firm, over 50 per cent of real estate buyers’ decisions are influenced by Internet research. “This phenomenon of researching online for real estate information before making a decision is not limited to metros but also extended to buyers in tier II cities,” Google India Industry Director Nitin Bawankule told reporters here. The overall influence of Internet on real estate transaction value of both residential and commercial property including rentals […]

In a universe that unthinkingly follows the rules, human agency is an anomaly. Can physics ever make sense of our power to change the physical world at will?

In a universe that unthinkingly follows the rules, human agency is an anomaly. Can physics ever make sense of our power to change the physical world at will?

Background

Transient loss of consciousness (TLOC) is a common reason for presentation to primary/emergency care; over 90% are because of epilepsy, syncope, or psychogenic non-epileptic seizures (PNES). Misdiagnoses are common, and there are currently no validated decision rules to aid diagnosis and management. We seek to explore the utility of machine-learning techniques to develop a short diagnostic instrument by extracting features with optimal discriminatory values from responses to detailed questionnaires about TLOC manifestations and comorbidities (86 questions to patients, 31 to TLOC witnesses).

Background:

Prediabetes is increasing in prevalence and is associated with risk of developing diabetes, heart disease, stroke, and retinopathy. Clinicians have limited tools to facilitate prediabetes discussions within primary care visits.

In this paper, a decision tree is presented, constructed on the basis of hydrogeological characteristics (water table depth, freshwater thickness, surface area required and distance between wells), to choose the optimal groundwater extraction method in the case of a coastal unconfined aquifer. A comparison is made of the groundwater extraction methods in a freshwater aquifer of limited thickness occurring in coastal dunes in the eastern region of the Province of Buenos Aires (Argentina). The negative effects brought about by the wrong use of the groundwater extraction methods are analysed, because, as a result of excessive extraction, such methods lead to the dramatic decrease of the freshwater reserves. The decision tree is a useful tool to assist decision-makers as it suggests the most suitable groundwater extraction method options (vertical wells or wellpoints), as well as identifying areas that are unsuitable for sustainable groundwater extraction.

ABSTRACTBackground:The focused assessment with sonography for HIV-associated tuberculosis (TB) (FASH) ultrasound protocol has been increasingly used to help clinicians diagnose TB. We sought to quantify the diagnostic utility of FASH for TB among individuals with HIV in Malawi.Methods:Between March 2016 and August 2017, 210 adults with HIV who had 2 or more signs and symptoms that were concerning for TB (fever, cough, night sweats, weight loss) were enrolled from a public HIV clinic in Lilongwe, Malawi. The treating clinicians conducted a history, physical exam, FASH protocol, and additional TB evaluation (laboratory diagnostics and chest radiography) on all participants. The clinician made a final treatment decision based on all available information. At the 6-month follow-up visit, we categorized participants based on clinical outcomes and diagnostic tests as having probable/confirmed TB or unlikely TB; association of FASH with probable/confirmed TB was calculated using Fisher's exact tests. The impact of FASH on empiric TB treatment was determined by asking the clinicians prospectively about whether they would start treatment at 2 time points in the baseline visit: (1) after the initial history and physical exam; and (2) after history, physical exam, and FASH protocol.Results:A total of 181 participants underwent final analysis, of whom 56 were categorized as probable/confirmed TB and 125 were categorized as unlikely TB. The FASH protocol was positive in 71% (40/56) of participants with probable/confirmed TB compared to 24% (30/125) of participants with unlikely TB (odds ratio=7.9, 95% confidence interval=3.9,16.1; P<.001). Among those classified as confirmed/probable TB, FASH increased the likelihood of empiric TB treatment before obtaining any other diagnostic studies from 9% (5/56) to 46% (26/56) at the point-of-care. For those classified as unlikely TB, FASH increased the likelihood of empiric treatment from 2% to 4%.Conclusion:In the setting of HIV coinfection in Malawi, FASH can be a helpful tool that augments the clinician's ability to make a timely diagnosis of TB.

BackgroundAwareness of the importance of shared decision making (SDM) is widespread; however, little research has focused on discussions surrounding investigations, despite increasing laboratory testing in primary care.AimTo explore the discussion of blood tests in routine primary care consultations.Design and settingA secondary analysis of 50 video-recorded routine primary care consultations, linked surveys, and records data (all from the One in a Million [OiaM] archive). The consultations were taken by 22 GPs across 12 practices.MethodA coding scheme was developed, using qualitative content analysis, to explore discussion of blood tests in transcripts of recorded consultations. Codes focused on instigating testing, the extent of SDM, and how results were explained. Survey data were used to compare patients’ pre-visit expectations with consultation content. Medical records were reviewed to compare tests discussed with those ordered.ResultsIn 36 out of 50 consultations that discussed ordering blood tests, 11 patients (31%) hinted that they wanted a blood test; however, none asked explicitly. Only four patients (11%) were offered alternative options. In 29 cases (81%) the GP gave some explanation of the indication, but only in six cases (17%) were the limitations of testing explained. Only 10 out of 31 patients (32%) were informed about all blood tests ordered. Of the 23 out of 50 consultations in which results were conveyed, the GP gave no explanation of the results in six cases (26%). Thirteen patients (57%) were only informed of an assessment of the results (for example, ‘normal’), rather than the actual results.ConclusionA lack of information dissemination and SDM exists around ordering tests and conveying results. Promoting SDM could reduce unnecessary testing and improve patient-centred care.

BackgroundUrinary tract infections (UTIs) are one of the most common bacterial infections managed in general practice. Many women with symptoms of uncomplicated UTI may not benefit meaningfully from antibiotic treatment, but the evidence base is complex and there is no suitable shared decision-making resource to guide antibiotic treatment and symptomatic care for use in general practice consultations.AimTo develop an evidence-based, shared decision-making intervention leaflet to optimise management of uncomplicated UTI for women aged <65 years in the primary care setting.Design and settingQualitative telephone interviews with GPs and patient focus group interviews.MethodIn-depth interviews were conducted to explore how consultation discussions around diagnosis, antibiotic use, self-care, safety netting, and prevention of UTI could be improved. Interview schedules were based on the Theoretical Domains Framework.ResultsBarriers to an effective joint consultation and appropriate prescribing included: lack of GP time, misunderstanding of depth of knowledge and miscommunication between the patient and the GP, nature of the consults (such as telephone consultations), and a history of previous antibiotic therapy.ConclusionConsultation time pressures combined with late symptom presentation are a challenge for even the most experienced of GPs: however, it is clear that enhanced patient–clinician shared decision making is urgently required when it comes to UTIs. This communication should incorporate the provision of self-care, safety netting, and preventive advice to help guide patients when to consult. A shared decision-making information leaflet was iteratively co-produced with patients, clinicians, and researchers at Public Health England using study data.

Background:

Recent studies have shown substantial deficiencies in the quality or quantity (or both) of communication and decision-making during serious illness. We evaluated the efficacy of a novel decision support intervention, the Plan Well Guide, in increasing completion of a standard medical order form for advance medical care planning and improving decisional outcomes in nonacademic primary care settings.

Chelsea news and gossip is coming in thick and fast so Express Sport is on hand to bring you all the very latest from Stamford Bridge.

Liverpool are looking to make Sadio Mane an offer that would tarnish Real Madrid's hopes of signing him.

The covid-19 pandemic has led to rushed guidelines for doctors making treatment decisions, and has encouraged more people to make advance decisions on CPR and ventilation

A new process to harness multiple disease models for outbreak management has been developed by an international team of researchers. The team will immediately implement the process to help inform policy decisions for the COVID-19 outbreak.

Read our live updates on coronavirus HERE Coronavirus: The symptoms

RAF plane still awaiting go-ahead for flight to Turkey to collect supplies

The Foreign Office's top civil servant has backtracked after saying ministers took a "political decision" not to take part in an EU scheme to get vital coronavirus equipment.

The Health Secretary has been forced to deny the UK's failure to take part in an EU scheme to get vital ventilators for the coronavirus crisis was politically motivated.

"The fact that we are the world’s largest democracy and we are all aware that power and a role in global affairs for a nation comes from economic strength."

Cabinet Office minister says Government does not want the UK to continue with its 'European Union-lite membership' beyond December 2020

Exactly one week since Georgia Gov. Brian Kemp began reopening the state's economy, small businesses shared early success stories as customers welcomed their return. But at what cost? Business owners say only time will tell.

Presenter said she is 'proud' of craft show despite criticism