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Systems Thinking

Elisabet Sundewall Thorén, Julie Hefting Pedersen, Nis Ove Jørnæs
Purpose: This paper describes the results from the iterative development and usability testing of an online audiological rehabilitation (OAR) program. The OAR was based on previous experience with Internet interventions and OAR. Method: The described OAR consisted of weekly learning modules, each of which had a specific topic and contained information and learning activities. A virtual coach, a trained audiologist, led the participants through the modules. The participants' feedback was collected using the "think-aloud" method in which the participants gave their feedback in a structured manner...
October 1, 2016: American Journal of Audiology
Don Husereau, Chris Henshall, Laura Sampietro-Colom, Sarah Thomas
OBJECTIVES: Health technology assessment (HTA) has to innovate to best support changing health system environments and to help provide access to valuable innovation under fiscal constraint. METHODS: Issues associated with changing HTA paradigms were identified through scoping and explored through deliberation at a meeting of industry and HTA leaders. RESULTS: Five broad areas of change (engagement, scientific dialogue, research prioritization, adaptive approaches, and real world data) were identified...
October 21, 2016: International Journal of Technology Assessment in Health Care
Sook-Yee Chong, Oliver Röhrle
A satisfactorily fitted socket interacts dynamically with the stump in order to support body weight, transmit load effectively, enhance dynamic stability, and enable the control and stabilization of the residual limb. The internal dynamics occurring within a socket is important in determining optimal fit. Many measurement and imaging techniques, such as X-rays, have been utilized to investigate the movement of the residual femur within the stump during gait. However, due to associated health risks and costs, none of the current techniques have been extended to clinical prosthetics...
2016: PloS One
Lukas K Schoenenberger, Steffen Bayer, John P Ansah, David B Matchar, Rajagopal L Mohanavalli, Sean Sw Lam, Marcus Eh Ong
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care...
2016: SAGE Open Medicine
James Scholey
The classical view of the RAS is a linear signaling pathway beginning with the conversion of angiotensinogen to ANG I by renin, an enzyme secreted by the kidney. ANG I is converted to ANG II by angiotensin converting enzyme (ACE) ANG II binds to the G-protein coupled angiotensin II receptor type 1. The RAS is a circulating system but we now know that the RAS is also locally expressed in a number of tissues, including the kidneys and the heart. ANG II exerts adverse hemodynamic and non-hemodynamic effects on renal cells...
September 2016: Journal of Hypertension
Sadayoshi Ito
The presence of chronic kidney disease (CKD) is a strong risk factor not only for end stage kidney disease (ESKD) but also cerebro-cardiovascular disease (CVD). CKD is defined as GFR < 60ml/min/1.73m and/or the evidence of renal damages for more than 3 months. Epidemiological studies have shown that albuminuria even as little as 10mg/gCr is a strong risk factor for CVD, especially stroke. The significance of albuminuria can be recognized when we think of the fact that the amount of albumin in 24 hour-GFR is as large as 6 kg (4...
September 2016: Journal of Hypertension
Juan Herrera-Tejedor
The preferences of the very elderly are not taken into account in healthcare planning. For this reason, a medical literature review was performed in order to fill the gap in appropriate information on this issue. The majority of them think that they receive good healthcare. They favour building a trusting relationship, with the physician handling their decision-making. They also maximise their quality of life at the expense of quantity, and give great importance to comfort and safety. Most of them express the wish to be cared for and die at home...
October 14, 2016: Revista Española de Geriatría y Gerontología
Brent C Pottenger, Richard O Davis, Joanne Miller, Lisa Allen, Melinda Sawyer, Peter J Pronovost
OBJECTIVE: To determine whether Comprehensive Unit-based Safety Program (CUSP) teams could be used to enhance patient experience by improving care transitions and discharge processes in a 318-bed community hospital. METHODS: In 2015, CUSP teams produced feasible solutions by participating in a design-thinking initiative, coupled with performance improvement tools involving data analytics and peer-learning communities. Teams completed a 90-day sprint challenge, involving weekly meetings, monthly department leader meetings, and progress trackers...
October 2016: Quality Management in Health Care
Mimi Jenko, Nancy M Short
Bereavement services for families are an established part of hospice and palliative care. However, patients also die in the acute care and long-term care environments. Often, hospice is not involved, creating a potential gap in care. This article recounts a journey to improve care for all families of deceased patients, despite the presence or absence of hospice. A palliative care clinical nurse specialist led a quality improvement team, which used a systems thinking approach to develop and implement a downloadable bereavement booklet for families...
November 2016: Dimensions of Critical Care Nursing: DCCN
Barbara Schildkrout
A new nosology for mental disorders is needed as a basis for effective scientific inquiry. Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases diagnoses are not natural, biological categories, and these diagnostic systems do not address mental phenomena that exist on a spectrum. Advances in neuroscience offer the hope of breakthroughs for diagnosing and treating major mental illness in the future. At present, a neuroscience-based understanding of brain/behavior relationships can reshape clinical thinking...
October 2016: Journal of Nervous and Mental Disease
D Wayne Taylor
Canadians need to talk about their healthcare, about who pays for what, when. Lack of money is not the issue; how that money is spent is the issue-what public healthcare is covering and not covering. The same dollar amount can be spent quite differently and more effectively. The 1950s first-dollar, single-payor decision shifted the burden from the individual to government, but a lot has changed since the 1950s. Today Medicare is not universal, comprehensive, reasonably accessible, or portable. With residual constitutional power residing in Ottawa, there is no reason for the fragmentation and inequalities facing Canadians...
October 15, 2016: Healthcare Management Forum
Nikolaos Voulvoulis, Karl Dominic Arpon, Theodoros Giakoumis
The Water Framework Directive 2000/60/EC (WFD) is widely accepted as the most substantial and ambitious piece of European environmental legislation to date. It has been referred to as a once in a generation opportunity to restore Europe's waters and a potential template for future environmental regulations. However, fifteen years since it was adopted, and with many problems and delays in its implementation, the WFD has not delivered its main objectives of non-deterioration of water status and the achievement of good status for all EU waters...
October 13, 2016: Science of the Total Environment
Yafit Maza, Efrat Shechter, Neta Pur Eizenberg, Efrat Gortler Segev, Moshe Y Flugelman
BACKGROUND: The physician manager role in the health care system is invaluable as they serve as role models and quality setters. The requirements from physician managers have become more demanding and the role less prestigious; yet burnout and its prevention in this group have received little attention. Physician leadership development programmes have generally dealt directly with skill and knowledge acquisition. The aim of this research was to evaluate an intensive workshop designed to modify attitudes and improve skills of physician-managers of community clinics, through focus on personal well-being and empowerment...
October 14, 2016: BMC Medical Education
Robin S Mickelson, Kim M Unertl, Richard J Holden
BACKGROUND: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts...
October 12, 2016: JMIR Human Factors
Brent I Fox, Bill G Felkey
Some things really never change. For example, medication adherence remains a critical factor that influences the effectiveness of our modern health care system. Is there a magic bullet to solve the problem of nonadherence? We don't think there is. We do believe, however, that tools to monitor adherence continue to improve in their utility.
November 2015: Hospital Pharmacy
Luigi Pagliaro, Agostino Colli
The clinician - the doctor who treats sick people - should be able to establish a good human relationship with his or her patients and their family; should be able to reach a diagnosis even in patients with rare diseases, or atypical presentations - or should refer the patient to a senior colleague; and should be able to recommend the best treatment (or no treatment at all). And he - or she - should be able to draw these abilities from the "deliberate practice" according to Ericsson, i.e. from the combination of experience with reflection - not, or with much lesser strength, from the medical literature as suggested by Evidence-Based Medicine...
September 2016: Recenti Progressi in Medicina
Faouzi Jaïdi, Faten Labbene-Ayachi, Adel Bouhoula
Nowadays, e-healthcare is a main advancement and upcoming technology in healthcare industry that contributes to setting up automated and efficient healthcare infrastructures. Unfortunately, several security aspects remain as main challenges towards secure and privacy-preserving e-healthcare systems. From the access control perspective, e-healthcare systems face several issues due to the necessity of defining (at the same time) rigorous and flexible access control solutions. This delicate and irregular balance between flexibility and robustness has an immediate impact on the compliance of the deployed access control policy...
December 2016: Journal of Medical Systems
Ruifu Yang, Vladimir L Motin
As omics-driven technologies developed rapidly, genomics, transcriptomics, proteomics, metabolomics and other omics-based data have been accumulated in unprecedented speed. Omics-driven big data in biology have changed our way of research. "Big science" has promoted our understanding of biology in a holistic overview that is impossibly achieved by traditional hypothesis-driven research. In this chapter, we gave an overview of omics-driven research on Y. pestis, provided a way of thinking on Yersinia pestis research in the age of big data, and made some suggestions to integrate omics-based data for systems understanding of Y...
2016: Advances in Experimental Medicine and Biology
David G Angeler
This paper builds a bridge between heavy metal music, complexity theory and sustainability science to show the potential of the (auditory) arts to inform different aspects of complex systems of people and nature. The links are described along different dimensions. This first dimension focuses on the scientific aspect of heavy metal. It uses complex adaptive systems theory to show that the rapid diversification and evolution of heavy metal into multiple subgenres leads to a self-organizing and resilient socio-musicological system...
2016: SpringerPlus
Gene Kurosawa, Mariko Kondo, Yoshikazu Kurosawa
When the technology for constructing human antibody (Ab) libraries using a phage-display system was developed, many researchers in Ab-related fields anticipated that it would be widely applied to the development of pharmaceutical drugs against various diseases, including cancers. However, successful examples of such applications are very limited. Moreover, researchers who utilize phage-display technology now show divergent ways of thinking about phage Ab libraries. For example, there is debate about what should be the source of VH and VL genes for the construction of libraries to cover the whole repertoire of Abs present in the human body...
October 5, 2016: Biochemical and Biophysical Research Communications
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