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complexity, decision making, systems

Susan Monaro, Sandra West, Jana Pinkova, Janice Gullick
AIMS AND OBJECTIVES: To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). BACKGROUND: CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia...
May 18, 2018: Journal of Clinical Nursing
Laura Downey, Neethi Rao, Lorna Guinness, Miqdad Asaria, Shankar Prinja, Anju Sinha, Rajni Kant, Arvind Pandey, Francoise Cluzeau, Kalipso Chalkidou
Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data.   Methods : We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India...
2018: F1000Research
Abd Moain Abu Dabrh, Robert P Shannon, Richard J Presutti
There is an upward trend incidence of multiple chronic life-limiting conditions with a well-documented associated impact on patients and their caregivers. When patients approach the end of life, they are often faced with a challenging multidimensional burden while navigating a complex health care system. Patients and families/caregivers are faced with daily decisions, often with little or no frame of reference or medical knowledge. The "what, how, when, and where" puzzle during this challenging time can be overwhelming for patients and their families, and when clinicians do not contemplate this associated workload's impact on patients and caregivers' capacity for self-care, patients and caregivers scramble to find compensatory solutions, often putting their health care at lower priority...
March 13, 2018: Curēus
Amy A Lemke, Christina G Hutten Selkirk, Nicole S Glaser, Annette W Sereika, Dyson T Wake, Peter J Hulick, Henry M Dunnenberger
AIM: To explore primary care physicians' views of the utility and delivery of direct access to pharmacogenomics (PGx) testing in a community health system. METHODS: This descriptive study assessed the perspectives of 15 healthcare providers utilizing qualitative individual interviews. RESULTS: Three main themes emerged: perceived value and utility of PGx testing; challenges to implementation in practice; and provider as well as patient needs...
September 2017: Personalized Medicine
Antje Wulff, Birger Haarbrandt, Erik Tute, Michael Marschollek, Philipp Beerbaum, Thomas Jack
BACKGROUND: Clinical decision-support systems (CDSS) are designed to solve knowledge-intensive tasks for supporting decision-making processes. Although many approaches for designing CDSS have been proposed, due to high implementation costs, as well as the lack of interoperability features, current solutions are not well-established across different institutions. Recently, the use of standardized formalisms for knowledge representation as terminologies as well as the integration of semantically enriched clinical information models, as openEHR Archetypes, and their reuse within CDSS are theoretically considered as key factors for reusable CDSS...
May 9, 2018: Artificial Intelligence in Medicine
Christine KirungaTashobya, Freddie Ssengooba, Juliet Nabyonga-Orem, Juliet Bataringaya, Jean Macq, Bruno Marchal, Timothy Musila, Bart Criel
BACKGROUND: In 2003 the Uganda Ministry of Health (MoH) introduced the District League Table (DLT) to track district performance. This review of the DLT is intended to add to the evidence base on Health Systems Performance Assessment (HSPA) globally, with emphasis on Low and Middle Income Countries (LMICs), and provide recommendations for adjustments to the current Ugandan reality. METHODS: A normative HSPA framework was used to inform the development of a Key Informant Interview (KII) tool...
May 10, 2018: BMC Health Services Research
Sinem Değirmenci, Ferhat Bingöl, Sait C Sofuoglu
Development of new wind energy projects require complex planning process involving many social, technical, economic, environmental, political concerns, and different agents such as investors, utilities, governmental agencies, or social groups. The aim of this study is to develop a tool combining Geographic Information System (GIS) and Multi-Criteria Decision-Making (MCDM) methodologies, and its application for Turkey as a case study. A variety of constraints and criteria were identified based on a literature review and regulations gathered from variety of agencies, use of which resulted in determination of infeasible sites...
May 8, 2018: Environmental Science and Pollution Research International
Michael Sharp, Brian A Weiss
With the ever-increasing demand for reconfigurability and modularity in manufacturing, industrial work cells are increasingly integrating newer and more diverse technologies to not only support the production of a wider range of parts, but also ease the repair or replacement of faulty systems and components. Complex relationships between different elements of a work cell originate from the integration of multiple layers of hardware and software needed to successfully execute the complicated manufacturing processes...
January 2018: Manufacturing Letters
Christine W Nibbelink, Janay R Young, Jane M Carrington, Barbara B Brewer
Critical care nurses practice in a challenging environment that requires responses to patients with complex, often unstable health conditions. The electronic health record, access to clinical data, and Clinical Decision Support Systems informed by data from clinical databases are informatics tools designed to work together to facilitate decision-making in nursing practice. The complex decision-making environment of critical care requires informatics tools that support nursing practice through integration of current evidence with clinical data...
June 2018: Critical Care Nursing Clinics of North America
Leonard M Pogach, David C Aron
In Israel, as in other Organization for Economic Co-operation and Development countries, performance measurement is a key public health strategy in monitoring and improving population health outcomes. The Israeli Quality Indicators in Community Healthcare (QICH) program has utilized electronic health records to monitor ambulatory care for the entire Israeli population since 2002. In 2006 the measures were updated to include laboratory values. They have been subsequently revised by stratifying by age, duration, adding medications, and changing frequency of testing for certain process measures...
May 3, 2018: Israel Journal of Health Policy Research
Binyam Tilahun, Alemayehu Teklu, Arielle Mancuso, Zeleke Abebaw, Kassahun Dessie, Desalegn Zegeye
BACKGROUND: Immunisation remains one of the most important and cost-effective interventions to reduce vaccine-preventable child morbidity, disability and mortality. Health programmes like the Expanded Program of Immunization rely on complex decision-making and strong local level evidence is important to effectively and efficiently utilise limited resources. Lack of data use for decision-making at each level of the health system remains the main challenge in most developing countries. While there is much evidence on data quality and how to improve it, there is a lack of sufficient evidence on why the use of data for decision-making at each level of the health system is low...
May 3, 2018: Health Research Policy and Systems
Emily K Plowman, Ianessa A Humbert
Speech-language pathologists (SLPs) are the primary healthcare providers responsible for the evaluation and treatment of dysphagia. Fundamental to this role is the ability to make accurate clinical judgements to distinguish between normal versus disordered swallowing for subsequent treatment planning. In this review, we highlight recent data collected from practising clinicians in the USA that reveal low levels of agreement across clinicians and poor to moderate levels of accuracy for making binary diagnostic ratings (normal vs...
May 3, 2018: International Journal of Speech-language Pathology
Rui Lin, Joris Van Kerrebrouck, Xiaodan Pang, Michiel Verplaetse, Oskars Ozolins, Aleksejs Udalcovs, Lu Zhang, Lin Gan, Ming Tang, Songnian Fu, Richard Schatz, Urban Westergren, Sergei Popov, Deming Liu, Weijun Tong, Timothy De Keulenaer, Guy Torfs, Johan Bauwelinck, Xin Yin, Jiajia Chen
A BiCMOS chip-based real-time intensity modulation/direct detection spatial division multiplexing system is experimentally demonstrated for both optical interconnects. 100 Gbps/λ/core electrical duobinary (EDB) transmission over 1 km 7-core multicore fiber (MCF) is carried out, achieving KP4 forward error correction (FEC) limit (BER < 2E-4). Using optical dispersion compensation, 7 × 100 Gbps/λ/core transmission of both non-return-to-zero (NRZ) and EDB signals over 10 km MCF transmission is achieved with BER lower than 7% overhead hard-decision FEC limit (BER < 3...
April 16, 2018: Optics Express
Kiyoshi Kurata
Recent studies have revealed that the ventral premotor cortex (PMv) of nonhuman primates plays a pivotal role in various behaviors that require the transformation of sensory cues to appropriate actions. Examples include decision-making based on various sensory cues, preparation for upcoming motor behavior, adaptive sensorimotor transformation, and the generation of motor commands using rapid sensory feedback. Although the PMv has frequently been regarded as a single entity, it can be divided into at least five functionally distinct regions: F4, a dorsal convexity region immediately rostral to the primary motor cortex (M1); F5p, a cortical region immediately rostral to F4, lying within the arcuate sulcus; F5c, a ventral convexity region rostral to F4; and F5a, located in the caudal bank of the arcuate sulcus inferior limb lateral to F5p...
April 28, 2018: Neuroscience
Wojciech Marlicz, Karolina Skonieczna-Żydecka, Konstantinos John Dabos, Igor Łoniewski, Anastasios Koulaouzidis
Inflammatory bowel disease (IBD) is an umbrella term for Crohn's disease (CD) and ulcerative colitis (UC). In light of evolving epidemiology of CD, its clinical management is still complex and remains a challenge for contemporary physicians. With the advent of new diagnostic and treatment paradigms, there is a growing need for new biomarkers to guide decision-making, differential diagnosis, disease activity monitoring, as well as prognosis. However, both clinical and endoscopic scoring systems, widely utilized for disease monitoring and prognosis, have drawbacks and limitations...
2018: Therapeutic Advances in Gastroenterology
Frederick M Burkle, Adam L Kushner, Christos Giannou, Mary A Paterson, Sherry M Wren, Gilbert Burnham
Since 1945, the reason for humanitarian crises and the way in which the world responds to them has dramatically changed every 10 to 15 years or less. Planning, response, and recovery for these tragic events have often been ad hoc, inconsistent, and insufficient, largely because of the complexity of global humanitarian demands and their corresponding response system capabilities. This historical perspective chronicles the transformation of war and armed conflicts from the Cold War to today, emphasizing the impact these events have had on humanitarian professionals and their struggle to adapt to increasing humanitarian, operational, and political challenges...
April 30, 2018: Disaster Medicine and Public Health Preparedness
Susan L Groenwald
Leadership in higher education on the best of days is complex and challenging due to the many competing internal and external demands and constituents. In today's climate of decreased funding, dwindling enrollments and political debate over the value of higher education, the higher education leader is often in the crossfires of debate and conflict. Nursing education leaders have the added requirement of protecting the public safety by graduating competent and safe practitioners. The role of the higher education leader is even more complex when the institution has multiple campuses, whether within one state or across states...
March 2018: Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing
Alexis Courbet, Patrick Amar, François Fages, Eric Renard, Franck Molina
Biological systems have evolved efficient sensing and decision-making mechanisms to maximize fitness in changing molecular environments. Synthetic biologists have exploited these capabilities to engineer control on information and energy processing in living cells. While engineered organisms pose important technological and ethical challenges, de novo assembly of non-living biomolecular devices could offer promising avenues toward various real-world applications. However, assembling biochemical parts into functional information processing systems has remained challenging due to extensive multidimensional parameter spaces that must be sampled comprehensively in order to identify robust, specification compliant molecular implementations...
April 26, 2018: Molecular Systems Biology
Chris Miller-Rosales, Stacy A Sterling, Sabrina B Wood, Thekla Ross, Mojdeh Makki, Cindy Zamudio, Irene M Kane, Megan C Richardson, Claudia Samayoa, Nancy Charvat-Aguilar, Wendy Y Lu, Michelle Vo, Kimberly Whelan, Connie S Uratsu, Richard W Grant
Background/Aims: Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting patients who have persistently not met goals of CVD risk factor control. Methods: Informed by published evidence, relevant theoretical frameworks, stakeholder advice, and patient input, we developed a group-based intervention (Changing Results: Engage and Activate to Enhance Wellness; "CREATE Wellness") to address the complex needs of patients with elevated or unmeasured CVD-related risk factors...
December 2017: Contemporary Clinical Trials Communications
Kirsten Jung, Florian Fabiani, Elisabeth Hoyer, Jürgen Lassak
Every living cell possesses numerous transmembrane signalling systems that receive chemical and physical stimuli from the environment and transduce this information into an intracellular signal that triggers some form of cellular response. As unicellular organisms, bacteria require these systems for survival in rapidly changing environments. The receptors themselves act as 'sensory organs', while subsequent signalling circuits can be regarded as forming a 'neural network' that is involved in decision making, adaptation and ultimately in ensuring survival...
April 2018: Open Biology
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