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complexity, decision making, systems

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In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with a global overview of the role of PRM in healthcare systems in Europe. Several documents and reports by WHO and the UN call for the worldwide strengthening of rehabilitation as a key health strategy of the 21st century. Therefore, further implementation of PRM in healthcare systems is crucial. Many aspects need to be considered when implementing PRM in a health system. Since PRM should be provided along the whole continuum of care, a specific phase model has been developed...
April 2018: European Journal of Physical and Rehabilitation Medicine
Kelson Zawack, Will Love, Cristina Lanzas, James G Booth, Yrjö T Gröhn
The growth of antimicrobial resistance presents a significant threat to human and animal health. Of particular concern is multi-drug resistance, as this increases the chances an infection will be untreatable by any antibiotic. In order to understand multi-drug resistance, it is essential to understand the association between drug resistances. Pairwise associations characterize the connectivity between resistances and are useful in making decisions about courses of treatment, or the design of drug cocktails...
April 1, 2018: Preventive Veterinary Medicine
K Schneider
The radiographic technique of pediatric chest X‑rays is substantially different from that in adults. In nearly all cases ap/pa X‑rays are sufficient and lateral radiographs are rarely needed. In the first years of life the thymus may overshadow the heart, the great vessels and the lung hila. The most important anatomical structures essential for diagnosing pathological findings of the lungs and mediastinum are the trachea with the bifurcation and the main bronchi with the adjacent great vessels. For the assessment of distended lungs and intrathoracic consolidations, fundamental knowledge of the anatomy in childhood and malformations which can involve the airways, the lungs, the heart, as well as systemic and pulmonary vessels are indispensable...
March 19, 2018: Der Radiologe
Marc-Olivier Baradez, Daniela Biziato, Enas Hassan, Damian Marshall
Cell therapies offer unquestionable promises for the treatment, and in some cases even the cure, of complex diseases. As we start to see more of these therapies gaining market authorization, attention is turning to the bioprocesses used for their manufacture, in particular the challenge of gaining higher levels of process control to help regulate cell behavior, manage process variability, and deliver product of a consistent quality. Many processes already incorporate the measurement of key markers such as nutrient consumption, metabolite production, and cell concentration, but these are often performed off-line and only at set time points in the process...
2018: Frontiers in Medicine
Miguel Ángel Lozada Aguilar, Andrei Khrennikov, Klaudia Oleschko
As was recently shown by the authors, quantum probability theory can be used for the modelling of the process of decision-making (e.g. probabilistic risk analysis) for macroscopic geophysical structures such as hydrocarbon reservoirs. This approach can be considered as a geophysical realization of Hilbert's programme on axiomatization of statistical models in physics (the famous sixth Hilbert problem). In this conceptual paper , we continue development of this approach to decision-making under uncertainty which is generated by complexity, variability, heterogeneity, anisotropy, as well as the restrictions to accessibility of subsurface structures...
April 28, 2018: Philosophical Transactions. Series A, Mathematical, Physical, and Engineering Sciences
Xiaosong He, Danielle S Bassett, Ganne Chaitanya, Michael R Sperling, Lauren Kozlowski, Joseph I Tracy
Temporal lobe epilepsy tends to reshape the language system causing maladaptive reorganization that can be characterized by task-based functional MRI, and eventually can contribute to surgical decision making processes. However, the dynamic interacting nature of the brain as a complex system is often neglected, with many studies treating the language system as a static monolithic structure. Here, we demonstrate that as a specialized and integrated system, the language network is inherently dynamic, characterized by rich patterns of regional interactions, whose transient dynamics are disrupted in patients with temporal lobe epilepsy...
March 15, 2018: Brain: a Journal of Neurology
Suzanne Grant, Bruce Guthrie
Patient safety is an increasing concern for health systems internationally. The majority of administrative work in UK general practice takes place in the context of organisational routines such as repeat prescribing and test results handling, where high workloads and increased clinician dependency on administrative staff have been identified as an emerging safety issue. Despite this trend, most research to date has focused on the redistribution of the clinical workload between doctors, nurses and allied health professionals within individual care settings...
March 2, 2018: Social Science & Medicine
John I Alawneh, Joerg Henning, Timothy W J Olchowy
Decision-making processes to assess and improve the health of dairy herds are often unstructured due to the complexity of interactions that exist between the health and productivity of the herd, for which there are no ready to hand solutions. Decisions made in the face of these complex herd health problems are often based on the experience and perceptions of what might be a quick or the easiest solution. To shift from this unstructured process to semistructured decision-making requires a more holistic understanding of potential health problems and access to herd productivity information and to analytical methods suitable for examining and evaluating such data...
2018: Frontiers in Veterinary Science
Bronwyn Louise Pearse, Claire M Rickard, Samantha Keogh, Yoke Lin Fung
BACKGROUND: Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost...
March 8, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Isabel M Leal, Lillian S Kao, Burzeen Karanjawala, Richard J Escamilla, Tien C Ko, Stefanos G Millas
BACKGROUND: Greater understanding of barriers to screening of colorectal cancer among lower socioeconomic, particularly Hispanic, patients is needed to improve disparities in care. OBJECTIVE: This study aimed to explore patients' perceptions and experiences of care seeking for colorectal cancer to identify barriers to early diagnosis and treatment. DESIGN: This explorative qualitative study was conducted as a focused ethnography of patients diagnosed with advanced-stage colorectal cancer...
April 2018: Diseases of the Colon and Rectum
Giovanni Improta, Mario Alessandro Russo, Maria Triassi, Giuseppe Converso, Teresa Murino, Liberatina Carmela Santillo
Health technology assessments (HTAs) are often difficult to conduct because of the decisive procedures of the HTA algorithm, which are often complex and not easy to apply. Thus, their use is not always convenient or possible for the assessment of technical requests requiring a multidisciplinary approach. This paper aims to address this issue through a multi-criteria analysis focusing on the analytic hierarchy process (AHP). This methodology allows the decision maker to analyse and evaluate different alternatives and monitor their impact on different actors during the decision-making process...
March 5, 2018: Mathematical Biosciences
Christian E Vincenot
Progress in understanding and managing complex systems comprised of decision-making agents, such as cells, organisms, ecosystems or societies, is-like many scientific endeavours-limited by disciplinary boundaries. These boundaries, however, are moving and can actively be made porous or even disappear. To study this process, I advanced an original bibliometric approach based on network analysis to track and understand the development of the model-based science of agent-based complex systems (ACS). I analysed research citations between the two communities devoted to ACS research, namely agent-based (ABM) and individual-based modelling (IBM)...
March 14, 2018: Proceedings. Biological Sciences
Jane Kaye, Sharon F Terry, Eric Juengst, Sarah Coy, Jennifer R Harris, Don Chalmers, Edward S Dove, Isabelle Budin-Ljøsne, Clement Adebamowo, Emilomo Ogbe, Louise Bezuidenhout, Michael Morrison, Joel T Minion, Madeleine J Murtagh, Jusaku Minari, Harriet Teare, Rosario Isasi, Kazuto Kato, Emmanuelle Rial-Sebbag, Patricia Marshall, Barbara Koenig, Anne Cambon-Thomsen
BACKGROUND: Governments, funding bodies, institutions, and publishers have developed a number of strategies to encourage researchers to facilitate access to datasets. The rationale behind this approach is that this will bring a number of benefits and enable advances in healthcare and medicine by allowing the maximum returns from the investment in research, as well as reducing waste and promoting transparency. As this approach gains momentum, these data-sharing practices have implications for many kinds of research as they become standard practice across the world...
March 7, 2018: Human Genomics
Natália B Andriguetti, Roberta Z Hahn, Lilian F Lizot, Suziane Raymundo, Jose L Costa, Kelly F da Cunha, Ramon M M Vilela, Helena M Kluck, Gilberto Schwartsmann, Marina V Antunes, Rafael Linden
BACKGROUND: Paclitaxel (PCT) is a chemotherapeutic drug widely used for the treatment of several types of tumors, and its use is associated with severe adverse events, mainly neurologic and hematopoietic toxicities. The relation between systemic exposure and clinical response to PCT was previously described, making paclitaxel a potential candidate for therapeutic drug monitoring (TDM). The use of dried blood spot (DBS) sampling could allow complex sampling schedules required for TDM of PCT...
March 4, 2018: Clinical Biochemistry
Syra Madad, Anna Tate, Maytal Rand, Celia Quinn, Neil M Vora, Machelle Allen, Nicholas V Cagliuso, Jennifer L Rakeman, Sean Studer, Joseph Masci, Jay K Varma, Ross Wilson
The Zika virus was largely unknown to many health care systems before the outbreak of 2015. The unique public health threat posed by the Zika virus and the evolving understanding of its pathology required continuous communication between a health care delivery system and a local public health department. By leveraging an existing relationship, NYC Health+Hospitals worked closely with New York City Department of Health and Mental Hygiene to ensure that Zika-related processes and procedures within NYC Health+Hospitals facilities aligned with the most current Zika virus guidance...
March 7, 2018: Disaster Medicine and Public Health Preparedness
Anu Paul, Manuel Comabella, Roopali Gandhi
Multiple sclerosis (MS) is a chronic neurodegenerative autoimmune disease with a complex clinical course characterized by inflammation, demyelination, and axonal degeneration. Diagnosis of MS most commonly includes finding lesions in at least two separate areas of the central nervous system (CNS), including the brain, spinal cord, and optic nerves. In recent years, there has been a remarkable increase in the number of available treatments for MS. An optimal treatment is usually based on a personalized approach determined by an individual patient's prognosis and treatment risks...
March 2, 2018: Cold Spring Harbor Perspectives in Medicine
Salama A Mostafa, Aida Mustapha, Mazin Abed Mohammed, Mohd Sharifuddin Ahmad, Moamin A Mahmoud
Autonomous agents are being widely used in many systems, such as ambient assisted-living systems, to perform tasks on behalf of humans. However, these systems usually operate in complex environments that entail uncertain, highly dynamic, or irregular workload. In such environments, autonomous agents tend to make decisions that lead to undesirable outcomes. In this paper, we propose a fuzzy-logic-based adjustable autonomy (FLAA) model to manage the autonomy of multi-agent systems that are operating in complex environments...
April 2018: International Journal of Medical Informatics
Irene Sui Lan Zeng, Thomas Lumley
Integrated omics is becoming a new channel for investigating the complex molecular system in modern biological science and sets a foundation for systematic learning for precision medicine. The statistical/machine learning methods that have emerged in the past decade for integrated omics are not only innovative but also multidisciplinary with integrated knowledge in biology, medicine, statistics, machine learning, and artificial intelligence. Here, we review the nontrivial classes of learning methods from the statistical aspects and streamline these learning methods within the statistical learning framework...
2018: Bioinformatics and Biology Insights
Cristina Soguero-Ruiz, Inmaculada Mora-Jiménez, Javier Ramos-López, Teresa Quintanilla Fernández, Antonio García-García, Daniel Díez-Mazuela, Arcadi García-Alberola, José Luis Rojo-Álvarez
Many indices have been proposed for cardiovascular risk stratification from electrocardiogram signal processing, still with limited use in clinical practice. We created a system integrating the clinical definition of cardiac risk subdomains from ECGs and the use of diverse signal processing techniques. Three subdomains were defined from the joint analysis of the technical and clinical viewpoints. One subdomain was devoted to demographic and clinical data. The other two subdomains were intended to obtain widely defined risk indices from ECG monitoring: a simple-domain (heart rate turbulence (HRT)), and a complex-domain (heart rate variability (HRV))...
March 1, 2018: International Journal of Environmental Research and Public Health
Darko Vucicevic, Lily Honoris, Federica Raia, Mario Deng
Heart failure (HF) is a complex clinical syndrome that results from structural or functional cardiovascular disorders causing a mismatch between demand and supply of oxygenated blood and consecutive failure of the body's organs. For those patients with stage D HF, advanced therapies, such as mechanical circulatory support (MCS) or heart transplantation (HTx), are potentially life-saving options. The role of risk stratification of patients with stage D HF in a value-based healthcare framework is to predict which subset might benefit from advanced HF (AdHF) therapies, to improve outcomes related to the individual patient including mortality, morbidity and patient experience as well as to optimize health care delivery system outcomes such as cost-effectiveness...
January 2018: Annals of Cardiothoracic Surgery
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