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https://www.readbyqxmd.com/read/28428392/ecosystem-management-as-a-wicked-problem
#1
REVIEW
Ruth DeFries, Harini Nagendra
Ecosystems are self-regulating systems that provide societies with food, water, timber, and other resources. As demands for resources increase, management decisions are replacing self-regulating properties. Counter to previous technical approaches that applied simple formulas to estimate sustainable yields of single species, current research recognizes the inherent complexity of ecosystems and the inability to foresee all consequences of interventions across different spatial, temporal, and administrative scales...
April 21, 2017: Science
https://www.readbyqxmd.com/read/28428202/precision-physiology-and-rescue-of-brain-ion-channel-disorders
#2
REVIEW
Jeffrey Noebels
Ion channel genes, originally implicated in inherited excitability disorders of muscle and heart, have captured a major role in the molecular diagnosis of central nervous system disease. Their arrival is heralded by neurologists confounded by a broad phenotypic spectrum of early-onset epilepsy, autism, and cognitive impairment with few effective treatments. As detection of rare structural variants in channel subunit proteins becomes routine, it is apparent that primary sequence alone cannot reliably predict clinical severity or pinpoint a therapeutic solution...
April 20, 2017: Journal of General Physiology
https://www.readbyqxmd.com/read/28428165/a-framework-for-the-study-of-complex-mhealth-interventions-in-diverse-cultural-settings
#3
Marion A Maar, Karen Yeates, Nancy Perkins, Lisa Boesch, Diane Hua-Stewart, Peter Liu, Jessica Sleeth, Sheldon W Tobe
BACKGROUND: To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites...
April 20, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28427915/-multimorbidity-in-general-practice-and-the-ariadne-principles-a-person-centred-approach
#4
Alexandra Prados-Torres, Isabel Del Cura-González, Juan Daniel Prados-Torres, Francisca Leiva-Fernández, Juan Antonio López-Rodríguez, Amaia Calderón-Larrañaga, Christiane Muth
Multimorbidity, defined as the coexistence of two or more chronic conditions in one same individual, has negative consequences for people suffering from it and it poses a real challenge for health systems. In primary care, where most of these patients are attended, the clinical management of multimorbidity can be a complex task due, among others, to the high volume of clinical information that needs to be handled, the scarce scientific evidence available to approach multimorbidity, and the need for coordination among multiple health providers to guarantee continuity of care...
April 17, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28427481/triage-and-the-lost-art-of-decoding-vital-signs-restoring-physiologically-based-triage-skills-in-complex-humanitarian-emergencies
#5
Frederick M Burkle
Triage management remains a major challenge, especially in resource-poor settings such as war, complex humanitarian emergencies, and public health emergencies in developing countries. In triage it is often the disruption of physiology, not anatomy, that is critical, supporting triage methodology based on clinician-assessed physiological parameters as well as anatomy and mechanism of injury. In recent times, too many clinicians from developed countries have deployed to humanitarian emergencies without the physical exam skills needed to assess patients without the benefit of remotely fed electronic monitoring, laboratory, and imaging studies...
April 21, 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/28426672/how-to-determine-if-a-model-is-right-for-neglected-tropical-disease-decision-making
#6
Bruce Y Lee, Sarah M Bartsch
Mathematical and computational modeling can transform decision making for neglected tropical diseases (NTDs) if the right model is used for the right question. Modeling can help better understand and address the complex systems involved in making decisions for NTD prevention and control. However, all models, modelers, and modeling are not the same. Thus, decision makers need to better understand if a particular model actually fits their needs. Here are a series of questions that a decision maker can ask when determining whether a model is right for him or her...
April 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28423982/from-data-to-improved-decisions-operations-research-in-healthcare-delivery
#7
Muge Capan, Anahita Khojandi, Brian T Denton, Kimberly D Williams, Turgay Ayer, Jagpreet Chhatwal, Murat Kurt, Jennifer Mason Lobo, Mark S Roberts, Greg Zaric, Shengfan Zhang, J Sanford Schwartz
BACKGROUND: The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems...
April 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28420381/operations-research-in-global-health-a-scoping-review-with-a-focus-on-the-themes-of-health-equity-and-impact
#8
REVIEW
Beverly D Bradley, Tiffany Jung, Ananya Tandon-Verma, Bassem Khoury, Timothy C Y Chan, Yu-Ling Cheng
BACKGROUND: Operations research (OR) is a discipline that uses advanced analytical methods (e.g. simulation, optimisation, decision analysis) to better understand complex systems and aid in decision-making. Herein, we present a scoping review of the use of OR to analyse issues in global health, with an emphasis on health equity and research impact. A systematic search of five databases was designed to identify relevant published literature. A global overview of 1099 studies highlights the geographic distribution of OR and common OR methods used...
April 18, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28419019/complexities-of-consent-ethics-in-the-pediatric-emergency-department
#9
Naomi Dreisinger, Nathan Zapolsky
Informed consent is a communicative process of sharing information with patients, which helps assure their understanding of the information provided and asks for their permission to proceed. Informed consent allows a patient or a patient's family to use his or her own value system to determine the need for a particular procedure or test. Asking a patient for permission to treat requires the provider to respect the patient's autonomy through allowing him or her to be an active part of the decision-making process...
April 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28412766/integrative-governance-of-environmental-water-in-australia-s-murray-darling-basin-evolving-challenges-and-emerging-pathways
#10
Zachary Bischoff-Mattson, Amanda H Lynch
Integration, a widely promoted response to the multi-scale complexities of social-environmental sustainability, is diversely and sometimes poorly conceptualized. In this paper we explore integrative governance, which we define as an iterative and contextual process for negotiating and advancing the common interest. We ground this definition in a discussion of institutional factors conditioning integrative governance of environmental water in Australia's Murray-Darling Basin. The Murray-Darling Basin is an iconic system of social-ecological complexity, evocative of large-scale conservation challenges in other developed arid river basins...
April 15, 2017: Environmental Management
https://www.readbyqxmd.com/read/28411260/the-fast-ed-app-a-smartphone-platform-for-the-field-triage-of-patients-with-stroke
#11
Raul G Nogueira, Gisele S Silva, Fabricio O Lima, Yu-Chih Yeh, Carol Fleming, Daniel Branco, Arthur H Yancey, Jonathan J Ratcliff, Robert Keith Wages, Earnest Doss, Mehdi Bouslama, Jonathan A Grossberg, Diogo C Haussen, Teppei Sakano, Michael R Frankel
BACKGROUND AND PURPOSE: The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. METHODS: Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved...
April 14, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28407718/perspectives-on-tactile-intervention-for-children-with-cerebral-palsy-a-framework-to-guide-clinical-reasoning-and-future-research
#12
Megan L Auld, Leanne M Johnston
PURPOSE: Many children with cerebral palsy (CP) are known to experience tactile impairments. Research evaluating specific interventions to manage this is, however, minimal. This paper seeks to consolidate current literature and provide a framework to help clinicians and researchers think strategically about tactile treatment selection and future research planning. METHOD: The framework is described via a novel analogy - "The Apartment Block Theory". The theory describes the relative effectiveness of three intervention strategies aimed at overcoming a poorly responsive tactile system: (1) Pressing the buzzer - providing repeated passive tactile stimulation at the periphery; (2) Sneaking in the door - providing active tactile-enhanced motor training that capitalises on the opportunity to provide high-dose tactile input during motor interventions; and (3) Connecting another way - providing visually enhanced touch strategies with the aim of enhancing tactile function, which can be compared to phoning the apartment as an alternative to using the buzzer...
April 14, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28402913/the-impacts-of-decision-uncertainty-on-municipal-solid-waste-management
#13
Atousa Soltani, Rehan Sadiq, Kasun Hewage
Municipal solid waste treatment options are not necessarily pragmatic if the stakeholders in the system don't mutually agree on their shares of liabilities. Stakeholders will select an option if their benefits are maximized and costs are minimized. A decision support framework is required to assess various waste treatment options and predict the optimal decision, considering multiple criteria and conflicting preferences of multiple stakeholders. Because of the inherent complexity, uncertainty is unavoidable and should be acknowledged to enhance the reliability in the decision-making process...
April 9, 2017: Journal of Environmental Management
https://www.readbyqxmd.com/read/28399985/immunosuppressive-treatment-of-non-infectious-uveitis-history-and-current-choices
#14
Zhao Chan, Zhang Meifen
Non-infectious uveitis is one of the leading causes of preventable blindness worldwide. Long-term immunosuppressive treatment is generally required to achieve durable control of inflammation in posterior and panuveitis. Although systemic corticosteroids have been the gold standard of immunosup- pressive treatment for uveitis since first introduced in 1950s, its side effects of long-term use often warrant an adjuvant treatment to reduce the dosage/duration of corticosteroids needed to maintain disease control...
April 10, 2017: Chinese Medical Sciences Journal, Chung-kuo i Hsüeh K'o Hsüeh Tsa Chih
https://www.readbyqxmd.com/read/28396476/engaging-communities-anthropological-insights-from-the-west-african-ebola-epidemic
#15
REVIEW
A Wilkinson, M Parker, F Martineau, M Leach
The recent Ebola epidemic in West Africa highlights how engaging with the sociocultural dimensions of epidemics is critical to mounting an effective outbreak response. Community engagement was pivotal to ending the epidemic and will be to post-Ebola recovery, health system strengthening and future epidemic preparedness and response. Extensive literatures in the social sciences have emphasized how simple notions of community, which project solidarity onto complex hierarchies and politics, can lead to ineffective policies and unintended consequences at the local level, including doing harm to vulnerable populations...
May 26, 2017: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
https://www.readbyqxmd.com/read/28395016/impact-of-commercial-computerized-provider-order-entry-cpoe-and-clinical-decision-support-systems-cdsss-on-medication-errors-length-of-stay-and-mortality-in-intensive-care-units-a-systematic-review-and-meta-analysis
#16
Mirela Prgomet, Ling Li, Zahra Niazkhani, Andrew Georgiou, Johanna I Westbrook
Objective: To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs). Methods: We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population; (2) evaluated the impact of CPOE or the addition of CDSSs to an existing CPOE system; (3) reported quantitative data on medication errors, ICU LOS, hospital LOS, ICU mortality, and/or hospital mortality; and (4) used a randomized controlled trial or quasi-experimental study design...
March 1, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28386868/monitoring-for-a-specific-management-objective-protection-of-shorebird-foraging-habitat-adjacent-to-a-waste-water-treatment-plant
#17
Liz Morris, David Petch, David May, William K Steele
Intertidal invertebrates are often used in environmental monitoring programs as they are good indicators of water quality and an important food source for many species of fish and birds. We present data from a monitoring program where the primary aim is to report on the condition of the potential invertebrate prey abundance, biomass and diversity for migrating shorebirds on mudflats adjacent to a waste water treatment plant in a Ramsar listed wetland in Victoria, Australia. A key threat to the foraging habitat at this site has been assessed as a reduction in potential prey items as a result of the changes to the waste water treatment processes...
May 2017: Environmental Monitoring and Assessment
https://www.readbyqxmd.com/read/28380481/shared-decision-making-and-treatment-satisfaction-in-japanese-patients-with-inflammatory-bowel-disease
#18
Jorg Mahlich, Katsuyoshi Matsuoka, Rosarin Sruamsiri
BACKGROUND: Inflammatory bowel disease (IBD) is a range of complex disorders that imposes a high burden on patients' quality of life and on available health resources. Only 50% of those with this disease appear to be satisfied with the treatment methods. Therefore, this has a negative effect on their willingness to comply with treatment. OBJECTIVE: This study examined whether patients are more satisfied when they and their doctors agree on how much of their management decisions should be shared...
April 6, 2017: Digestive Diseases
https://www.readbyqxmd.com/read/28379931/an-expanded-conceptual-framework-of-medical-students-primary-care-career-choice
#19
Eva Pfarrwaller, Marie-Claude Audétat, Johanna Sommer, Hubert Maisonneuve, Thomas Bischoff, Mathieu Nendaz, Anne Baroffio, Noëlle Junod Perron, Dagmar M Haller
In many countries, the number of graduating medical students pursuing a primary care career does not meet demand. These countries face primary care physician shortages. Students' career choices have been widely studied, yet many aspects of this process remain unclear. Conceptual models are useful to plan research and educational interventions in such complex systems.The authors developed a framework of primary care career choice in undergraduate medical education, which expands on previously published models...
April 4, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28377194/applying-grade-to-coverage-decisions-results-of-a-stakeholder-survey-and-workshop
#20
Philipp Dahm, Andrew D Oxman, Benjamin Djulbegovic, Gordon H Guyatt, M Hassan Murad, Laura Amato, Elena Parmelli, Marina Davoli, Rebecca L Morgan, Reem A Mustafa, Shahnaz Sultan, Yngve Falck-Ytter, Elie A Akl, Holger J Schünemann
BACKGROUND: Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. METHODS: We surveyed key United States (U.S.)-based stakeholders regarding their current approaches for coverage decisions. Then we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria...
April 1, 2017: Journal of Clinical Epidemiology
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