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Managing care at the end of life
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Disease trajectories and prognostic indicators are useful adjuncts to anticipating the needs of the person; however, everyone with life-limiting illnesses will at some point experience a deterioration in their condition that will require EoLC. The onus is on health professionals to identify the triggers, such as recurrent exacerbations, repeated hospitalisations, deterioration in general condition, weight loss, increasing lethargy and dependence. In doing so, health professionals will employ an attitude of anticipation that informs proactive planning, rather than reactive care, which often has poorer outcomes. ACP can facilitate open discussions and proactive care planning of future needs, wishes and preferences of the person (Macmillan Cancer Support 2017; Thomas et al. 2016).
Implementation systems that support resilient performance
Published in Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite, Implementation Science, 2022
The goal of the implementation system research was to increase the anticipatory power of monitoring systems in order to reduce late responses to signs of physiological decompensation. The line of implementation system research began with studies to determine 1) the current strategies and capabilities for early detection of patient decompensation (Horwood et al. 2018a) and 2) how current tools supported and sometimes hobbled clinician monitoring tactics (Horwood et al. 2018b). The research showed that effective anticipation was based on clinicians’ ability to recognize change over time and departures from the patient-specific, context-aligned baseline. The factors shown to hobble anticipation and slow recognition depended on staffing, patient numbers, documentation demands, coordination across unit staff, and design of monitoring technology including alarms and displays. Importantly, the research showed that alarms and displays meant to improve anticipation often actually hobbled it. The studies also revealed ways that clinicians adapted their work and interactions to demonstrate resilient performance most of the time despite system characteristics that impaired anticipation, particularly with respect to poor alerts and displays.
The Brave New World of Genomics
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Sandra García Herrero, Blanca Simon Frances, Cristian Perez-Garcia, Javier Garcia-Planells
Whole-exome sequencing (WES) is being used in the clinical setting to obtain a personalized diagnosis of more than 30% of individuals with intellectual disabilities, developmental delay, or congenital abnormalities [3] and allowing for the diagnosis of genetically heterogeneous diseases or those with a complex differential diagnosis that previously represented an unsolvable, diagnostic maze. Currently, NGS technologies provide: i) complete genetic analysis of a newborn admitted to the ICU in a few days to provide the most accurate treatment; ii) analysis of fetal DNA in a few hours from a maternal blood sample without the need for unnecessarily increasing the risk of miscarriage through the use of invasive tests; iii) identification of the genetic profile of a tumor in order to accurately tailor the treatment, providing a precise and personalized treatment for the patient and the disease; iv) identification of mutations and categorization of tumor profiles by liquid biopsy, useful for follow-up and monitoring of the evolution of the disease in a previously treated patient; v) recognition of variants accountable for increased predisposition to common diseases; vi) prediction of individual patient response to certain drugs, avoiding their adverse effects; and vii) the anticipation and prevention of clinical scenarios, one of the great challenges in medicine in developed societies.
Planning Catching Movements: Advantages of Expertise, Visibility and Self-Throwing
Published in Journal of Motor Behavior, 2022
Lena Hagenfeld, Marc H. E. de Lussanet, Kim Joris Boström, Heiko Wagner
Anticipation of spatiotemporal changes of the environment is a basic feature of motor control and is necessary for timed actions like ball catching. Anticipation can be defined as a future-oriented action, decision, or behavior based on an implicit or explicit prediction (Pezzulo, 2008). For a successful interception, the catcher has to guide one hand to a future position of the ball, based on predictions about the ball’s trajectory. Many studies have examined whether the knowledge of the physical properties of the environment (e.g. gravity, object familiarity) can improve timed actions (Hosking & Crassini, 2010, 2011; Indovina et al., 2005; López-Moliner et al., 2007; López-Moliner & Keil, 2012). During a ball catching task, our brain uses early visual information about the ball’s trajectory to make reliable predictions of future states and to anticipate the target’s trajectory (Diaz et al., 2013; Hayhoe & Ballard, 2005; Zago et al., 2009). Predictions about the ball’s trajectory are continuously updated and may thus change during the interceptive movement (de la Malla & López-Moliner, 2015). At some time during the catching process, the internal prediction will be accurate enough that the catcher can anticipate the future trajectory of a ball for the interception (López-Moliner et al., 2010; Mason & Carnahan, 1999). Near the end of the movement only small, final corrections can yet be made.
Physiological behavior during stress anticipation across different chronic stress exposure adaptive models
Published in Stress, 2022
Dejana Popovic, Svetozar Damjanovic, Bojana Popovic, Aleksandar Kocijancic, Dragana Labudović, Stefan Seman, Stanimir Stojiljković, Milorad Tesic, Ross Arena, Ratko Lasica
There is high physiological variability of stress system activation, depending on age, genetic factors, gender, race, nutritional status, psychological factors, and physical activity habits (Bergh et al., 2015; Bernard et al., 2017; Bossé et al., 2015; Garrido, 2011; Lightman, 2008; Popovic et al., 2013, 2014; Wittert et al., 1996). Physical activity is a common condition for athletes allowing better understanding of what the exercise will involve and how they will respond to it. Confounding effects of possible psychological differences between athletes and controls cannot be ruled out. However, different types of chronic stress adaptation models, in this case different athletic groups, acted differently to the anticipation of an acute physical stress and we do not generalize our findings. Further studies involving other laboratory stress as an intervention are warranted. Moreover, in the present study, resting parameters were defined as measurements taken 10 min before testing. Of note, stress cannot be fully accounted for in that time point, since any information of being in the study may produce stress. However, even these time points distinguished the groups well enough in terms of their stress responsiveness. The results of present study have to be confirmed and explored in greater detail in larger clinical trials. Specifically, future research is warranted to better define the potential of stress hormone analysis during anticipation of stress to guide medical care and treatment options.
Interventions in Congenital Heart Disease: A Review of Recent Developments: Part II
Published in Structural Heart, 2021
Recently, patient-specific computational models have been developed for prediction of procedural outcomes. Using of simulation methodologies such as finite-element (Abaqus/Explicit, Dessault Systemes, RI, USA) and computational fluid dynamics (Fluent, Ansys, Canonsburg, USA), the anatomic and hemodynamic effects of interventions such as PPVI and coarctation stenting can be modeled by virtually deploying devices within the reconstructed surface anatomies.136 For each intervention, modeling of different device sizes or multiple devices and deployment configuration allows feasibility testing within the patient-specific anatomy.136 As such, anticipation of potential adverse events can minimize periprocedural complications or alter device choice and management decisions. Caimi et al. studied the differential impact of RVOT stenting on various calcification patterns in conduits to predict the risk of coronary artery compression, stent fracture, conduit injury, or arterial distortion. With this information, anticipatory strategies such as implantation of a covered stent or changes in deployment position can be envisioned.137 Ultimately, conventional development factors such as accuracy, practicality, portability, and cost-effectiveness will determine the future of these 3D visualization platforms in routine clinical practice.