Applications of complex systems theory in nursing education, research, and practice.

The clinical and administrative processes in today's healthcare environment are becoming increasingly complex. Multiple providers, new technology, competition, and the growing ubiquity of information all contribute to the notion of health care as a complex system. A complex system (CS) is characterized by a highly connected network of entities (e.

Cytology from pancreatic cysts has marginal utility in surgical decision-making.

Background: Preoperative diagnosis of pancreatic cystic neoplasms is problematic. We evaluated our experience with endoscopic ultrasound (EUS) to determine the utility of fine-needle aspiration cytology (FNAC) in surgical decision-making.

Methods: Patients evaluated for pancreatic cysts with EUS fine-needle aspiration (FNA) from 3/1996-10/2003 were included.

A historic perspective on the contributions of surgeons to the understanding of acute pancreatitis.

Background: Acute pancreatitis is a disease with a broad spectrum of presentation, severity, and treatment. Current management involves a multidisplinary team of surgeons, gastroenterologists, and interventional radiologists whose varied clinical skills contribute to the evolving diagnostic and therapeutic strategies for this disease. However, critical aspects of therapy have remained the responsibility of the general surgeon.

Predicting the impact of an electronic health record on practice patterns using computational modeling and simulation.

The overall purpose of this research study is to discover and apply new knowledge regarding methods to predict the impact of an electronic health record (EHR) on clinical practice guidelines in complex systems such as hospitals. Specifically, the aims of this study are: 1) to build, simulate and validate the accuracy of a computational model representing the current practice patterns in a sample of patients diagnosed with heart failure (HF) and treated in a community hospital; and 2) using computational modeling and simulation, develop a method to predict the effects of best practice guidelines on practice patterns after implementation of an EHR.

Distal pancreatectomy is not associated with increased perioperative morbidity when performed as part of a multivisceral resection.

Purpose: To evaluate the indications for and the outcomes from distal pancreatectomy.

Methods: Retrospective chart review of 171 patients who underwent distal pancreatectomy at Brigham and Women's Hospital between January 1996 and August 2005.

Results: Nearly one-third of distal pancreatectomies were performed as part of an en bloc resection for a contiguous or metastatic tumor.

Hydrated silicate minerals on Mars observed by the Mars Reconnaissance Orbiter CRISM instrument.

Phyllosilicates, a class of hydrous mineral first definitively identified on Mars by the OMEGA (Observatoire pour la Mineralogie, L'Eau, les Glaces et l'Activitié) instrument, preserve a record of the interaction of water with rocks on Mars. Global mapping showed that phyllosilicates are widespread but are apparently restricted to ancient terrains and a relatively narrow range of mineralogy (Fe/Mg and Al smectite clays). This was interpreted to indicate that phyllosilicate formation occurred during the Noachian (the earliest geological era of Mars), and that the conditions necessary for phyllosilicate formation (moderate to high pH and high water activity) were specific to surface environments during the earliest era of Mars's history.

Control: what we can learn from complex systems science.

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on managing social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory.

Colorectal cancer in HNPCC: cumulative lifetime incidence, survival and tumour distribution. A report of 121 families with proven mutations.

Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant condition caused by inactivating mutations of DNA mismatch repair (MMR) genes. An accurate estimation of colorectal cancer risk for mutation carriers is essential for counselling and rationalizing screening programmes. Families were referred on the basis of clinical criteria.

Coordination: new ways of harnessing complexity.

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on management in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory.

Directing: a complex systems perspective.

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on managing in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory.

Organizing: new ways to harness complexity.

As systems evolve, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on managing in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory.

Planning: what we can learn from complex systems science.

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on managing in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory.

Connectivity can be used to identify key genes in DNA microarray data: a study based on gene expression in nasal polyps before and after treatment with glucocorticoids.

Conclusions: The presented analysis of nasal polyposis using connectivity based on the PubGene literature co-citation network demonstrates that this tool can be used to identify key genes in DNA microarray studies of human polygenic diseases.

Objectives: DNA microarray studies of complex diseases may reveal differential expression of hundreds of genes. According to network theory and studies of yeast cells, genes that are connected with several other genes appear to have key regulatory roles.

The benefits of standardized nursing languages in complex adaptive systems such as hospitals.

Paperwork is a major source of frustration for hospital nurses and takes valuable time away from patient care. Studies indicate that nurses spend an estimated 13% to 28% of total shift time documenting. The growth in documentation requirements for nurses can, in part, be attributed to an exponential rise in health system complexity.

Post-gastric bypass hyperinsulinism with nesidioblastosis: subtotal or total pancreatectomy may be needed to prevent recurrent hypoglycemia.

Symptomatic hyperinsulinemic hypoglycemia and pancreatic nesidioblastosis have recently been described in a small series of patients after gastric bypass surgery for morbid obesity. In the limited published reports of patients with this condition, hyperinsulinism and nesidioblastosis have been managed with distal or subtotal pancreatectomy, with the extent of resection guided by calcium angiography. However, nesidioblastosis may involve the pancreas diffusely, and limited pancreatic resections may predispose patients to further hypoglycemic episodes.

Alkaline phosphatase predicts survival in patients with metastatic neuroendocrine tumors.

The clinical course of patients with metastatic neuroendocrine tumors is highly variable. While some patients experience an indolent clinical course over many years, other patients may rapidly succumb to their disease. Little is known about prognostic factors in these patients, making decisions regarding their management more difficult.

Road-crossing safety in virtual reality: a comparison of adolescents with and without ADHD.

This study investigated the potential accident-proneness of adolescents with attention deficit hyperactivity disorder (ADHD) in a hazardous road-crossing environment. An immersive virtual reality traffic gap-choice task was used to determine whether ADHD adolescents show more unsafe road-crossing behavior than controls. Participants (ages 13 to 17) were identified with (n = 24) or without (n = 24) ADHD according to a standardized protocol (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and Conners' Scales), with equal number of boys (n = 12) and girls (n = 12) in each group.

Cytokeratin 20 expression identifies a subtype of pancreatic adenocarcinoma with decreased overall survival.

Background: Cytokeratins are markers of epithelial cell differentiation useful in determining histogenesis for malignancies with an unknown primary. Application of this principle to a single malignancy may identify cancer subtypes with altered developmental programs. Herein, we investigate the relevance of two widely used cytokeratins (CKs), 7 and 20, to subtype pancreas cancer and identify associations with clinical features.